Summary of Tectonic Therapeutic (TECX) Conference Call Company Overview - **Company**: Tectonic Therapeutic (TECX) - **Event**: 2025 Conference at Cantor Healthcare Conference - **Date**: September 04, 2025 Industry Context - **Industry**: Biopharmaceuticals, specifically focusing on relaxin therapies for heart failure and pulmonary hypertension Key Points and Arguments Eli Lilly's Data Impact - Eli Lilly's recent trial results have negatively impacted Tectonic Therapeutic, referred to as "triple jeopardy" due to three separate impacts from the trial [4][3] - Eli Lilly's trial involved patients with decompensated heart failure, which is a challenging population to treat, leading to concerns about fluid retention and sodium avidity [5][6] - Tectonic's approach differs as they focus on stable patients who are not fluid overloaded, emphasizing the importance of euvolemic status before treatment [7] Tectonic's Phase 1B Data - Tectonic reported positive Phase 1B data showing a **35% reduction in pulmonary vascular resistance** and a **20% reduction in pulmonary artery pressure** [11] - The study indicated a **3 mm drop in pulmonary capillary wedge pressure**, which is significant as it suggests improved hemodynamics [21] - The increase in cardiac output by **almost 20%** was unexpected and indicates effective treatment [21] Future Studies and Patient Population - Tectonic is focusing on a specific patient population with combined pre- and post-capillary pulmonary hypertension (CP-CPH), aiming to reduce pulmonary vascular resistance [37] - The company plans to enrich for patients with high pulmonary vascular resistance (PVR) in their studies, with **70% of patients in the Phase 2 study required to have PVR greater than 3 WU units** [12][13] Competitive Landscape - AstraZeneca has an ongoing relaxin program, which provides reassurance to Tectonic as it indicates continued interest and potential in the relaxin space [16][18] - Tectonic believes that the presence of other therapies, such as Merck's sotatercept, could open the market for their product, as there is currently no approved therapy for CP-CPH [39][40] Regulatory Considerations - The primary endpoint for Tectonic's studies is the **six-minute walk test**, which is considered sufficient for regulatory approval [48] - There is potential for composite endpoints in future studies, including cardiovascular death and hospitalization [48] Upcoming Data and Trials - Tectonic plans to release additional data in the second half of October, focusing on patients with reduced ejection fraction heart failure [30] - A Phase 2 study for pulmonary hypertension associated with interstitial lung disease (PH-ILD) is in the planning stages, with a focus on a small cohort of 20 patients [49][50] Market Positioning - Tectonic aims to be the first systemic therapy for PH-ILD, addressing a significant unmet need in the market [52] - The company is considering testing their therapy in combination with existing treatments if initial studies show efficacy [52] Conclusion - Tectonic Therapeutic is navigating a challenging landscape following Eli Lilly's trial results but remains optimistic about its unique approach and upcoming data releases. The focus on specific patient populations and the potential for regulatory approval through established endpoints positions the company favorably in the biopharmaceutical market.

Core Viewpoint - Merck's disappointing performance in the first half of 2025 has led to a significant cost-cutting plan, including a global layoff of approximately 6,000 employees, which is about 8% of its workforce. The company aims to save $3 billion annually by 2027 through this initiative [2][3][4]. Financial Performance - Merck reported total revenue of $31.3 billion for the first half of 2025, a 2% year-over-year decline. The pharmaceutical business generated $27.7 billion, down 3% year-over-year. Revenue from the China region plummeted by 70% to approximately $1.1 billion [2][11]. - The sales of Merck's HPV vaccine in the first half of 2025 were $2.453 billion, a staggering 48% decrease year-over-year, with a 55% drop in the second quarter alone [7][8]. Layoff and Cost-Cutting Measures - The company plans to cut around 6,000 jobs globally, which is expected to save approximately $1.7 billion annually by 2027. The layoffs will primarily affect administrative, sales, and research positions [3][4]. - Merck has already accounted for $649 million in expenses related to the layoff plan in its GAAP earnings for the second quarter of 2025 [5]. Market Dynamics - The decline in HPV vaccine sales is attributed mainly to decreased demand in China, where Merck has paused supply due to market conditions and high inventory levels [9][10]. - Merck's revenue from China, which had previously been a strong market, has seen a drastic decline from $6.7 billion in 2023 to approximately $1.1 billion in the first half of 2025, representing less than 4% of its global pharmaceutical business [11]. Product Pipeline and Future Outlook - Merck's key product, Keytruda, generated $15.2 billion in sales in the first half of 2025, accounting for 48% of total revenue, but its growth rate has slowed significantly compared to previous years [12][13]. - The company is actively seeking new blockbuster products to replace Keytruda, which faces patent expiration in 2028. Recent acquisitions, such as Verona Pharma for $10 billion, aim to bolster its product pipeline [14][15][16].

Investment Rating - The report maintains a "Positive" investment rating for the industry [1] Core Insights - The report highlights the significant potential of blocking the Activin receptor (ActR) signaling pathway to promote muscle growth, particularly in treating muscle atrophy-related diseases [4][9] - There is a substantial unmet clinical need for muscle-targeted therapies, especially for patients with spinal muscular atrophy (SMA) and those experiencing muscle loss due to aging or weight management [4][29] - The market for muscle-targeted therapies is projected to be large, with current SMA therapies generating approximately $4.5 billion in sales, indicating a significant opportunity for new treatments [4][33] Summary by Sections 1. ActR Pathway - The ActR pathway plays a crucial role in regulating muscle, blood, and bone through members of the TGFβ superfamily, including Myostatin [9] - Blocking the ActR pathway can effectively treat muscle atrophy by inhibiting Myostatin, which negatively regulates muscle growth [4][10] 2. Clinical Applications of ActR Pathway Blockade: Spinal Muscular Atrophy (SMA) - SMA is a genetic neuromuscular disease caused by mutations in the SMN1 gene, leading to severe muscle atrophy and respiratory failure [22][23] - Current SMA therapies primarily target SMN protein, but they have limitations, highlighting the need for combined therapies that also address muscle atrophy [25][29] 3. Clinical Applications of ActR Pathway Blockade: Weight Management - Muscle loss is a significant issue not only in genetic diseases but also in aging populations, with a 1% annual muscle loss in individuals over 60 [36] - The widespread use of GLP-1RA medications has been linked to 25-40% muscle loss in users, creating a demand for therapies that preserve or enhance muscle mass during weight management [36] 4. Targeted ActRII Pathway Drugs - Apitegromab, developed by Scholar Rock, is a monoclonal antibody targeting latent Myostatin, showing promising results in Phase 3 trials for SMA and expected to submit for FDA approval [38][39] - Taldefgrobep, developed by BIOHAVEN, targets active Myostatin but did not meet primary endpoints in its Phase 2 trial for SMA, although it showed trends of benefit in certain subgroups [57][62] - GYM329, developed by Roche, specifically targets latent Myostatin and is currently undergoing clinical trials for various indications, demonstrating potential for muscle mass increase [69]