Summary of Fractyl Health FY Conference Call (December 03, 2025) Company Overview - **Company**: Fractyl Health (NasdaqGM:GUTS) - **Focus**: Development of Revita, a treatment targeting obesity and type 2 diabetes through an outpatient endoscopic procedure Key Industry Insights - **Obesity and GLP-1 Drugs**: There are approximately 10 million people using GLP-1 medications for weight loss, with an estimated 6 million expected to stop treatment this year, leading to significant weight regain risks for many patients [1][2] - **Market Opportunity**: The potential market for Revita includes nearly 1 million patients annually who are already undergoing endoscopies for other reasons, making it easier to integrate the Revita procedure into existing healthcare practices [8] Core Findings from Clinical Studies - **Reveal-1 Study**: - Patients who lost an average of 24% body weight (over 50 pounds) on GLP-1s and then underwent Revita maintained a weight regain of only 1.5% over six months, compared to an expected regain of over 10% [4][5] - The study demonstrated that 40% of patients continued to lose weight after the procedure, indicating a stable weight maintenance profile [14] - Hemoglobin A1c levels remained stable, with only a 0.04% change, suggesting effective glucose control alongside weight maintenance [15][16] - **Remain-1 Study**: - In a pilot study with 45 subjects, those who received Revita lost an average of 2 kg after stopping tirzepatide, while the sham group regained approximately 8 kg, highlighting a significant treatment difference of about 10 kg [21] - The pivotal Remain-1 study, which includes 315 patients, is expected to provide further data in the second half of 2026, with a focus on post-GLP-1 weight maintenance [24][23] Important Data Points - **Endoscopy Statistics**: Approximately 20 million endoscopies are performed annually in the U.S., with 800,000 of those being patients on GLP-1s [7] - **Patient Cohorts**: Fractyl is studying three patient cohorts: Reveal-1 (open-label), Remain Midpoint (pilot randomized), and Remain pivotal [13][20] - **FDA Designation**: The company has received Breakthrough Device Designation from the FDA, which may expedite the approval process for Revita [25] Additional Considerations - **Market Expectations**: A 50% reduction in weight regain is considered a significant win for the market, with stability in weight maintenance being a critical factor for patient outcomes [30][32] - **Clinical Consistency**: The data from both Reveal-1 and Remain-1 studies show a consistent signal of stability in weight maintenance, which is crucial for the therapeutic potential of Revita [33] This summary encapsulates the key points discussed during the Fractyl Health FY Conference Call, highlighting the company's innovative approach to addressing obesity and the promising clinical data supporting its treatment.

Core Insights - Fractyl Health, Inc. announced significant results from the REMAIN-1 Midpoint Cohort, indicating that the Revita procedure may be the first therapy to maintain weight loss after discontinuation of GLP-1 drugs, with Revita-treated patients losing an additional 2.5% total body weight compared to a 10% regain in sham-treated patients [2][3][10] Study Results - The REMAIN-1 Midpoint Cohort study involved 45 participants who had achieved at least 15% total body weight loss with tirzepatide, randomized to receive either Revita or a sham procedure [4][5] - At the 3-month mark, the study met its primary efficacy endpoint with a statistically significant p-value of 0.014, demonstrating the effectiveness of Revita in promoting further weight loss [8][10] - Safety and tolerability were excellent, with no serious adverse events related to Revita observed, and side effects were mild and transient [8] Future Outlook - The ongoing REMAIN-1 Midpoint Cohort is expected to provide 6-month data in Q1 2026, while the Pivotal Cohort aims to complete randomization in early 2026, with topline primary endpoint data and potential PMA filing anticipated in H2 2026 [11] - These milestones are crucial for establishing Revita as a potential first-in-class treatment for post-GLP-1 weight maintenance, opening a new therapeutic category in obesity care [11] Company Background - Fractyl Health focuses on innovative metabolic therapeutics targeting the root causes of obesity and type 2 diabetes, aiming to transform treatment from chronic management to durable disease-modifying therapies [13][15] - The company holds a robust intellectual property portfolio, including 33 granted U.S. patents and approximately 40 pending applications, positioning it well in the metabolic disease treatment landscape [13]

Core Insights - Fractyl Health, Inc. announced positive 3-month data from the REVEAL-1 Cohort of its REMAIN-1 pivotal study, indicating that Revita may help individuals maintain or lose weight after discontinuing GLP-1 drugs, suggesting a potential for durable, drug-free weight maintenance [2][3][5] Group 1: Study Findings - In the REVEAL-1 Cohort, 12 of 13 participants either maintained or lost weight at 3 months, with 6 participants losing additional weight after stopping GLP-1 therapy and undergoing the Revita procedure [1][7] - The median weight change was stable at 0.46% (~1 pound), significantly lower than the expected 5-6% weight regain (10-15 pounds) after stopping GLP-1 therapy [1][7] - The Revita procedure demonstrated excellent tolerability, with treatment-emergent adverse effects being infrequent, mild, and transient [1][7][9] Group 2: Participant Profile - The REVEAL-1 Cohort included 22 participants, with 3-month follow-up data available for 13 individuals, averaging 49 years of age, and a gender distribution of 11 women and 2 men [4] - Participants had previously been treated with GLP-1 therapy for 5 months to 3 years, achieving a median total body weight loss of 20.9% while on therapy [4] Group 3: Future Expectations - Randomized Midpoint Cohort data is expected in Q3 2025, with pivotal cohort data anticipated in H2 2026, aimed at demonstrating Revita's potential for weight maintenance after GLP-1 discontinuation [2][9] - The company emphasizes the significant unmet need in obesity treatment, particularly the ability for patients to stop GLP-1 drugs without regaining weight [5][10] Group 4: Revita's Mechanism - Revita is designed to remodel the duodenal lining via hydrothermal ablation to reverse damage caused by chronic high-fat and high-sugar diets, addressing root causes of metabolic disease [11] - The product has received U.S. FDA Breakthrough Device designation for weight maintenance in individuals who discontinue GLP-1 based drugs [11]

Core Insights - The collaboration between Fractyl Health and Bariendo aims to develop a scalable clinical pathway for the Revita procedure, which is intended for weight maintenance after discontinuation of GLP-1 drugs, pending FDA approval [1][5][6] - There is a growing demand for endoscopic alternatives to GLP-1 drugs, as many patients experience rapid weight regain after stopping these medications [5][6] - Revita is positioned as a potential first disease-modifying therapy targeting the root causes of obesity by resurfacing the duodenal lining [3][8] Company Overview - Fractyl Health focuses on innovative metabolic therapeutics that address the root causes of obesity and type 2 diabetes, aiming to transform treatment from chronic management to durable therapies [7] - Bariendo is a direct-to-consumer platform that offers advanced endoscopic weight loss procedures and aims to provide long-term solutions to obesity without ongoing medication [9] Clinical Development - Fractyl is preparing for three key data readouts from its pivotal study of Revita: open-label data from REVEAL-1 expected in June 2025, midpoint data from REMAIN-1 in Q3 2025, and primary endpoint data from REMAIN-1 in the second half of 2026 [2] - The collaboration will focus on pre-commercial preparation, including clinical workflow design, provider education, and health economic analysis [5] Market Context - The increasing use of GLP-1 drugs has highlighted the need for effective solutions to maintain weight loss after discontinuation, creating an urgent market opportunity for Revita [5][6] - Bariendo's holistic approach to obesity care aligns with the goals of Revita, emphasizing the importance of integrating metabolic endoscopic solutions into clinical practice [4][6]