Summary of Alnylam Pharmaceuticals (ALNY) Update / Briefing - August 30, 2025 Company Overview - **Company**: Alnylam Pharmaceuticals (ALNY) - **Key Product**: Zalbesiran, a novel treatment for uncontrolled hypertension - **Collaboration**: Partnership with Roche for the development of Zalbesiran Industry Context - **Focus Area**: Cardiovascular disease, specifically hypertension - **Global Burden**: Cardiovascular disease is the leading cause of death worldwide, with approximately 20 million deaths annually attributed to it, primarily due to high blood pressure [11][12] - **Treatment Gap**: Less than 40% of women and 30% of men achieve adequate blood pressure control, highlighting a significant unmet need in hypertension management [13] Core Points and Arguments Clinical Development and Results - **CARDIA Trials**: The presentation focused on the results of the CARDIA three trial, which evaluated Zalbesiran in patients with uncontrolled hypertension and high cardiovascular risk [27][38] - **Efficacy**: - CARDIA one showed a significant reduction in blood pressure of 15 mmHg as monotherapy [28] - CARDIA two demonstrated reductions of -19 mmHg with a diuretic, -10 mmHg with amlodipine, and -7 mmHg with olmesartan [29] - CARDIA three results indicated a placebo-adjusted reduction of -5 mmHg and -3.3 mmHg for the 300 mg and 600 mg doses, respectively, at three months [34][38] - **Safety Profile**: The safety profile was encouraging, with low rates of serious adverse events and manageable instances of hyperkalemia and kidney dysfunction [36] Mechanism of Action - **RNA Interference Technology**: Zalbesiran utilizes RNA interference to silence genes associated with hypertension, allowing for infrequent dosing (once every six months) [4][5] - **Blood Pressure Control**: The drug aims to provide consistent blood pressure control, addressing both daytime and nighttime variability, which is crucial for reducing cardiovascular risk [17][21] Market Opportunity - **Patient Population**: There are approximately 219 million patients with hypertension in major markets, with 62 million currently uncontrolled [40] - **Unmet Need**: Patients with uncontrolled hypertension and high cardiovascular risk represent a significant unmet need, particularly those with comorbidities like diabetes and chronic kidney disease [40] Future Directions - **Phase Three Trial (Zenith)**: The upcoming Zenith trial will enroll 11,000 patients with uncontrolled hypertension and established cardiovascular disease, focusing on cardiovascular outcomes [43][45] - **Regulatory Engagement**: The protocol for the Zenith trial has been filed with multiple regulators, with plans to activate sites soon [45] - **Commercial Strategy**: Alnylam and Roche are developing strategies for the commercialization of Zalbesiran, including potential additional indications [46][47] Important but Overlooked Content - **Adherence Issues**: The challenge of treatment adherence in chronic diseases like hypertension is significant, with about 40% of patients not taking their medications as prescribed [22][23] - **Long Duration of Action**: The six-month duration of action for Zalbesiran is highlighted as a major advantage in improving adherence and overall treatment outcomes [24][51] - **Synergistic Effects with Diuretics**: The potential for Zalbesiran to work synergistically with diuretics is noted, as diuretics can upregulate the renin-angiotensin system, enhancing the effectiveness of Zalbesiran [60][63] Conclusion - **Transformational Potential**: Zalbesiran is positioned as a potentially paradigm-shifting therapy for hypertension, with the ability to improve blood pressure control and cardiovascular outcomes significantly [55][56]

Summary of Alnylam Pharmaceuticals (ALNY) FY Conference Call - August 12, 2025 Company Overview - Alnylam Pharmaceuticals was founded in February 2002 and is recognized as a global leader in RNA interference technology, which has led to the development of a new class of medications [4][5] - The company has established a robust pipeline with six approved medications and aims to drive long-term growth through three pillars: leadership in transthyretin amyloidosis (ATTR), growth through innovation, and outstanding commercial performance [5][6] Core Points and Arguments Leadership in ATTR - The recent approval of Ambutra for ATTR cardiomyopathy is expected to set a new standard of care, addressing a significant unmet need in a rapidly growing patient segment [5][6] - Ambutra's clinical profile and the growing patient population present a strong franchise opportunity for Alnylam [5] Commercial Performance - Alnylam reported $492 million in revenues for the quarter, exceeding consensus estimates by 34% [8] - The launch of Ambutra has been successful, with half of the priority healthcare systems adding it to their formularies within five to six weeks of launch [12] - The company anticipates continued growth through increased diagnosis rates and treatment penetration among existing patients [15] Patient Demographics and Treatment Dynamics - Globally, there are approximately 300,000 patients affected by ATTR cardiomyopathy, with about 80% remaining undiagnosed [14] - In the U.S., around 150,000 patients are affected, with an estimated 10,000 new patients presenting annually [16] - There is a significant opportunity to treat patients who are stabilizer progressors, with about 45,000 patients globally on stabilizers, and 30-50% of them may continue to progress [19] Competitive Landscape - Alnylam positions Ambutra as the first RNAi silencer approved for both manifestations of ATTR, emphasizing its unique mechanism of action [21][22] - The company is focused on establishing Ambutra as a first-line treatment option, leveraging its robust clinical data package [24] - Future competition from gene editing technologies is acknowledged, but Alnylam is advancing its next-generation RNA silencer, Neuquesiran, which could provide significant benefits [28][29] International Expansion and Regulatory Considerations - Alnylam has received regulatory approvals in Europe, Brazil, and Japan, with international launches expected to ramp up in 2026 [30][31] - The company is monitoring the Most Favored Nation (MFN) policy but continues to move forward with its launch processes [31][33] Pipeline Developments - The Zalbeceran program targets hypertension, addressing a significant unmet need as up to 80% of patients on therapy do not meet blood pressure targets [35][36] - Alnylam is planning to start a cardiovascular outcomes trial for Zalbeceran later this year [41] - The company is also advancing its Melvisiran program targeting cerebral amyloid angiopathy (CAA), a condition with no approved therapies [44][45] Future Outlook - Alnylam is focused on internal growth and innovation, while remaining open to external opportunities that align with its strategic goals [54] Other Important Content - The company emphasizes the importance of adherence to treatment regimens, particularly in rapidly progressing conditions like ATTR and hypertension [27][36] - Alnylam's approach to treatment includes a focus on patient quality of life and functional capacity, which resonates with both physicians and patients [23]