Matthew Gline
Analyst · Leerink Partners
Thanks, Steph, and thank you all for joining this morning. I'm glad you're all here. We have -- I'm going to go through the deck, and I'll announce the slide numbers, then I'll start with the agenda on 3. Just a lot to hit today. So between stuff that we've already talked about on calls and some pretty exciting new updates. So I'm not going to go through it all in detail, but I just want to say what a tremendous quarter it's been for us and obviously transformational with the commercial launch of LISRAYA, as well as some other items. So I'll start on Page 4, which just hitting because this is our last quarterly update in 2026. Just it's been a phenomenal year for us, right, starting out with our calendar Q1 last February with the positive data in cutaneous sarcoidosis and then the fact that we got a trial started in LPP and in CS, we got LISRAYA approved. We got the NIU data. So the brepo franchise, the Priovant team executing at incredible quality. For 1402, obviously, the RA data was a really tremendous surprise. And today, we're putting out the Period 2 data, which is also surprising in that we hit the primary endpoint there, which feels really, really good as far as where that drug is headed. Obviously, earlier this quarter, we also announced that we hadn't succeeded in CLE. And we're announcing today, I can talk a little bit more about it, but we're not going to wind up progressing in all likelihood in Sjogren's based on various updates in the field. We're going to run that study out and learn what we can from it. And then an amazing year for mosli as well with obviously the phenomenal data earlier this quarter in PH-ILD, as well as the starting of the Phase III study there and the ongoing combo study with Tyvaso. So just an incredible year with a lot of really, really great updates. It's going to be tough to top in 2027, but we have lots of plans for that as well. I will start briefly, although I know there will be a lot of questions about it with the commercial quarter. Obviously, in August, we got LISRAYA approved. It's a really exciting moment for us for the dermatomyositis community for patients for prescribers. We're really proud that it's out on the market. So this quarter reflects on Slide 7, really 5 weeks on the market from approval. So there's only so much you can take away from it. Obviously, $31 million of net revenue reflects strong initial demand, lots of unmet medical need, lots of physician and patient enthusiasm, feeling really, really great about that. There were hundreds of patients on paid drug at the end of the quarter. There are many hundreds of patients on paid drug now. We have a broad initial prescriber base and the early payer dynamics have supported good uptake. So it's a little too early to extrapolate exactly what's going to happen from here. I think I'm sure we'll get some questions about exactly how to think about this. We're not providing a ton of information now because it's early, but we feel great about what we're learning from the field. The initial patient prescriber feedback is strong, although, again, it's early in the launch. One question I'm sure we'll get is on stocking or inventory dynamics. Again, we record revenue when the specialty pharmacies buy the drug from us. So there was a meaningful amount of undispensed drug as of 9/30. That drug has all been dispensed following the end of the quarter, and we continue to see strong uptake. So I think it really is a reflection of the pharmacies trying to get ahead of demand. There's probably a tailwind from those dynamics in the September quarter. There'll probably be a modest headwind from those dynamics in the December quarter, and I expect inventory stocking to be completely irrelevant as we round the corner into next year. So overall, again, just tremendously pleased with what this means in terms of patient and physician demand in terms of execution from the Priovant team. I think it's really just -- it's a signal of how high the unmet need has been in dermatomyositis that so many patients and so many prescribers are working with us. The payer dynamics have been clean so far. I expect we'll start to see more of these policies coming into effect that will sort of shape that from here on out. So we'll have to watch that and learn more about it as it comes. And I'd say those plans have been -- some have been quite good. Some have been a little bit more challenging. but I think we're going to be able to work through all of that, again, given the amount of patient and physician demand for the drug. Happy to take questions on it. I'm not going to talk much more about this today, but obviously, we'll continue to provide updates on the commercial uptake as we go. I want to jump now to another update that I wasn't totally expecting to provide today, but it's a great update, which is that period 2 of the IMVT-1402 RA study has now read out. And as a reminder, on Slide 9 of the way the study worked, this is a randomized withdrawal trial in which in period 1, all patients were on 600 milligrams. That's the high dose of 1402, and we reported that data. As a reminder, we had 70-plus percent ACR20 responses 50-plus percent kind of mid-50s ACR50 responses and around 35% ACR70 responses at the end of that period 1. In period 2, those patients who had achieved an ACR20 response were then put into a randomized withdrawal portion where they were either kept on 600 or randomized down to 300 or placebo. And then the primary endpoint was ACR20 at the end of that 12-week period, which we sort of think of as an ACR20 maintenance endpoint and that it's 100% of those patients roughly started or were randomized into this had ACR20 responses. So if you look at Slide 10, it was 118 patients had that ACR20 response and 117 of them were effectively rerandomized for the efficacy analysis in period 2 or 118 were rerandomized, 117 were analyzed. And the disposition was pretty straightforward in terms of balance across the arms. And as a reminder, before we get to the actual data on Slide 11, this is a big unmet medical need, right? These patients have all failed multiple lines of therapy. Many of them have failed TNFs and JAK inhibitors, some of them also failed IL-6, et cetera. We think there's about 85,000 patients in the U.S. We'll talk more about the commercial opportunity here at our upcoming Investor Day in December. But this is a large number of patients who have struggled to get adequately treated. And we know that autoantibody pathology matters at least in some of these patients. And it's increasingly clear that we have found a subset of patients for whom it matters quite a lot. These patients on Slide 12 have significant morbidity and quality of life impairment. A significant portion of them are fully work disabled for over a decade. They have many consultations with their physicians. A large number of them are dependent on external help to live. A lot of them require surgery, a lot of them cannot walk or report walking disability. So these are really struggling patients with late-line RA. This enrolled -- the trial, [indiscernible] enrolled a difficult-to-treat population. These were fourth-line plus patients having failed conventional therapy and again, 2-plus mechanisms of advanced therapy. You can see a little bit about -- this is all from the previously reported data on Slide 13. The arms on Slide 14 were reasonably well balanced once you get into the randomized withdrawal period, similar disease severity, similar balance of prior meds, et cetera. So a pretty well-balanced study. And I think what we saw on Slide 15 was just phenomenal across a couple of dimensions. So remember, 100% of these patients approximately had an ACR20 response at the beginning of this period. Almost all of them, 92.5%, still had an ACR20 response at the end of 28 weeks, whereas only 75%-ish had an ACR20 response on placebo. Notably, that got a p-value for the 600-milligram arm. Notably, and I think this is an important finding, 300 milligrams was not enough to preserve the response, 300 milligrams look pretty similar to placebo, which I think is just a further reinforcement of something we believed all along which is that depth of IgG suppression really matters across FcRn indications and that it took a higher dose with deeper IgG suppression to deliver the sustained clinical benefit in this patient population. You can see on Slide 16, similarly great data on ACR50 and ACR70. You start to run into end issues when you get to ACR70. But we hit a p-value on ACR50 as well. 80% of patients at 600 milligrams had, I think, a nominal p-value if stats wonks want to work. 80% on ACR50 had an ACR50 response at week 28 versus 56% on placebo. And again, nice separation without a nominal p-value on ACR70 at week 28. So consistent data across depth of response. And I really like Slide 17 that you can just see over time that these patients are just -- it looks like they're significantly benefiting. So this is the cohort of patients who were on 600 for the full period. And you can see already some meaningful ACR50 and ACR70 responses as early as week 4, and those responses really continue to get better and are well preserved through the end of the study, even though after week 16, there starts to be a "placebo effect" where some of these patients were -- where the patients thought they might have been taken off drug at that point. So this data looks great and in my opinion, supports a clinically meaningful profile for these patients that is pretty exciting. You can see on Slide 18, just a little bit more data here on separation from placebo on CDAI and SDAI, which reflect widely used scales in clinical practice for assessing sustained response. And you can see these placebo patients really worsened whereas the drug patients were able to preserve their response through week 28, which is pretty exciting. The other thing I'll just add on Slide 19 is looking at the JAK-experienced subset, the JAK-experienced subset did just about as well as the overall population. So even in these patients who have failed really the most effective anti-inflammatory mechanisms available in RA, we had really nice continued preserved responses, which feels good as well. And same thing on Slide 20, in the deeper response levels, ACR50 and ACR70, data looked good even among JAK failures. Safety on Slide 21 was entirely consistent with what we've shared before, consistent with the mechanism, event rates comparable with placebo, everything sort of looked reasonable, no new safety signals. 1402 continues to look safe and well tolerated as a drug, which is great for all of the ongoing programs that we've got. We had hoped on Slide 22 to be able to share together with this update that we were sort of through the FDA discussions and have a path forward. Those discussions are ongoing. Frankly, we had to disclose this data at this point because we had a p-value unexpectedly. And so we'll come back to you once we finished our FDA discussions probably later this year or early next year with an update on our trial plans. But we think based on this data, we have a really exciting set of opportunities here to treat a patient population with a high unmet need where the period 2 data really support deep therapeutic responses in a population that has failed multiple mechanisms, multiple advanced therapies. So excited to come back and think this is going to be one of the important pillars for 1402 potentially as a product. I am not going to go through the next 2 sections in great detail, but because they're both transformative updates for us, even though we've gotten the call before, I wanted to remind everybody of what we've seen both in NIU and in PH-ILD. So it was just a few weeks ago, we got on the phone together to talk about our NIU data. Again, just tremendously proud of what this has meant for us clinically in terms of brepo continues to do basically everything that we could ask for it as an agent. And NIU is a highly morbid disease on Slide 24. It's a poorly served indication. It's the third leading cause of blindness. There are hundreds of thousands of patients with anterior uveitis and then potentially hundreds of thousands of patients or at least we saw 70,000 to 190,000 patients with posterior intermediate or pan uveitis. That's obviously, a specific target population here. And the data from CLARITY, as a reminder, on Slide 25, really suggests we can achieve a new standard of care here as compared with placebo patients who failed therapy in around 12 weeks across the 2 studies, we did not see median treatment failure in this patient population in over 48 weeks, which is a phenomenal. I think it's the largest benefit ever seen for a nonsteroidal therapy in NIU. And it met the primary endpoint and all secondary endpoints in both of our studies with almost 2/3 of patients achieving steroid-free quiescence, which is a major treatment goal for physicians, consistent across all subgroups, statistically and clinically meaningful, generally well tolerated. So look, this data has been incredibly well-received by the doc community as we've been out talking about it. I think it's going to be an important new treatment option for NIU patients. We're going to spend a fair amount of time on our Investor Day in December talking about the marketplace for NIU and the commercial opportunity here. So I won't belabor the point here, but really looking forward to talking about that as I think NIU is going to be another pillar, hopefully as exciting as DM, which, given the earnings results today is a high bar to clear. So really exciting. I'm not going to go through the data slide by slide, but we have reproduced it here because we're quite proud of it. Same thing with mosliciguat, jumping to Slide 31. As a reminder, PH-ILD is a really tough disease with few current treatment options. These patients have 1.5 to 2 years median survival despite best available standard of care therapy. We said about up to 200,000 patients across the U.S. and Europe. It's likely an underreported disease. You see the market growing as new therapies like Tyvaso are on the market. And there are no non-treprostinil approved therapies for these patients. So there's a big opportunity to deliver something new. Again, don't need to belabor the data, but on Slide 32, we were just tremendously proud of what mosliciguat was able to do for these patients. On the primary endpoint of PVR, we saw a 56% placebo-adjusted PVR reduction at week 16. That is, we think, the deepest PVR ever shown certainly in the PH-ILD study. We showed a 35-meter statistically significant improvement in the key secondary, 6-minute walk at week 16. On multiple week 24 exploratory analyses, we saw tremendous outcomes, including a meaningful benefit on NT-proBNP and a phenomenal benefit on 6-minute walk at week 24. Cardiac measures, the sort of hemodynamics looks phenomenal and 98% of patients achieved a high dose, which is a good signal of safety and tolerability. And notably, given the tolerability profile of treprostinil, we saw well tolerated cough rates that were lower than placebo, which is something that's important for these patients with lung disease. Not going to go through it slide by slide here, but we reproduced the data again because we're just tremendously proud of what mosliciguat’ has been able to demonstrate in this patient population, but just phenomenal. On Slide 37, as a reminder, that Phase III study is underway, actively screening and enrolling patients. Excited to continue to provide updates on that, including based on the quality of this data, we've said multiple times, and we really mean it, this is a drug that we think is going to work in a lot of places, and we're excited to share updates in the coming months on initiation of other trials with mosliciguat in other indications where we are now hard at work. I will wrap up here with just a quick financial update on Slide 39, relatively consistent with expectations in terms of expenses for the quarter. Net of tax, loss from continuing operations of $153 million or non-GAAP of $133 million. Cash is back at $4.2 billion as of 9/30, reflecting in part of the receipts from the Moderna litigation that we got over the summer. And in the 6 months ended 9/30, we had repurchased about $280 million worth of stock, about 9.4 million shares. Look, on Slide 41, 2026 has been a tough year to beat for us just in terms of the phenomenal quantum of clinical data, the meaningfulness of that clinical data and now with the LISRAYA launch off to a start that we're pretty excited about. But 2027 is a very busy year in addition to getting the sNDA filed for NIU and hopefully adding another indication in relatively short order of brepo. We have some very important top line data coming for 1402 and Graves, some data in MG. We expect multiple program indication expansion, just a lot of other things coming, including some hopeful surprises over that time. So looking forward to next year, looking forward to seeing many of you in New York for our Investor Day next month. And yes, I think we've got a lot to come. So, with that, I will pause and just to remind everybody, our Investor Day is on December 9. Please register. The link is in the presentation from today. And I will hand it back to the operator to start Q&A. Thank you again, everybody. I want to just, before I do that, just say thank you again to everybody who makes this happen, the Roivant employees, the Vant employees, Priovant, Immunovant, Pulmovant, great updates from all those teams and then obviously, again, to the patients and investigators who trust us with their care. It's been a phenomenal year. Thanks. Operator, please go to Q&A.