Rhythm Pharmaceuticals (RYTM) Conference Call Summary Company Overview - **Company**: Rhythm Pharmaceuticals - **Focus**: Development of treatments for hypothalamic obesity, specifically through the drug Bivomelagon Key Industry Insights - **Industry**: Pharmaceuticals, specifically in the obesity treatment sector - **Market Opportunity**: Estimated prevalence of hypothalamic obesity (HO) in the US is around 10,000 patients, with similar numbers in Europe and Japan [10][10] Core Findings from the Conference Call 1. **Positive Phase II Trial Results**: - Bivomelagon showed comparable BMI reductions to cetmelanotide in similar patient populations [6][6] - The six hundred milligram cohort achieved a 9.3% reduction in BMI, while the four hundred milligram cohort achieved a 7.7% reduction [15][15] 2. **Safety and Tolerability**: - Safety profile consistent with MC4R agonism, with minimal reports of hyperpigmentation [7][7] - One serious adverse event (SAE) reported: lower intestinal bleeding, deemed possibly related to the drug [14][14] - Diarrhea occurred at a slightly higher frequency than in previous trials, but all cases were mild [28][28] 3. **Patient Demographics**: - Mean BMI of participants was nearly 39, with a significant portion (80%) having craniopharyngioma as the cause of their obesity [12][12] - Majority of patients were white, with a small representation from other ethnic backgrounds [13][13] 4. **Regulatory Plans**: - Plans to request an end of phase two meeting with the FDA and initiate phase three studies in the first half of 2026 [35][35] 5. **Patent Protection**: - Composition of matter patents for cetmelanotide extend to 2032, with formulation patents extending to 2034 [10][10] 6. **Future Drug Formulations**: - Development of smaller pills and chewable tablets to improve patient compliance, especially among younger patients [31][31][92][92] Additional Important Points - **Mechanism of Action**: Bivomelagon acts as a functional analog of alpha MSH, providing satiety signals and increasing resting energy expenditure, leading to weight loss [8][8] - **Compliance Issues**: Some patients experienced challenges with pill swallowing, particularly teenagers, which may have affected compliance and efficacy [32][32][72][72] - **Comparative Efficacy**: The results from Bivomelagon are similar to those observed with cetmelanotide, indicating a strong potential for market acceptance [25][25][81][81] Conclusion Rhythm Pharmaceuticals is positioned to advance its obesity treatment pipeline with promising Phase II results for Bivomelagon, a favorable safety profile, and strategic plans for regulatory engagement and product development. The company aims to address compliance challenges through improved formulations while capitalizing on the significant market opportunity in hypothalamic obesity.

Financial Data and Key Metrics Changes - Rhythm Pharmaceuticals reported global sales revenue of $37.7 million for Omsivri in Q1 2025, with a 14% increase in the number of patients on reimbursed therapy globally during the quarter [34] - Net product revenues increased by $11.7 million, or 45%, compared to Q1 2024 [37] - Cash on hand at the end of the quarter was $314.5 million, sufficient to cover planned operations into 2027 [41] Business Line Data and Key Metrics Changes - The demand for Omsivri, the only treatment addressing hyperphagia and obesity associated with Bardet-Biedl syndrome (BBS), remained strong, with a consistent number of new prescriptions leading to ongoing growth in patients on reimbursed therapy [19] - The inventory swing at specialty pharmacies affected revenue, with an $8.3 million inventory swing impacting Q1 results [35] - The international team is executing a country-by-country launch strategy for BBS, with significant contributions to revenues from France and Italy [10] Market Data and Key Metrics Changes - The U.S. percentage of overall product revenue decreased from 74% in Q4 2024 to 65% in Q1 2025 due to inventory swings [41] - Medicaid access for Emsivri has improved, with positive coverage decisions secured in states accounting for over 95% of covered Medicaid lives [22] Company Strategy and Development Direction - The company is on track for a Q3 filing with the FDA for cetmelanotide, with an in-person Type D meeting scheduled [8] - Rhythm Pharmaceuticals is focused on expanding access for Emsivri and preparing for the launch of INCIVRI for acquired hypothalamic obesity [22] - The company is also looking forward to the Bivomelagon Phase II readout in Q3 and ongoing studies in Prader-Willi syndrome and hypothalamic obesity [10] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the potential of cetmelanotide to transform the lives of patients with hypothalamic obesity, highlighting the medical complexity and unmet needs in this patient population [11] - The management team noted that the interactions with the FDA have been normal and responsive, indicating a positive outlook for the upcoming filing [8] - The company remains well-capitalized with a projected cash runway into 2027, allowing for continued investment in research and development [41] Other Important Information - The company reported a gross-to-net ratio for U.S. sales of 84.2%, consistent with previous quarters [37] - R&D expenses for Q1 2025 were $37 million, significantly lower than the previous year due to decreased costs associated with the acquisition of Bivomelagon [37] Q&A Session Summary Question: Can you talk about the non-responders highlighted? - Management noted that non-responders included patients who dropped out for various reasons, including inability to keep up with the trial and adverse reactions [46] Question: What is the real-world experience regarding patient compliance? - Management indicated that compliance rates are generally around 30% for patients, with expectations of better compliance in the hypothalamic obesity population [48] Question: Can you discuss the FDA meeting scheduled? - The meeting is to clarify what will be presented in the filing and ensure alignment with the FDA [69] Question: What is the payer mix for BBS patients? - Approximately 80% of the BBS patient population is covered by commercial and Medicaid, with Medicare being a smaller portion [71] Question: What is the expected revenue ramp for hypothalamic obesity? - Consensus estimates HO revenue ramping from around $115 million in 2026 to over $1 billion by 2030, with management expressing confidence in the launch [95]

Financial Data and Key Metrics Changes - Rhythm Pharmaceuticals reported global sales revenue of $37.7 million for Q1 2025, with a 14% increase in the number of patients on reimbursed therapy globally during the quarter [32] - Net product revenues increased by $11.7 million, or 45%, compared to Q1 2024 [36] - Cash on hand at the end of the quarter was $314.5 million, projected to cover operations into 2027 [39] Business Line Data and Key Metrics Changes - Demand for Omsivri, the treatment for Bardet-Biedl syndrome (BBS), remained strong, with a consistent number of new prescriptions leading to ongoing growth in patients on reimbursed therapy [17][18] - The inventory swing at specialty pharmacies resulted in a net revenue decrease of $4.1 million compared to Q4 2024, despite strong underlying growth [35] Market Data and Key Metrics Changes - The international team is executing a country-by-country launch strategy for BBS, with revenue contributions from France and Italy continuing to grow [8] - Medicaid access for Emsivri has improved, with positive coverage decisions secured in states accounting for over 95% of covered Medicaid lives [21] Company Strategy and Development Direction - The company is on track for a Q3 filing with the FDA for cetmelanotide, with an in-person Type D meeting scheduled [6] - Rhythm Pharmaceuticals is focused on expanding its commercial efforts globally, particularly in the endocrinology specialty, which is critical for patients with hypothalamic obesity [22][86] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the potential of cetmelanotide to transform the lives of patients with hypothalamic obesity, highlighting the medical complexity and unmet needs in this patient population [10][16] - The company anticipates a solid launch trajectory for acquired hypothalamic obesity, with a higher percentage of diagnosed and actively managed patients compared to BBS [94] Other Important Information - The company is well-capitalized with a projected cash runway into 2027, allowing for continued investment in R&D and commercial activities [39] - The company plans to present real-world data at upcoming medical conferences, which is expected to enhance understanding and interest in their therapies [28][31] Q&A Session Summary Question: Can you elaborate on the non-responders in the trial? - Management noted that several non-responders had good responses before dropping out, with reasons including inability to keep up with the trial and adverse reactions [44] Question: What is the real-world experience regarding patient compliance? - Compliance rates are generally around 30%, with expectations that the hypothalamic obesity population may see lower discontinuation rates due to the relief provided by treatment [46][47] Question: Can you discuss the FDA meeting scheduled? - The meeting is to clarify what will be presented in the filing and ensure alignment with the FDA [65] Question: What is the payer mix for BBS and expectations for HO? - Approximately 80% of the payer mix consists of commercial and Medicaid, with ongoing evaluations for the hypothalamic obesity opportunity [68] Question: What is the expected revenue ramp for HO? - Management expressed confidence in the launch potential, noting a higher percentage of diagnosed patients compared to BBS, but refrained from providing specific revenue guidance [94]