Daljit Aurora
Analyst · William Blair
Thank you, Josh. We are excited about the data from NMRA-511, which demonstrated a differentiated profile for the treatment of agitation in Alzheimer's disease. In January, we shared top line results from our Phase Ib signal-seeking study of 511. This was a 2-part signal-seeking study that was not powered to detect statistical significance. Instead, we evaluated the effect size of 511 on a variety of clinical measures to inform additional development in AD agitation. In the Phase Ib study, 511 demonstrated an unsurpassed clinical effect size on CMAI total score and a range of other endpoints in a prespecified population with elevated anxiety at baseline. Today, we announced new data from a prespecified analysis from the Phase Ib in 53 patients with an NPI-AA score of greater than or equal to 4 at baseline. This population is similar to the group studied in pivotal trials with Rexulti and Auvelity. 511 treated patients demonstrated a clinical benefit and had a Cohen's d effect size of 0.32 to 0.34 on CMAI total score, a similar magnitude to Rexulti. Additionally, in this population, 511 showed an unsurpassed effect size across the CMAI aggressive behavior subfactor score and CGI-S agitation score. Notably, 511 demonstrated a favorable tolerability and safety profile in Phase Ib, which we believe provides an opportunity for us to test higher doses. We are advancing a MAD extension study this year with data expected in the second half of the year before moving to a Phase II study in the first quarter of 2027. Transitioning to navacaprant, we are pleased with the significant progress we have made with the navacaprant KOASTAL program for the treatment of major depressive disorder. Today, we announced that KOASTAL-2 and KOASTAL-3 studies are fully enrolled with more than 400 patients enrolled in each study. We expect to report a joint top line data readout for KOASTAL-2 and KOASTAL-3 in the second quarter of 2026. As a reminder, KOASTAL-2 and KOASTAL-3 are Phase III studies being run both in the U.S. and in ex-U.S. territories. The design for these studies incorporated key learnings that we implemented in early 2025 following the KOASTAL-1 readout. This included enhanced medical monitoring to verify inclusion of appropriate patients, screening tools to rule out professional patients and site selection that focused on sites with expertise in conducting MDD studies. We believe that these optimizations facilitated appropriate patient enrollment in these trials. For example, we saw an approximately 10% higher screen fail rate in the KOASTAL-2 and KOASTAL-3 studies compared to KOASTAL 1. Overall, we are confident that these changes will result in a stronger data set and look forward to the results. In the joint top line readout, we expect to include top line results for each individual study as well as prespecified analyses with more than 450 patients enrolled after study optimizations occurred in early 2025. We believe this approach will provide a comprehensive view of the data and help us better assess navacaprant's clinical profile. We will assess next steps regarding regulatory submission once we have the data in hand, but we believe that with the FDA's recent commentary, one positive study plus supportive evidence may be sufficient for approval. With one positive study, we would request a pre-NDA meeting with the FDA. Lastly, on our M4 positive allosteric modulator franchise, today, we announced that we have designated NMRA-898 as the lead program in the franchise and plan to advance it for development in schizophrenia. This decision is supported by the encouraging data we have seen to date from our ongoing Phase I study. In that study, NMRA-898 demonstrated an approximately 80 to 100-hour half-life in humans, which confirms the potential for once-daily dosing and is within a similar range to the half-lives of highly successful neuropsychiatry medications like Vraylar, Abilify and Rexulti. We also observed dose proportional exposures with low variability as well as predicted free brain exposure significantly above the in vitro M4 EC50 levels. In addition, we saw on-target changes in heart rate that were similar to those demonstrated by Cobenfy, which we believe provide pharmacodynamic evidence of target engagement. Taken together, these findings strengthen our confidence in NMRA-898 and support our view that it has a potential best-in-class pharmacologic profile. We are conducting a multiple ascending dose study of 898 in healthy volunteers and patients with stable schizophrenia. The goals of this study are to identify a maximum tolerated dose and to confirm CNS penetration through CSF exposure. We expect to report data from this MAD study in the second half of 2026. While we have paused development of our other M4 PAM, NMRA-861, we believe it has a profile that could support development in the future. We are pleased to have this optionality in our portfolio. As you can see, we are making significant progress across our clinical pipeline that I believe has the potential to translate to meaningful medicines for patients. With that, I'll now turn it over to Nick to walk through our NLRP3 update in more detail. Nick?