Vertex Pharmaceuticals Incorporated

Good day and welcome to the Vertex Pharmaceuticals second quarter 2026 earnings call. All participants will be in a listen-only mode. Should you need assistance, please signal a conference specialist by pressing the star key followed by zero. After today's presentation, there will be an opportunity to ask questions. To ask a question, you may press star then 1 on your touchtone phone. And to withdraw your question, please press star then 2. Please note this event is being recorded. I would now like to turn the conference over to Ms. Susie Lisa. Please go ahead.

Good evening, all. My name is Susie Lisa, and as the Senior Vice President of Investor Relations, it is my pleasure to welcome you to our second quarter 2026 Financial Results Conference call. On tonight's call, making prepared remarks, we have Dr. Reshma Kewalramani, Vertex's CEO and President, Charlie Wagner, Chief Operating Officer and Chief Financial Officer, and Duncan McKechnie, Chief Commercial Officer. We recommend that you access the webcast slides as you listen to this call. The call is being recorded and a replay will be available on our website. We will make forward-looking statements on this call that are subject to the risks and uncertainties discussed in detail in today's press release and in our filings with the Securities and Exchange Commission. Our pipeline, the proposed acquisition of Krenetics Pharmaceuticals and the expected benefits of that transaction, and Vertex's future financial performance are based on management's current assumptions. Actual outcomes and events could differ materially. I would also note that select financial results and guidance that we will review on the call this evening are presented on a non-GAAP basis. I'll now turn the call over to Reshma.

Thanks, Susie. Good evening, all, and thank you for joining us on the call today. Vertex's second quarter performance was excellent, with strong momentum in the commercial portfolio, rapid progress across our R&D pipeline, and the announcement of the definitive agreement to acquire Krenetics Pharmaceuticals, which brings rare endocrine diseases as a fifth pillar to Vertex. Second quarter total revenue grew 12% year-on-year, driven by the strength of our cystic fibrosis portfolio and the growing contributions from our newer products, Caschevy and Jernavix. As I've previously highlighted, this is a year of execution for Vertex across commercial, clinical, and regulatory, and on each of those fronts, we advanced significantly in the second quarter. Commercially, we delivered strong revenue growth across all diseases, made meaningful progress in reimbursed access and continue to execute on near-term launch planning to drive the next phase of growth. Clinically, we continue to make significant progress in advancing our pipeline including completing enrollment in the Aglow Phase 2 study of VX407 in ADPKD, tracking to complete enrollment in the Amplitude Phase 3 study in AMKD by the end of this year, and reporting results from the interim analysis cohort of Amplitude in the beginning of 2027. We also remain on track to release results Later this year, from a proof of concept study in DM1 and an expanded population for AMKD in the amplified trial, as well as the initial patient data from VX828 in CF. On the regulatory front, the BLA for POVI and IGAN was accepted in the U.S. with a November 30th PDUFA date. We achieved expanded labeling in record time for Caschevy in patients ages 2 to 11 in the U.S., And I'm very pleased to share that as we continue to dose the Phase 1-2-3 study of Zamylocell in type 1 diabetes, the IND was cleared for the blood type O islet cells in our T1D program, VX017. We expect initiation of the VX017 Phase 1-2 study in the near term. Finally, with the announced acquisition of Krenetics Pharmaceuticals, we look forward to multiple benefits of the deal, establishing a fifth pillar in rare endocrine diseases, adding to our innovative R&D pipeline, accelerating revenue growth, and enhancing long-term earnings. Tonight, I'll limit my R&D comments to new news in CF, renal, and type 1 diabetes, and close with some additional remarks regarding the Krenetics acquisition. Thank you for joining us. Among children with CF under 12 years of age, the majority across all eligible genotypes achieve a sweat chloride less than 30 millimoles, which is the median among CF carriers. This is remarkable because at these sweat chloride levels, CF carriers do not exhibit the manifestations of disease. In addition, we have initiated global regulatory submissions for Lyftrac in children ages 2 to 5. Global regulatory submissions for Trikafta in patients ages 1 to 2 are also in progress. Turning to our next wave in CF and VX828, our next generation 3.0 CFTR modulator recently completed dosing in the patient cohort. and Data are expected in the second half of this year. Behind VX828, we continue to advance additional correctors in the NextGen 3.0 family, and both VX581 and VX272 are in healthy volunteer studies. Let me close on CF with this. Our ultimate goal has been consistent for two plus decades, to bring patients to carrier levels of sweat chloride. Frankly, a lift tracks remarkable results where nearly two-thirds of younger patients achieved sweat chloride levels less than 30 millimole per liter. and for patients ages 12 plus, more than 75% achieve sweat chloride levels within the carrier range of CFTR function means we are very close to that goal. Given the improvements in sweat chloride, PPFEV1, pulmonary exacerbations, hospitalizations, lung transplant, Thank you for watching. and cohorts of patients with CF. However, we will only advance assets into Phase 2 and beyond that show promise to beat a lift track. In other words, to bring even more patients to sweat chloride levels less than 30 across all genotypes with once daily dosing and excellent drug-like properties including drug-drug interactions. Anything less would not be competitive. Moving now to our renal franchise, where we have four programs in mid- and late-stage development, povitacicept in IGAN and primary membranous nephropathy, enaxiplin in APOL1-mediated kidney disease, NVX407 in ADPKD, or autosomal dominant polycystic kidney disease. Let me start with the most advanced program and significant milestone. In late May, the FDA accepted our BLA for POVI in IGAN and assigned a PDUFA date of November 30th of this year. As a reminder, the Rainier Phase III interim analysis was a home run, delivering statistically significant and clinically meaningful results across the primary and all secondary endpoints, with a favorable safety profile and consistency in the primary endpoint of change from baseline We are in the final stages of launch readiness. Duncan will provide more details regarding our approach and excitement to go to market with POVI's differentiated profile of potentially best-in-class efficacy, a well-tolerated safety profile, and patient-centric administration through small-volume, once-monthly dosing via an auto-injector at home. We are also advancing POVI internationally. We have completed the regulatory submission for accelerated approval of POVI in IGAN in Saudi Arabia, where POVI has received breakthrough designation. Turning to POVI in membranous nephropathy, our Olympus Phase 2-3 pivotal trial is well underway. The Phase 2 portion is complete, and the Phase 3 portion initiated last quarter. I'm pleased to share that the IDMC has completed its review and selected the Phase 3 dose, 80 mg subcutaneously, every four weeks. We hold fast-track, orphan drug designation, and EMA prime designations for POVI in membranous. Stepping briefly outside of renal, on POVI in Myasthenia Gravis, I'm also pleased to share that the 30-patient Phase 2 Proof of Concept Study is on track to complete enrollment by the end of this year. Recall, this study evaluates 80 mg and 240 mg doses of POVI versus placebo for 12 weeks. Turning now to Anaxipline in AMKD. On Amplitude, our pivotal Phase 2-3 study in AMKD, we completed enrollment of the Interim Analysis cohort in September of last year and are on track to complete full enrollment by the end of this year. The interim analysis will be conducted following 48 weeks of treatment and we remain on track to share these IA results in early 2027. If positive, we would be positioned to file for potential accelerated approval in the US thereafter. Amplified is our Phase IIb basket study of enaxiplin in AMKD patients with either lower proteinuria or AMKD patients with diabetes. Expanded patient populations not studied in amplitude. The Amplified study has completed enrollment and dosing, and we expect to share results this fall. Lastly in the renal portfolio is VX407 in ADPKD or autosomal dominant polycystic kidney disease. Our Aglow Phase 2 study has completed enrollment. This is a proof-of-concept study with up to 52 weeks of treatment. We are excited about the potential for VX407 in ADPKD and look forward to sharing more information as dosing continues and the data matures. Let me now touch on type 1 diabetes. We had very constructive meetings with the FDA following our voluntary pause in order to conduct a manufacturing analysis of a Zamylocell. As we shared on our Q1 call, we have resumed dosing patients in the Zamylocell Phase 1-2-3 study. Thank you for watching. By designing and bringing to market VX017, another allogeneic, off-the-shelf, glucose-responsive, insulin-producing, fully differentiated islet cell therapy, in this case for any blood type, we anticipate doubling our market opportunity from about 60,000 to about 120,000 patients. A silver lining to the pause we took in the Zamyla Cell Type A program is that the Type O program time differential versus Zamyla Cell has shortened. Type O is making rapid progress, and thus we are considering options to further streamline our regulatory strategy and commercialization approach. We expect to provide updated T1D plans, including timelines, later this year. Thank you so much for joining us. Thank you for watching. We believe the two lead assets, Palsonify and Achumelnant, together represent a peak sales opportunity of about $5 billion. Both are small molecules that address serious diseases for patients, treated by a concentrated group of specialized endocrinologists. This fits directly within Vertex's proven, efficient, specialty commercial model. We enter this transaction from a position of strength. We view CF as a long-duration franchise with sustained growth. We continue to expect both Caschevy and Gernavix to be multi-billion dollar assets, and we anticipate our emerging renal franchise could one day rival CF in revenue. In addition, we have a broad and deep pipeline in earlier stages of development. The Krenetics acquisition will add to this innovation pipeline, Thank you for watching.

Thanks very much, Reshma. Our commercial story this quarter is one of building momentum across each of our franchises, supported by the appropriate investments to drive growth. We are very excited for the close of the Krenetics acquisition and for Vertex to establish a new pillar in specialty endocrine diseases like acromegaly, CAH, and Cushing's syndrome. Krenetic's Q2 results were excellent, with strong growth in Palsonify revenue and patients treated, but I will hold any further comments until after the deal closes. So tonight, let me start with CF. CF continues to perform very well. Global CF revenue grew 11% year-over-year in the second quarter, with balanced growth across the US and internationally, and continued strength from both Eliftrek and Trikafta. Eliftrek performance has been excellent and crossed another significant milestone, exceeding $1 billion in revenue in the first half of 2026. In the US, we continue to see patients initiating Eliftrek who are new to therapy, returning to therapy, and patients switching from Trikafta. The majority of Eliftrek revenue continues to come from these Trikafta switch patients, which reflects the benefits of Eliftrek and our success establishing Eliftrek as the new standard of care. We're pleased with the pace at which physicians and patients are embracing Oliftrec given its improved sweat chloride profile and once daily dosing. We've seen accelerated uptake of Oliftrec from the recent approvals in rare mutations as well as patients rolling off our open label extension studies. Outside the US, the Oliftrec European launches remain very strong. With no requirement for augmented liver monitoring in the EU, we are seeing rapid uptake by patients in Europe transitioning from Trikafta or one of our other CFTR modulators. In fact, in Germany and the UK, more than one in three eligible CF patients are now benefiting from Oliftrec. Globally, the CF growth drivers for the remainder of 2026 are clear. Continued Eliftrek uptake, the label expansion into rare mutations, younger patients, and additional geographies. Shifting to Heem and Kasjevi, where the momentum continues to build. During the second quarter, we delivered $76 million in Casgevi revenue, reflecting approximately 75% sequential growth versus Q1 2026 and over 150% year-over-year growth. This was in line with our expectations based on our visibility into patient scheduling patterns. The strength of the Casgevi franchise continues to build. New data on Casgevi at EHA, with simultaneous publication in the New England Journal of Medicine, demonstrated its transformative potential in pediatric patients as well as durable benefits, reinforcing the importance of early intervention to prevent the complications of sickle cell disease and beta thalassemia in children. Stemming from this compelling data, last month, Casgevi became the first and only gene therapy FDA approved to treat children as young as two years old in both sickle cell disease and beta thalassemia. Casgevi received supplemental approval in the U.S. in a record 53 days post filing, and our first pediatric patient has already initiated therapy and conducted cell collection. and the United Kingdom. On the reimbursement front, we are seeing strong trends in initiations in Germany after reaching a historic reimbursement agreement there, as well as continued strong uptake in the UK, Italy and the Middle East following the negotiations of sustainable access agreements. The Kastjevi story continues to be one of an increasingly robust pipeline of patients initiating the treatment journey. There were more Kastjevi infusions in the first half of 2026 than in all of 2025. Second quarter 2026 was also the third sequential quarter with more than 100 patient initiations, which enhances our visibility to continued growth for the rest of this year and early 2027 as patients continue to move through cell collection, editing and infusion. Thank you for watching. Turning to Genavix in moderate to severe acute pain, where our launch continues to gain traction. In the second quarter, Genavix generated $50 million in revenue, reflecting sequential revenue growth of approximately 70% and sequential prescription growth of approximately 45% versus Q1 2026. Unpacking Q2 performance, revenue was positively impacted by channel build after we'd seen a drawdown in Q1. At this stage, in an acute product launch, we continue to expect some quarterly volatility in inventory build and drawdown as full-line wholesalers and retail channel buying patterns normalize to reflect formulary adoption, physician awareness, and seasonality in elective surgeries. We are building a pain franchise for the long term and are focused on the following four critical markers of success. Prescription growth, breadth and depth of prescribers, the addition of genavics to hospital and IDN pathways, and broad payer coverage. These are the building blocks of a sustainable, long-term, multi-billion dollar business. Thank you for joining us. As securing unrestricted payer access and physician education catches up with prescription growth. Let me break down what I mean by that. At this point we have a total of 260 million lives covered out of a total possible of approximately 320 million. Of the 260 million covered lives, 180 million of them have unrestricted coverage. This means that there are 60 million lives yet to be covered and about 80 million lives who have coverage but with some form of restriction, making some of them eligible for the PSP program. These restrictions are usually very minor in nature, such as a 14-day quantity limit or a prior authorization to indication. As we continue to educate physicians and their office staff about the quantity limits and prior authorizations, we expect the PSP to be triggered less frequently and therefore more revenue to be recognized. Let me now provide you with some more details on prescriptions, prescribers and access before concluding our thinking on the PSP program and gross-to-net. In terms of prescriptions, Q2 2026 Genavix prescriptions totaled approximately 535,000 and just over 900,000 for the first half of 2026. The prescriptions continue to be split roughly 50-50 between the hospital and retail channels. In both channels, monthly prescriptions were approximately 50,000 in January and doubled to approximately 100,000 in each channel in June. In terms of prescribers, we added approximately 18,000 new HCP prescribers to Genavix in Q2 26, and are pleased that Genavix is now on 1400 hospital and 130 IDN pathways in terms of formulary, protocol or order sets. These are important metrics as we seek to convert practices and continue to embed the use of Genavix among our target physicians. We've also made further progress with respect to access. We recently signed agreements to expand reimbursed access to Genavix with two additional Medicare Part D plans, effective from July 1st. With these additions, three of the big four Medicare Part D plans now provide covered access alongside the three large commercial PBMs. As mentioned, this brings the total covered lives for Genavix to approximately 260 million out of a total possible of 320 million and within that approximately 180 million lives with unrestricted access. Our goal continues to be to ensure the prescribing experience for physicians and patients is as seamless as possible in a market where the delivery of the medicine is highly time sensitive. We will continue to work to educate physicians to navigate the minimal quantity limits and prior authorizations that exist and secure ever broader coverage. In the meantime, we will maintain the PSP program so that patients who are prescribed Genavix can get it. We continue to see this as a strategic choice as we seek to convert physician practices away from decades of reliance on opioids to ongoing and sustained use of genavics for many years to come. As a result, we continue to expect Gross2Net to normalize in line with other branded oral medicines, but now in the first half of 2027. To conclude on pain, we also continue to be on track to exceed our goal of more than tripling the 550,000 prescriptions and more than tripling revenue from 2025 into 2026, as well as delivering more than $500 million in revenue from Casgevi and Genavix combined in 2026. Thank you for watching. Our goal is for POVI to be physicians' first choice among disease-modifying therapies for IGAM. And we know from our market research and from nephrologist feedback that physicians are looking for treatments that meaningfully and rapidly reduce proteinuria, have a favorable tolerability profile, and offer a seamless treatment experience from access through patient support to convenient dosing. We believe POVI has the winning trifecta of efficacy, tolerability, and ease of use for patients and physicians alike. With dual BAF April inhibition, POVI has clear best-in-class potential and delivers effectively on all the needs we've heard from the community in research and advisory boards, making it the ideal first choice after baseline therapy with ACE ARBs and SGLT2s. We have completed the hiring of our renal field force of whom about 90% have nephrology experience and was built with the breadth of our renal pipeline in mind. We anticipate that we will have the largest field force among the novel April or April BAF therapies for IGAM. Our payer conversations are also proceeding well. In the US, approximately 70% of patients with IGAN have commercial coverage. From our engagements with payers, their awareness of IGAN and the new BAF April inhibitors is high. Payers understand the unmet need, have a good understanding of the Cadego guidelines, and how the new therapies fit into treatment pathways. Thank you for watching. POVI and IGAN is the first component of our emerging renal franchise and we're excited to bring it to nephrologists and to their patients. We believe POVI's trifecta of efficacy, tolerability and ease of use delivers exactly what nephrologists are seeking. and just as we've done for over a decade in CF, POVI's success will be driven by a field force delivering a high science sell fueled by a potentially best-in-class product, broad reimbursement and robust, high-quality patient programs. We are very excited to commercialize POVI in IGAN and begin building our multi-billion dollar renal franchise at Vertex. I'll now turn the call over to Charlie to review the financials.

Thanks, Duncan. As Reshma noted, Vertex's second quarter results demonstrate our consistent, strong performance and attractive growth profile. Second quarter 2026 total revenue of $3.3 billion increased 12% year over year with growth balanced between the U.S. and international markets. As expected, Q2 2026 revenue growth reflects an approximate 170 basis point benefit from foreign exchange rates. Q2-26 global CF revenue grew 11% year-over-year, and new disease areas also contributed, with Casgevi delivering $76 million compared to $30 million in Q2 of 2025, and Gernavix revenue of $50 million compared to $12 million in Q2 of 2025. As a reminder, Q2-25 results also included $21 million of collaboration revenue. Q2-26 U.S. CF revenue grew 9% year-over-year, led by strong volume growth from a Lyftrek uptake, continued performance from Trikafta, and higher realized net price. Outside the U.S., CF revenue grew 12% year-over-year, driven by strong Lyftrek launches, timing of orders in certain geographies, as well as the benefit from FX. Note that global CF revenue growth for the first half of 2026 was 8%, including the benefit of prior year U.S. price increases and foreign exchange. We expect both of these factors to contribute less to growth in the second half of the year. Our second quarter 2026 gross margin was 85.6%, an expected sequential step down from Q1 of 26. This step down reflects the impact of product mix as well as manufacturing network investments in various products. As our new products, particularly Casgevi, increase in revenue contribution with higher cost of goods sold than our small molecules CF products, we continue to expect full-year gross margin of just under 86%, roughly in line with this quarter's result. The impact from product mix and manufacturing network investment costs will be more pronounced in the second half than they were in the first half of 2026. Turning to operating expenses. We continue to invest appropriately given the attractive opportunity presented by our ongoing and near-term launches as well as our attractive mid- and late-stage pipeline. Second quarter non-GAAP R&D expense of $889 million increased 1% year-over-year with steady progress across multiple Phase III studies and the earlier stage pipeline. Non-GAAP SG&A expense of $520 million increased 45% year-over-year, driven primarily by commercial investments split roughly evenly between pain and renal. We also recorded $21 million in acquired IPR&D expense in the quarter. Note that while R&D continues to account for nearly two-thirds of our operating expenses, the modest growth rate reflects that we are in a period where we can redeploy dollars from programs that wind down to fund programs that are new or scaling up. In contrast, much of our commercial spending is to build new businesses and thus is incremental, as reflected in the higher year-over-year growth rates when compared to R&D spending. Our second quarter 2026 non-GAAP effective tax rate was 21.1%, including some one-time expenses. Our second quarter 2026 non-GAAP earnings per share of $4.73 represents 5% growth versus prior year, reflecting strong revenue growth as well as investments in our pipeline and commercial capabilities. Turning to the balance sheet, we ended the quarter with approximately $13.6 billion in cash and investments. During the second quarter, we deployed approximately $455 million to repurchase roughly 1 million shares. This activity reflects our ongoing commitment to returning value to shareholders while maintaining the flexibility to act on strategic growth opportunities. Of course, our top priority for capital deployment remains investing in innovation, as evidenced by our recent announcement to acquire Krenetics for approximately $8.8 billion net of cash acquired. Now turning to guidance. Given our strong first half performance and the momentum across the business, we are raising our full year 2026 total revenue guidance to a range of $13.1 to $13.2 billion. 2026 revenue guidance reflects continued strong performance from the CF franchise, including a lift truck and truck hafta, We continue to expect revenue of $500 million or greater from our non-CF products and our outlook also continues to include an expected 150 basis point benefit from foreign exchange net of our hedging program. As I previously mentioned, we continue to expect full year gross margin of just under 86%. On operating expenses, we are reiterating our combined non-GAAP operating expense guidance of $5.65 to $5.75 billion, though we now expect to be at the high end of that range. This reflects continued investment in our late-stage clinical pipeline and the commercial infrastructure and activities that support our new launches and revenue diversification. We continue to expect our non-GAAP effective tax rate to be in the range of 19.5% to 20.5% for the full year 2026. I would note that today's guidance does not yet reflect the pending Krenetics acquisition, which is expected to close in the third quarter. Given the anticipated timing, we expect the impact to 2026 revenue and non-GAAP operating expenses to be relatively modest and we will provide updated guidance for 2026 around the time of closing. As a reminder, we expect to fund the transaction through a combination of cash on hand and proceeds from a $4.5 billion term loan and we expect the transaction to become accretive to non-GAAP operating income in 2029. In summary, Vertex delivered strong second quarter results. Our commercial launches and diversification are gaining momentum and we continue to invest with discipline in both innovation and commercialization. Overall, our financial performance and outlook remain compelling. With expanding CF leadership, heme and pain scaling, renal on the doorstep of launch, and the addition of a fifth pillar in specialty endocrine through the pending Krenetics acquisition, Vertex is exceptionally well positioned for continued growth. Thank you so much for joining us.

Jeff, can you pick us up?

Will do. We will now begin the question and answer session. To ask a question, you may press star then 1 on your touchtone phone. If you are on a speakerphone, please pick up your handset before pressing the keys. If at any time your question has been addressed and you would like to withdraw your question, please press star then 2. And our first question for today will come from Salveen Richter with Goldman Sachs. Please go ahead.

Good afternoon. Thanks for taking my questions. Two for me. One is you announced that the Phase 2-3 Olympus study for POVI and PMN is going to move to Phase 3 with an 80 milligram dose every four weeks. Can you frame what signal this was based on and whether you or the DSMB or what you or the DSMB saw in the Phase 2-B portion to move forward? And then on the pain front, it was really nice to see the progress here. Maybe help us understand where the bottlenecks lie now or what needs to be worked on with regard to formulary as well as the payer dynamics as you look at copay, etc. Thank you.

Sure thing, Salveen. Let me kick us off with the first question, which is about POVI in membranous. The Phase 2 is complete. The Phase 3 was already initiated, you might recall, a couple of months ago as we designed it as a seamless Phase 2-3. The DSMB was asked to base their decision and it was their decision because we do not have access to the unblinded data to look at on efficacy PLA2R which is the biomarker equivalent in membranous as GDIGA1 is to IGAN. Of course, they had full access to the safety results as they made their decision. I suppose in many ways it's not surprising that they picked the 80 milligram dose given the Ruby 3 results where you could see that the 80 milligrams had a very nice reduction in PLA2R. But that's how the decision was made. Studies are well on its phase 3 portion and we look forward to getting that study enrolled and completed. Duncan, I'm going to turn it over to you for a little commentary on Jurnavix, Scripps, and what more we're working on.

Right. Thank you. Good afternoon, Salveen. So, as you know, our goal with Jurnavix is to fundamentally transform how pain is treated and to move physician practices away from decades of reliance on opioids. In terms of our progress, we're very pleased with the prescription numbers that we're seeing. We're also very pleased with the increased number of hospitals that have adopted genetics, now 1,400 or so, with 130 IDNs having it on formularies. and we have also now secured two additional Medicare Part D plans to cover Genavix starting from July the 1st. So overall our progress is going very well and I would add that those prescriptions are coming from a broad range of physician types and being used in a broad range of pain types consistent with our label. In terms of the payer side and access, we're very pleased with the coverage that we've secured to date, 260 million lives, and that's ahead of those two Medicare Part D plans coming in. and I would say we have obviously more work to do to secure the final elements of access for Genavix and we also have to make sure that those patients whose physicians might have say a quantity limit are able to navigate that in order to ensure the patient In the meantime, we have the PSP program in place and anticipate that we'll continue to see prescriptions transition to increasing growth in revenue in the second half of 2026. and indeed as we've communicated before that our gross to net will ultimately normalize at the same level as other oral branded medicines in the pharmaceutical arena. So we're very happy with the progress. We have a little bit more work to do but we are very happy with where we're at right now in terms of physician adoption, payer coverage and hospital usage.

The next question will come from Jeff Meacham with Citibank. Please go ahead.

Hey, guys. Afternoon. Thanks for the question. I have two quick ones. The first one in CF, on A28 or the other assets in Phase 1, what are some of the clinical attributes you're looking for? I wasn't sure if you're looking for perhaps a not only better treatment effect or if there is a potential to not need liver monitoring, for example, in future combos. Second question on Gernavix. You guys have had substantial discussions with payers, hospital systems, physicians on acute pain, but in these conversations, have you gotten any perspectives or context on DPN? What the clinical profile needs to show as we look to the data end of the year, beginning of next year, or what the access and reimbursement could look like in this setting? Thank you.

Sure thing, Jeff. Let me take the second question first. On Jurnavix, we've been hyper-focused on Jurnavix and acute pain to make sure that we get all of those reimbursement contracts done and get access. So I think it would be just very fair to say we've spent all of our time hyper-focused on acute pain. We'll have more to say on where we are with DPN The data, what payers are looking for, what doctors are looking for, et cetera, in the coming months. But for here now, it's acute pain. On VX828 and the next-gen molecules, so just to give you all of the numbers, VX828 is the first of the next-gen. The second and third are VX581 and VX272. We are looking for potential improvement in efficacy, i.e. more people who can get down to less than 30 millimoles. and of course we're looking for safety as well. So the monitoring will depend on what the results in the clinical trial are. So sure, there's opportunity for monitoring to be different with this 828 program. It just depends on what the actual results are through the clinical trial program. Last thing to say, once daily dosing, really good-looking DDIs as well as other drug-like properties remain really important, as I mentioned in my prepared remarks.

The next question will come from Jessica Fai with JP Morgan. Please go ahead.

Hey, guys. Good afternoon. Thanks for taking my question. Maybe for Reshma, I'm curious if you expect to see material differentiation on EGFR across the new IGAN products like POVI and its competitors, and if so, over what time horizon do you think any differentiation on that endpoint would become apparent? Thank you. Sure thing, Jess.

As we've discussed before, in IGAN in particular, but you could say this for homogeneous proteinuric kidney diseases in general, good reductions in proteinuria should, based on everything we know, result in stabilization of GFR. I expect that to be the case with April BAF inhibitors as well. I think so that your question is asking a very important second point and to me the most important point. What is the differentiation we can expect between various molecules if you have more reduction in proteinuria or hematuria or in the case of IgA nephropathy, GD IgA1, these inciting antibodies? And I think for that the answer is it's really about time to ESRD That's to say time to dialysis, transplantation, or death. And I do expect that the medicine that has the stronger reductions in pertinuria, the medicine that gets more patients to less than 0.5 or 0.3, better improvements in hematuria and GDIGA1, are more likely to have an improved profile when it comes to that ultimate endpoint. Pertinuria, one-year GFR, two-year GFR, These are all endpoints on the way to that ultimate endpoint, and I think that's where you'll see the real differentiation.

Great, thank you.

The next question will come from Corey Kasimov with Evercore ISI. Please go ahead.

Hey, good afternoon, guys. Thanks for taking the question. Wanted to ask about enaxiplin and the amplitude study and what kind of data would be necessary in that interim analysis to file for accelerated approval? Basically, what constitutes the win with this first data look? Thank you.

Sure thing. Corey, I think you're asking about amplitude. So the core study that's now in phase three in patients with two ApoL1 alleles Moderate to Heavy Pertinuria, and Depressed GFR. We were really pleased and remain very pleased that the agency has provided and we have an agreement with the agency for a potential accelerated approval based on the primary endpoint at the time of the IA, which is one-year GFR. So that's what our agreement is based on. Obviously, we're also going to look at the pertinuria, but the agreement with the agency for the potential to file for accelerated approval based on the interim analysis is one-year GFR.

Great. Thank you, Reshma.

You bet. The next question will come from Brian Abrams with RBC Capital Markets. Please go ahead.

Hey guys, thanks so much for taking my question and congrats on the quarter. On pain, we've seen some data published recently from another NAV18 and I'm just curious how you see the acute pain dynamics playing out with additional entrance to the market potentially. And then secondarily, just on Ximi, just wondering if you could talk about the potential impact to launch timing if you do end up syncing the filing with 017. Thanks.

Thanks for the kind words, Brian. Maybe I'll do the pain one first and then come on to type 1 diabetes. I did see the publication, and maybe, Brian, what I'll say is that ever since Vertex published VX150, which you'll remember was the molecule circa 2017 or so, We saw a spike in others following in our footsteps and pursuing NAV18 as a target. And what I'll say is that we decided not to advance 150, VX150, because we didn't think it had, as I described at the time, the perfect drug-like molecule properties that we were looking for. And we bypassed 150 in favor of what is now susetragine or VX548. So we know the space very well, we know the molecule well, and we know that every time we publish a patent, there's a slew of followers. Maybe if you say, well, what's the takeaway from that? I think that there is a high appetite in the biopharma industry to make non-opioids. There is high unmet need for non-opioid effective pain medicines that have Not only the right efficacy, but the right safety, tolerability, drug-like properties profile. And I really like where we are, well on the market with Gernavix, and I'm very much looking forward to the possibility of NAV1718 combination. And I've never felt better in Vertex history for the fact that that may come to pass for us to be able to bring that to the clinic. Switching then to the type 1 diabetes program. So let me just say what I said in my prepared remarks. I may have gotten a little quick there. The Zymylosal program is in phase 1, 2, 3, backup and dosing. And because it's a type A program, it serves about 60,000 people in the U.S. and Europe. The 017 program, because it's Type O, has the potential to serve 120,000 people because it's the universal donor Type O. And now what we're trying to do is see if we can't get the Type O program to go even faster and bring that program out either first or very close behind. That's what we're working on in terms of both the regulatory approach and the commercial approach. I don't have a timeline for you today, but we should be able to tell you our exact plans with timelines in the back half of this year. But I am very excited about the opportunity to perhaps bring Type O out first or very, very close behind.

Super helpful. Thanks, Reshma.

Yeah.

The next question will come from Evan Siegerman with BMO. Please go ahead.

Kyle, thank you so much for taking my question and congrats on the progress. So you've maintained the expectation for at least $500 million of non-CF revenue this year, while Kashchevi and Jornavix delivered roughly $125 million this quarter. So as you think about the path to this target, should we expect that the majority of the upside comes from accelerating patient starts with Kashchevi, continued growth with Jornavix, or kind of a relatively balanced contribution from both franchises?

Evan, I'll ask Charlie if he wants to make any additional comments on our guidance on the $500 million.

Yeah, Evan, thanks. As you pointed out, so far in the first half of the year, Kastjevi and Gernavix combined delivered about $200 million in revenue. So we're well on our way to achieving our target of $500 million plus. In that first half, Kastjevi has been a bigger contributor than Gernavix. But I'm not willing to give further color on the balance of the year other than to say we're very confident in getting to that $500 million plus.

The next question will come from Michael Yee with UBS. Please go ahead.

Hey, thank you for the question. IGAN competitor data to your EGFR data is hot off the press and it's out there on the tape and you can see that the approved product has essentially a stabilization of EGFR if not slightly above a baseline. So to what extent, Reshma, given that you have an approval coming up soon, should we think about comparing the two either from a launch perspective or perhaps given the strong numbers that they're putting up, it speaks to the significant market opportunity and You both can get equivalent share. Maybe just talk a little bit about the data that the competitors are putting up and how you think about your launch. Thank you.

Sure thing. I did just see the eGFR data, but I've just seen the top line number. And as you say, it shows a stabilization right around zero. That is what we should expect given the pertinuria reduction, so that seems very much in line. With regard to what it means for the povitacicept IGAM program, I would say all the more reason, if anybody needed a little bit more conviction, you can certainly look at these data that were presented today, look at the pertinuria reduction, look at the GFR, and We confirm for yourselves that significant reductions in proteinuria should and have resulted in GFR stabilization. So it makes a lot of sense to me. For what I see for POVI, I see us putting up very strong numbers on proteinuria, numerically the best out there, 52% change from baseline in terms of proteinuria reduction. 70 plus percent reductions in hematuria and 70 plus percent reductions in GDIGA1. That bodes very well for POVI. And then I'll emphasize, Mike, the patient-centric attributes of delivery. Once monthly, small volume, 0.46 mils via an auto-injector. And I think when you put all of that together, real excitement for me for what POVI may bring to patients once the PDUFA date comes and goes and we have the opportunity to launch.

Good, thank you.

You bet. The next question will come from Tazin Amin with Bank of America. Please go ahead.

Hi, good afternoon. Are you still planning on presenting additional data from the Rainier study this year? And if so, what level of data and where could that be And then secondly, for POVI and GMG, it's becoming an increasingly competitive space. So how are you thinking about what additional benefit your drug could provide into this space, either with efficacy, safety, or dosing frequency? Thanks.

Yeah. Yes, on Rainier, we are planning to present the data. The conferences don't like it when we suggest the name, when Submissions have been made, but acceptances haven't come through yet. So maybe I'll just leave it at yes. We plan to present the full Rainier IA data set. We're looking forward to do so. I'll say at a fall conference, and I'll leave it to your imagination for which one. On GMG and POVI, this one is really exciting. And you gave me three options for why we're excited about POVI and GMG, efficacy, safety, or patient benefits administration, all three. This is another one of those trifectas that Duncan has talked about. On efficacy, there is another molecule, a wild-type tachy, so not engineered for optimal potency, binding affinity, or tissue distribution. That has already shown substantial efficacy benefit. And remember, that's a wild type tachy compared to POVI, which is an engineer tachy. So that's on efficacy. On safety, POVI does not need to have a cycle on and a cycle off. That gives real benefit on safety, but that also has the secondary benefit on efficacy because you don't have that off period where the autoantibodies are allowed to return. and the third is same thing, auto-injector. We have to figure out whether it's the 80 or 240, but in either case, it'll be auto-injector once monthly at home, low volume dosing. So of your options, I expect POVI to be better across the board on all three dimensions.

The next question will come from Phil Nadu with TD Cowan. Please go ahead.

Good afternoon. Thanks for taking our question. There's a lot of focus on the upcoming data from one of your competitors where we're going to get incremental sweat chloride reductions above Trikafta. We're curious to hear Vertex's opinion on how you're going to interpret that data. Is there a level of sweat chloride reduction that would get your attention? Or, Reshma, as you've suggested in the prepared remarks, is it more about simply the proportion of patients who get to less than 30 millimoles per liter and the exact reduction maybe isn't as meaningful because it can be influenced by things like baseline characteristics. Thanks.

Yeah, Phil, I think you have it right on our perspective. Where we sit today with Ali, a Lyft truck, we already know we can get two-thirds of patients to less than 30. That's that normal or carrier threshold. And Furthermore, if you think about, as all physiologic parameters do, there is a Gaussian distribution around that median sweat chloride of 30. If you superimpose across all age groups via lift-track data, on the carrier data, more than 75% of people across age groups overlap that distribution. So with those kind of data, I think that The bar is exceptionally high. and rests on getting more patients to less than 30. That is the mark and that's the mark that we or anyone else has to hit in order to have a competitive medicine. And of course, it goes without saying it has to be safe, it has to be well tolerated, it has to have good DDIs, it has to be once daily. But on pure efficacy, it has to be a molecule that gets more patients Thank you.

The next question will come from Terrence Flynn with Morgan Stanley. Please go ahead.

Hi, thanks for taking the question. I had another one on Anaxaprin. I was just wondering if you can help set expectations for the upcoming Amplified Phase 2 trial and then how to think about any read-through to Amplitude. Thank you.

So Amplify is the study that's phase two. It's the expanded AMKD population. By that I mean it's the population with two ApoL1 alleles and in one arm of the basket study it's two ApoL1 alleles, diabetes, and in the other arm it's two ApoL1 alleles and let's call it modest proteinuria, so low-grade proteinuria. The way I would frame it up is the study is completed. We are on track for us to be able to share results this fall. And what I'd be looking for and looking to understand is, can we derive benefit on proteinuria when you have very modest proteinuria to start with. So this is 0.2 to 0.7 grams of protein as opposed to 0.7 grams and above. And of course, it all comes down to what the mean entry baseline level of protein is. Or in the case of diabetes, can we alter the proteinuria when you have a second kidney disease involved? These are questions worth studying, but they're clearly different populations than Amplitude, which is why we specifically did not include them in the Phase II original study of Anaxoplin, and equally why we didn't include them in the Phase III study called Amplitude. So we're super excited to look at these results. We're going to learn a lot, and I'm very, very happy, and I think you'll see the wisdom Thank you very much for taking my question.

maybe a question for Duncan if you want to help with the prescription trends here for genetics. So obviously prescription growth is very strong, but how should we think about the prescribing behavior in terms of how many days of therapy physicians are writing? Has it changed at all in last few quarters or so? Because it does seem like you have good access, you have good prescription. But this is probably a missing piece which could improve here. Thank you.

Hi, Mohit. So to answer your question specifically, as I think we've communicated before, in hospitals, the prescription duration is around about five days or so. In retail, it's around about 12, 14 days. So on average, you net out at around about 10 days. or 11 days or so for each Genavix prescription. And candidly, that dynamic has not changed since the launch because it's really driven by the dynamics of the institution that the patient's in rather than anything else. So to answer your question simply, those are the numbers and it has not changed over the last few months. Last question please, Chuck.

The last question will come from Ellie Merle with Barclays. Please go ahead.

Hey guys, thanks for taking the question. So in terms of the DM1 program, what would be good data at the data update in the second half? And how are you thinking about it in the context of the broader competitive landscape in DM1? Thanks.

Sure, Ellie. Maybe I can take that one. In DM1, as you know, there hasn't been a clear correlation between the various endpoints that others in the field have looked at, albeit with different approaches. What people have tended to do in their phase two studies to get an early read is look at splicing, a functional endpoint called VHOT, and another functional endpoint called QMT. VHOT is sort of how long does it take to open, close your hand and QMT is a measure of muscle function. And what I would say is that of all of those, splicing is an important one and we certainly are looking at splicing and these measures of muscle function are also something that we're looking at. The reason I like this approach compared to anything else has more to do with mechanism of action. And that has to do with the fact that it's an oligo, which others are also trying, but it's an oligo linked to a circular peptide. Thank you very much. in order to get into the cell have used mechanisms that have some safety tolerability concerns and that has not been a concern through the circular peptide program that we use. So for the efficacy endpoints in phase two splicing and we will also look at these QMT and VHOT endpoints, albeit in small numbers of patients.

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