Core Insights - Medexus Pharmaceuticals reported fiscal Q1 2026 results, highlighting a net revenue of $24.6 million and a net income of $0.5 million, with a focus on the successful launch of GRAFAPEX [1][2][8] Financial Performance - Fiscal Q1 2026 net revenue was $24.6 million, a decrease of $2.7 million or 9.9% compared to $27.3 million in fiscal Q1 2025, primarily due to reduced sales of Rupall and Gleolan [9] - Adjusted EBITDA for fiscal Q1 2026 was $3.4 million, down $2.7 million or 44.3% from $6.1 million in fiscal Q1 2025 [9] - Operating income decreased to $0.9 million, a drop of $3.1 million or 77.5% compared to $4.0 million in fiscal Q1 2025 [9] - Available liquidity as of June 30, 2025, was $9.3 million, down from $24.0 million as of March 31, 2025, mainly due to a $15.5 million payment under a credit agreement [9] GRAFAPEX Performance - GRAFAPEX generated $3.0 million in product-level net revenue during fiscal Q1 2026, matching the investment in personnel and infrastructure for the product [3][12] - The company anticipates GRAFAPEX's product-level net revenue for fiscal Q2 2026 to be between $3.0 million and $3.5 million, considering observed wholesaler purchasing patterns [5][12] - GRAFAPEX is expected to contribute positively to quarterly operating cash flows by fiscal Q3 2026 [5][12] Market Response and Future Outlook - Positive market response to GRAFAPEX includes formulary inclusion by nine large commercial payers covering approximately 48 million patient lives [5] - The US Centers for Medicare & Medicaid Services approved New Technology Add-On Payment (NTAP) reimbursement for GRAFAPEX, which will provide additional reimbursement starting October 1, 2025 [11] - The company expects annual product-level net revenue from GRAFAPEX to exceed $100 million within five years post-launch [11] Product Portfolio and Competitive Landscape - The company is facing challenges with Rupall, which has seen a 29% decrease in unit demand due to the expiration of market exclusivity and increased generic competition [17] - Other products like Trecondyv and IXINITY have shown varying performance, with Trecondyv experiencing a 38% growth in unit demand over the past year [13][14]

Financial Data and Key Metrics Changes - Q2 Rytello net revenues were $49 million, representing an increase of approximately 24% over the first quarter [5][29] - As of June 30, 2025, cash and marketable securities were approximately $433 million, up from $503 million as of December 31, 2024 [29] - Research and development expenses for Q2 were $22 million, down from $31 million for the same period in 2024, primarily due to lower clinical trial costs [30] Business Line Data and Key Metrics Changes - Demand growth in Q2 was 17% higher compared to Q1, with approximately 1,000 sites of care utilizing Rytello, an increase of about 400 new sites since the beginning of the year [13][14] - Approximately two-thirds of accounts that previously ordered Rytello have reordered in Q2 [14] - Payer access improved, with approximately 90% of US covered lives now under favorable Rytello medical coverage policies, up from 85% in Q1 [16] Market Data and Key Metrics Changes - The company is focused on increasing brand awareness among US hematologists treating lower-risk MDS patients, with positive feedback on educational efforts [7][23] - The company plans to expand its commercial sales force and customer-facing roles by over 20% to enhance KOL support and advocacy [8][20] Company Strategy and Development Direction - The primary strategy remains the successful commercialization of Rytello in the US, with a focus on increasing brand awareness and physician education [5][10] - The company is preparing for the launch of Rytello in select EU markets next year, maintaining financial discipline in investments for this launch [10][22] - The appointment of Harout Semerjian as the new President and CEO is expected to drive shareholder value and enhance the company's strategic direction [4][12] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the execution of commercial strategies and the potential for continued growth, particularly in the US market [11][54] - The company is optimistic about the enrollment momentum in the Phase III IMPACT MF trial, expecting completion by year-end [11][25] Other Important Information - The company has doubled the size of its medical affairs team to enhance community awareness and KOL advocacy [23] - The gross-to-net percentage remained in the mid-teens from Q1 to Q2, consistent with previous guidance [29] Q&A Session Summary Question: How many active patients are now receiving Rytello? - The company estimates that there are at least 600 active patients based on the number of accounts that have prescribed Rytello [36] Question: How sustainable is the 17% quarter-over-quarter demand growth? - The company focuses on business drivers such as new patient starts and duration of treatment, with positive trends observed in physician prescribing behavior [42][44] Question: What was the biggest issue that held back the launch in Q4 and Q1? - Management identified the need to increase awareness, ensure prescribing comfort, and engage KOLs as key strategies that have been pivoted since March [52][53] Question: Any qualitative insights on early Q3 demand trends? - The company sees conscious optimism in demand trends based on internal sales data and claims data [62] Question: Any anecdotes about the type of physicians currently prescribing Rytello in earlier lines? - The company noted that earlier line use is seen among physicians who have had patient success in later lines of therapy [71] Question: What is the EU commercialization strategy? - The company is focused on securing the highest possible reimbursable rate and is engaged with potential partners for commercialization in the EU [81][84]