Company Overview - Akebia Therapeutics, Inc. is a biopharmaceutical company focused on developing therapies for kidney disease, with its primary product being Auryxia, which treats iron deficiency anemia in chronic kidney disease patients [1] Financial Performance - Akebia's Return on Invested Capital (ROIC) is 0.34%, while its Weighted Average Cost of Capital (WACC) is 10.46%, resulting in a ROIC to WACC ratio of 0.033, indicating inefficiencies in capital utilization [2][6] - Ardelyx, Inc. has a ROIC of -10.63% and a WACC of 7.62%, leading to a ROIC to WACC ratio of -1.395, which, despite being negative, is the highest among its peers [3] - FibroGen, Inc. and Karyopharm Therapeutics Inc. show concerning figures with ROICs of -122.23% and -1634.05%, respectively, and WACCs of 7.40% and 16.28%, resulting in ROIC to WACC ratios of -16.521 and -100.389 [4] - Calithera Biosciences, Inc. and Aldeyra Therapeutics, Inc. also face difficulties, with ROICs of -184.41% and -75.25%, and WACCs of 3.17% and 7.59%, leading to ROIC to WACC ratios of -58.23 and -9.913 [5][6]

Core Insights - Akebia Therapeutics is a leading commercial stage company focused on kidney disease with two commercial products [3] - Auryxia, a phosphate binder, generated $47 million in revenues in Q2 despite losing IP exclusivity in March [3] - Vafseo, launched in January, targets anemia due to chronic kidney disease in adult dialysis patients, representing a $1 billion market opportunity in the U.S. [4] Product Overview - Auryxia has been on the market for several years and continues to perform well despite recent challenges [3] - Vafseo is positioned for label expansion into the late-stage non-dialysis CKD population, which is expected to be a multibillion-dollar opportunity [4]

Financial Data and Key Metrics Changes - The company ended Q2 with $137 million in cash and believes it is financed to profitability [5][79] - Auryxia generated $47 million in revenues in Q2, while Vafsio generated $13.3 million in its launch quarter [3][11] Business Line Data and Key Metrics Changes - Auryxia, a phosphate binder, has seen stable performance despite losing IP exclusivity in March [3][78] - Vafsio, launched in January, is positioned as a treatment for anemia due to chronic kidney disease (CKD) and is expected to capture a significant market share [4][10] Market Data and Key Metrics Changes - The U.S. market for anemia treatment in CKD is estimated to be a billion-dollar opportunity, with potential expansion into the non-dialysis CKD population representing a multibillion-dollar market [4][18] - There are approximately 550,000 dialysis patients with anemia in the U.S., with segments underserved by current treatments [25][27] Company Strategy and Development Direction - The company aims to establish Vafsio as the new standard of care for anemia due to CKD, focusing on expanding prescribing access and generating clinical data to support its efficacy [5][14] - Plans to initiate a Phase III trial for Vafsio in the non-dialysis segment by the end of the year [19][22] Management's Comments on Operating Environment and Future Outlook - Management expressed optimism about the growth potential of Vafsio, citing strong physician interest and advocacy [30][31] - The company is focused on generating data from the VOICE study to demonstrate the benefits of Vafsio, particularly in reducing hospitalization rates [61][64] Other Important Information - The company has secured contracts covering nearly 100% of U.S. dialysis patients, which is crucial for the successful launch of Vafsio [10][46] - The Transitional Drug Add-On Payment Adjustment (TDAPA) program will provide additional financial incentives for dialysis organizations to adopt Vafsio [53][56] Q&A Session Summary Question: What is the opportunity in treating anemia associated with dialysis? - The dialysis market for anemia is stable, with around 550,000 patients, and has been growing at 2% to 4% prior to COVID [25][26] Question: What is the safety profile of Vafsio? - Vafsio works by stimulating the body's natural production of erythropoietin, leading to more consistent treatment outcomes compared to ESAs [28][29] Question: How has the commercial launch progressed? - The company has seen strong advocacy from physicians, with over 80% of US Renal Care physicians prescribing Vafsio [31][32] Question: What is the process for moving a drug into a new dialysis organization? - The process involves contracting, protocol development, and operationalizing the protocol within the organization [46][48] Question: What does TDAPA mean for Vafsio? - TDAPA provides additional payments to incentivize dialysis organizations to adopt innovative therapies like Vafsio [53][54] Question: What are the financial projections for the company? - The company is in a strong financial position, projecting revenues from its products while managing expenses effectively [79]

Summary of Akebia Therapeutics Conference Call Company Overview - **Company**: Akebia Therapeutics - **Key Product**: Vafsio, an oral HIF for treating anemia due to chronic kidney disease (CKD) in dialysis patients Core Points and Arguments 1. **Launch Performance**: - Vafsio generated $12 million in revenue in Q1 and $13.3 million in Q2, reflecting a 55% growth quarter-over-quarter [6][9] - Initial access to approximately 40,000 out of 550,000 dialysis patients in the U.S. [7] 2. **Market Expansion Plans**: - Anticipation of expanding prescribing access to additional dialysis providers, potentially increasing access to 275,000 patients by November [8][9] - Focus on making Vafsio the standard of care for anemia management in dialysis patients [12][48] 3. **Market Opportunity**: - The anemia of CKD market is primarily in the dialysis population, with 500,000 out of 550,000 patients on ESA treatments [11] - Non-dialysis market presents a significant opportunity, with a potential market size comparable to dialysis, but with a higher average price per patient post-TDAPA [38] 4. **Clinical Differentiation**: - Vafsio shows a favorable safety profile with no increased risk of major adverse cardiovascular events (MACE) compared to ESAs [20][21] - Fewer hemoglobin excursions and reduced dose titrations required with Vafsio, enhancing convenience for physicians [22][24] 5. **Patient Compliance**: - Oral administration of Vafsio improves patient compliance compared to injectable ESAs, particularly in home dialysis patients [25][26] 6. **Regulatory and Reimbursement Landscape**: - TDAPA (Transitional Drug Add-on Payment Adjustment) allows for reimbursement outside the bundled payment for dialysis for two years, facilitating the adoption of Vafsio [41][42] - Post-TDAPA, Vafsio will become part of the bundled payment, necessitating a strategic pricing approach to maintain market share [44][46] 7. **Future Studies and Trials**: - Plans to initiate a new study in the non-dialysis population, with a target enrollment of 1,500 patients [40][56] - Ongoing studies (VOICE and VOCAL) to explore alternative dosing regimens [27][60] 8. **Auryxia Update**: - Auryxia, a phosphate binder, lost exclusivity in March but continues to generate revenue without significant marketing efforts [49][50] Additional Important Insights - The dialysis market is valued at approximately $1 billion in the U.S., with significant potential for Vafsio to capture market share [38][45] - The company is focused on aligning with the FDA for future studies to ensure a clear path for product development and market entry [57][60] - The ongoing lack of generic approvals for Auryxia is viewed positively for cash flow, contributing to the company's financial stability [51][52]

Financial Data and Key Metrics Changes - Total revenues for Q2 2025 were $62.5 million, up from $43.6 million in Q2 2024, representing an increase of $18.9 million [24] - Net product revenues increased to $60.5 million in Q2 2025 from $41.2 million in Q2 2024, driven by sales of Vaseo and Auryxia [24] - The company generated a net income of $247,000 in Q2 2025 compared to a net loss of $8.6 million in Q2 2024 [26] Business Line Data and Key Metrics Changes - Vaseo generated over $13 million in revenue in Q2 2025, with demand sales increasing by 55% over Q1 [5] - Auryxia sales were $47.2 million in Q2 2025, up from $41.2 million in Q2 2024 [24] - Cost of goods sold decreased to $9.9 million in Q2 2025 from $17 million in Q2 2024, primarily due to the elimination of a non-cash amortization charge [25] Market Data and Key Metrics Changes - The company expects to increase patient access from approximately 40,000 to over 75,000 dialysis patients in Q3 2025, with potential access to 275,000 patients by Q4 2025 [7][23] - Medicare Advantage plans are covering about 20% of total prescriptions, with expectations for growth as more contracts are established [33] Company Strategy and Development Direction - The company aims to establish Vaseo as the standard of care for treating anemia due to chronic kidney disease, focusing on expanding access and enhancing physician education [4][14] - Plans include launching the VALOR trial for non-dialysis patients by the end of 2025, which could significantly expand the addressable market [12][45] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the ongoing launch of Vaseo and the potential for significant growth as more dialysis providers come online [7][23] - The company is optimistic about the resilience of Auryxia's revenue stream despite the presence of an authorized generic [52] Other Important Information - The company ended Q2 2025 with $137.3 million in cash and cash equivalents, indicating a strong financial position to support ongoing operations and growth initiatives [26][27] Q&A Session Summary Question: Insights on patient segments and Medicare Advantage - Management noted that approximately 12% of prescriptions are for home patients, with expectations for continued broad use as more dialysis organizations implement protocols [31][32] - Currently, 20% of prescriptions are filled in the Medicare Advantage segment, with growth anticipated as more contracts are established [33] Question: Average dose strength for prescriptions - The average refill dose is approximately 28% higher than the initial 300 mg starting dose, reflecting increased physician comfort with dosing [36][37] Question: Timeline for DaVita's operational pilot - DaVita's operational pilot is expected to go live around mid-August, with broad access anticipated by November [42][43] Question: Outlook for Auryxia amid generic competition - Management highlighted that Auryxia's growth is supported by increased access post-bundle implementation, and they remain cautious about future generic competition [51][52]

Summary of Akebia Therapeutics (AKBA) FY Conference Call Company Overview - Akebia Therapeutics is a fully integrated biotech company founded in February 2007, focused on improving the lives of patients with chronic kidney disease (CKD) [2][3] - The company has two commercial products: Auryxia and Vassio [5][6] Core Products Auryxia - Auryxia is a phosphate binder used for controlling serum phosphorus in dialysis patients and treating iron deficiency anemia in non-dialysis adult patients [5][6] - The product lost exclusivity in March 2025, leading to the launch of an authorized generic [35][36] - Despite the competition, Auryxia has maintained strong clinical demand due to its clinical profile and economic value proposition [36][37] Vassio - Vassio is an oral HIF PH inhibitor launched in January 2025, indicated for treating anemia due to CKD in adult patients on dialysis [6][12] - It stimulates the body's natural production of erythropoietin, offering a novel mechanism of action compared to traditional erythropoiesis-stimulating agents (ESAs) [8][9] - Approximately 25% of patients on ESAs struggle to meet hemoglobin targets, highlighting a significant unmet need in the market [9][10] Market Dynamics - The dialysis market is characterized by a slow adoption process, with small to mid-sized dialysis organizations adopting new therapies before larger organizations [24][26] - The TDAPA (Transitional Drug Add-On Payment Adjustment) mechanism incentivizes dialysis organizations to adopt innovative therapies like Vassio [28][30] - Vassio's pricing post-TDAPA is set at approximately $2,500 per year, which is significantly lower than the initial starting dose price of $15,500, making it a billion-dollar market opportunity [30][31] Launch Progress and Adoption - In the first quarter post-launch, over 640 physicians prescribed Vassio, averaging 12 prescriptions per physician [18][21] - The company anticipates that larger dialysis organizations will begin to adopt Vassio more significantly in the second half of the year [26][34] - A pilot program with a large dialysis organization is expected to start in Q3 2025, testing operational systems for Vassio [31][34] Future Opportunities - The non-dialysis (NDD) market represents a significant opportunity, with a potential market size four to five times greater than dialysis [46][48] - The company plans to initiate a phase three study for NDD in the second half of the year, following FDA feedback on the protocol [48][49] Key Catalysts - Near-term catalysts include successful pilot program execution, full enrollment in the voice study aimed at reducing hospitalization and mortality, and progress on NDD studies [57][61] - The company is focused on Vassio as the primary growth driver, with plans to leverage its clinical differentiation and real-world physician experience to establish it as the standard of care [40][41] Underappreciated Aspects - Akebia has a pipeline of early-stage HIF assets, including studies for acute kidney injury and retinopathy of prematurity, which are significant unmet needs [62][63] - While investor focus is primarily on Vassio, the company aims to highlight its broader pipeline once Vassio demonstrates continued success [63]

Vafseo Launch and Market Opportunity - Vafseo (vadadustat) has launched as a treatment for anemia due to chronic kidney disease (CKD) in adult patients on dialysis[8] - The U S market opportunity for Vafseo in the dialysis patient population is approximately $1 billion[8] - Akebia is pursuing label expansion of Vafseo for the late-stage non-dialysis CKD population, representing a multi-billion-dollar U S market opportunity[8] - Contracts are secured covering nearly 100% of U S dialysis patients for Vafseo[12, 20] Clinical and Patient Considerations - Current standard of care for dialysis patients (ESAs) has remained unchanged for 30 years, with nearly 25% of patients falling below target hemoglobin levels[13] - Approximately 20% of patients on dialysis are ESA hyporesponders, leading to higher hospitalization and mortality rates[13] - Market research indicates that over 2 out of 3 nephrologists identify an unmet need for anemia treatment in CKD, particularly for oral options and ESA-resistant patients[14] VOICE Trial and Label Expansion - The VOICE trial, with over 650 subjects enrolled as of January 10, 2025, is designed to demonstrate non-inferiority for all-cause mortality and superiority for a 10% reduction in all-cause hospitalization[23, 24] - A Phase 3 clinical trial for Vafseo in late-stage CKD patients not on dialysis is planned to begin in mid-2025[8, 46] Non-Dialysis Market - In patients with pre-hemodialysis Hb <9 0 g/dL (n=4855), 73 4% did not receive ESA pre-HD[26] - The U S non-dialysis market opportunity for anemia treatment is approximately $1 billion, driven by predominantly private and unbundled government payment structures[40, 41] HIF-based Pipeline - Akebia is advancing a HIF-based pipeline targeting high unmet needs, including ROP (rare disease) with a ~$1 5B+ U S market opportunity and ~30K patients[50]

Vafseo Launch and Market Opportunity - Vafseo (vadadustat) has launched as a treatment for anemia due to chronic kidney disease (CKD) in adult patients on dialysis[8] - The U S market opportunity for Vafseo in the dialysis patient population is approximately $1 billion[8] - Akebia is pursuing label expansion of Vafseo for the late-stage non-dialysis CKD population, representing a multi-billion-dollar U S market opportunity[8] - Contracts are secured covering nearly 100% of U S dialysis patients for Vafseo[12, 20] Clinical and Patient Considerations - Current standard of care for dialysis patients (ESAs) has remained unchanged for 30 years, with nearly 25% of patients falling below target hemoglobin levels[13] - Approximately 20% of patients on dialysis are ESA hyporesponders, leading to higher hospitalization and mortality rates[13] - Market research indicates that over 2 out of 3 nephrologists identify an unmet need for anemia treatment in CKD, particularly for oral options and ESA-resistant patients[14] Vafseo Advantages and Ongoing Trials - Vafseo is an oral HIF-PH inhibitor with the potential to become standard of care, offering a unique mechanism of action and convenient oral dosing[15] - The VOICE trial, with a target enrollment of ~2,200 patients, is underway to demonstrate Vafseo's non-inferiority for all-cause mortality and superiority for a 10% reduction in all-cause hospitalization[24] Non-Dialysis Market and Future Plans - In patients with pre-hemodialysis Hb <9 0 g/dL (n=4855), 73 4% did not receive ESA pre-HD[26] - A Phase 3 clinical trial is planned to begin in mid-2025 for Vafseo in patients with late-stage CKD anemia not on dialysis, targeting ~1,500 U S subjects[8, 46] Pipeline and Financial Outlook - Akebia expects its existing cash resources and cash from operations to be sufficient to fund its current operating plan for at least two years[8] - Akebia is advancing a HIF-based pipeline targeting high unmet needs, including ROP (~$1 5B+ U S market opportunity), ARDS (~$2B U S market opportunity), and CS associated AKI (~$1 5B+ U S market opportunity)[50]

Summary of Akebia Therapeutics (AKBA) 2025 Conference Call Company Overview - **Company**: Akebia Therapeutics (AKBA) - **Product**: Vafsio, a treatment for anemia in dialysis patients - **Conference Date**: June 05, 2025 Key Points Product Launch and Sales Performance - **Successful Launch**: Vafsio had a strong first quarter launch with 640 physicians prescribing the product, indicating broad reach [2][4] - **Prescribing Depth**: Average of over 12 prescriptions per physician in Q1, indicating high adoption [4] - **Patient Population**: Broad prescribing across various patient types, not limited to initially identified profiles [4] Market Dynamics - **Payer Mix**: - 40% of prescriptions are from fee-for-service Medicare patients - 40% coverage from Medicare Advantage Plans, with an additional 20% coverage seen in Q1 [7][8] - **Home Patients**: Approximately 12% of prescriptions are for home patients, aligning with the dialysis community's demographics [7] Growth Strategy - **Transitional Drug Add-On Payment Adjustment (TDAPA)**: - Provides additional reimbursement outside the bundled payment system for dialysis treatments [17] - Expected to help cover costs of innovation during the two-year TDAPA period [18] - **Post-TDAPA Pricing**: Anticipated to be competitive at approximately $2,500 per year, targeting a billion-dollar market with 500,000 anemic patients [18][19] Clinical Trials and Data Generation - **VOICE Trial**: Aims to demonstrate a 10% reduction in hospitalization and mortality, crucial for economic viability [27] - **Enrollment Status**: 75% enrollment of 2,200 patients completed, with expectations to finish soon [32] Non-Dialysis Dependent (NDD) Market Opportunity - **Significant Unmet Need**: NDD population represents a multi-billion dollar market opportunity, with approximately 500,000 patients in the U.S. [25][23] - **FDA Engagement**: Plans to initiate a Phase 3 trial for NDD in the second half of the year, focusing on cardiovascular outcomes [38][40] Competitive Landscape - **Unique Position**: Akebia is the only company with a novel HIF inhibitor therapy in the U.S. market, differentiating itself from previous competitors [46][50] - **Clinical Profile**: Vafsio has a broader label without the heart failure warning present in previous products, enhancing its marketability [50] Financial Position - **Cash Reserves**: Ended Q1 with $113 million in cash, indicating a strong financial position to support ongoing operations and trials [72] - **Expense Management**: Efficient management of expenses, with a focus on reaching profitability while supporting pipeline activities [73][75] Pipeline and Future Opportunities - **Emerging Programs**: Plans to advance programs for acute kidney injury (AKI) and retinopathy of prematurity (ROP) into clinical trials [70][71] Additional Insights - **Market Dynamics**: The transition from traditional erythropoietin-stimulating agents (ESAs) to HIF inhibitors represents a significant shift in treatment paradigms for anemia management in chronic kidney disease [58] - **Physician Engagement**: Continuous engagement with physicians to highlight the benefits of Vafsio and its mechanism of action is crucial for adoption [58][59] This summary encapsulates the key insights and strategic directions discussed during the Akebia Therapeutics conference call, highlighting the company's growth potential and market positioning.

Financial Data and Key Metrics Changes - The first quarter marked the initial launch of Vafsio in the U.S. for anemia in CKD patients receiving dialysis, with nearly 640 physicians having prescribed the product by the end of the quarter [8][9] - Average prescriptions per prescriber were about 12, indicating a transition from trial to adoption [9] Business Line Data and Key Metrics Changes - Vafsio is positioned as a hypoxia-inducible factor prolyl hydroxylase inhibitor, with a focus on becoming the standard of care for all chronic kidney disease patients, including those not on dialysis [4][5] - Auryxia, another commercial product, is a phosphate binder that has positively impacted patients [3] Market Data and Key Metrics Changes - The dialysis market is significant, with 150,000 patients in small and medium providers, and all five top dialysis providers, representing approximately 85% of treatment, have ordered the product [11][12] - The non-dialysis market for CKD anemia is equally substantial, with over 550,000 anemic patients in stages four and five, presenting a larger revenue opportunity compared to dialysis [55][56] Company Strategy and Development Direction - The company aims to expand its pipeline within kidney disease and explore applications of HIF technology beyond the kidney space [5][6] - The strategy includes engaging with the FDA for a path forward to make Vafsio available for non-dialysis patients [5][60] Management's Comments on Operating Environment and Future Outlook - Management expressed optimism about the early launch of Vafsio, highlighting the enthusiasm from nephrologists and the potential for broader adoption [7][19] - The company anticipates significant growth in Q4 as pilot programs expand, with expectations for increased prescriber engagement [46][48] Other Important Information - The TDAPA program allows for reimbursement outside the bundled payment system, facilitating the launch of Vafsio [36][38] - The company plans to initiate a Phase III trial for Vafsio in non-dialysis patients by the end of the year [60][61] Q&A Session Summary Question: How is the launch of Vafsio progressing? - The launch is progressing well, with nearly 640 physicians prescribing the product and an average of 12 prescriptions per prescriber [8][9] Question: What is the strategy for engaging with dialysis organizations? - The strategy involves creating contracts and protocols to ensure positive economics for dialysis organizations, which are financially liable for treatment costs [25][31] Question: What are the market opportunities for Vafsio? - The non-dialysis market presents a significant opportunity, with over 550,000 anemic patients in stages four and five, potentially yielding higher revenue compared to the dialysis market [55][56] Question: What are the timelines for upcoming trials? - The pilot for larger dialysis organizations is expected to start in Q3, with broader usage anticipated in Q4 [44][46]