Akebia Therapeutics Conference Call Summary Company Overview - **Company**: Akebia Therapeutics (NasdaqCM:AKBA) - **Focus**: Development of therapies for kidney disease, particularly anemia in chronic kidney disease patients Key Strategic Areas 1. **Commercial Product - Vafseo**: - Aim to establish Vafseo as the standard of care for anemia in chronic kidney disease patients on dialysis [3][7] - Ongoing phase four and three B trials to generate necessary data for standardization [3] 2. **Commitment to Kidney Disease**: - Focus on expanding the pipeline related to kidney disease, including drugs like praliciguat and AKB-907 [3][4] 3. **Future Beyond Kidney Disease**: - Small investments in other areas such as aducanumab and retinopathy of prematurity [4] Vafseo Product Insights - **Mechanism**: Vafseo is a HIF-PH inhibitor that offers a new approach to managing anemia, with fewer dose titrations and easier administration for physicians [7][8] - **Clinical Data**: - Phase 3 study showed a statistically significant reduction in mortality and hospitalization rates [8] - An 8% decrease in hospitalization and a 15% cost reduction per patient per year, translating to approximately $3.7 billion savings if all eligible patients switched from ESAs to Vafseo [9][10] - **Market Potential**: - Post-TDAPA market opportunity estimated at $1 billion, with potential for Vafseo to be a $500 million product [26][30] Dosing Strategy - **TIW Dosing**: - Transitioning to TIW (three times a week) dosing to improve patient adherence and ease of use for nephrologists [12][14] - Ongoing studies (VOICE and VOCAL) to validate TIW dosing effectiveness [15][37] Pipeline Developments 1. **Praliciguat**: - Targeting focal segmental glomerulosclerosis (FSGS) with a unique mechanism of action [49][50] - Phase 2 trials initiated, with a focus on demonstrating efficacy in a high unmet need area [50] 2. **AKB-097**: - A complement inhibitor with a tissue-targeted effect, expected to have a better safety profile and dosing regimen compared to existing treatments [51][52] - Basket study planned for multiple indications, including IgAN and lupus nephritis, with data expected in 2027 [53][54] Financial Metrics and Market Perception - **Investor Metrics**: - Focus on increasing the number of prescribers and adherence rates for Vafseo [60] - Balanced capital allocation to support both Vafseo and the pipeline [61] - **Market Understanding**: - Complexity of dialysis reimbursement may lead to underappreciation of Akebia's market potential [62] - Emphasis on the importance of consistent revenue growth and pipeline visibility to attract investor confidence [63][64] Conclusion - Akebia Therapeutics is positioned to leverage its innovative product Vafseo and a robust pipeline to address significant unmet needs in kidney disease, with a clear strategy for market penetration and growth potential in a billion-dollar market.

Financial Data and Key Metrics Changes - Total revenues increased to $57.6 million in Q4 2025 from $46.5 million in Q4 2024, and for the full year, revenues rose to $236.2 million from $160.2 million in 2024, driven by Vafseo and Auryxia sales [22][25] - Vafseo net product revenues were $6.2 million in Q4 2025 and $45.8 million for the full year, while Auryxia revenues were $48.1 million in Q4 2025 and $181.5 million for the full year [22][25] - Net loss decreased to $12.2 million in Q4 2025 from $22.8 million in Q4 2024, and for the year, net loss was $5.3 million compared to $69.4 million in 2024 [25] Business Line Data and Key Metrics Changes - Vafseo faced challenges in demand growth during the second half of 2025, with a slight decrease in Q4 demand compared to Q3, attributed to a transition to an observed dosing protocol [5][16] - Auryxia sales increased, but the company anticipates a decrease in Auryxia revenues in 2026 due to expected generic competition [23] Market Data and Key Metrics Changes - Over 1,000 prescribers at 24 dialysis organizations have written prescriptions for Vafseo, with 290,000 patients having access to it in dialysis clinics [6][17] - The company noted a significant increase in prescriber access and improved adherence rates among patients on observed dosing regimens [18][19] Company Strategy and Development Direction - The strategy includes making Vafseo the standard of care in a $1 billion U.S. market, supported by ongoing clinical data generation [6][10] - The company is expanding its pipeline with rare kidney disease treatments, including praliciguat and AKB-097, which are expected to be significant value drivers [11][12] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the growth of Vafseo, despite previous challenges, and emphasized the importance of clinical data in influencing physician adoption [33][40] - The company plans to host an R&D day to discuss mid-stage assets and the potential of its pipeline [70][71] Other Important Information - Cash and cash equivalents as of December 31, 2025, were $184.8 million, compared to $51.9 million at the end of 2024, indicating a solid financial position [26] Q&A Session Summary Question: Expectations for sequential Vafseo growth in 2026 - Management did not provide specific revenue guidance but indicated that demand has been flat and they expect growth from current levels [29][33] Question: Importance of VOICE study data for uptake - Management highlighted that published data will significantly influence physician utilization and adoption of Vafseo [32][33] Question: Current operationalization of Vafseo access at DaVita - DaVita has made Vafseo widely available and is focusing on educating physicians, particularly in the home dialysis population [34][38] Question: Trends in second and third refill rates - First refill adherence improved significantly, and management noted ongoing positive trends in adherence rates [45] Question: Differentiation of AKB-9090 from prior HIFs - AKB-9090 has a different pharmacokinetic profile, allowing for broader tissue penetration compared to vadadustat [51] Question: Expectations for R&D day on April 2 - The company plans to provide detailed insights into its pipeline, focusing on praliciguat and AKB-097, and will include external experts to discuss the potential of these products [70][71]

Financial Data and Key Metrics Changes - Total revenues increased to $57.6 million in Q4 2025 from $46.5 million in Q4 2024, and for the full year, revenues rose to $236.2 million from $160.2 million in 2024, driven by Vafseo and Auryxia sales [22] - Vafseo net product revenues were $6.2 million in Q4 2025 and $45.8 million for the full year, while Auryxia revenues were $48.1 million in Q4 2025 compared to $44.4 million in Q4 2024 [22] - Net loss decreased to $12.2 million in Q4 2025 from $22.8 million in Q4 2024, and for the year, net loss was $5.3 million compared to $69.4 million in 2024 [25] Business Line Data and Key Metrics Changes - Vafseo faced challenges in demand growth during the second half of 2025, with a slight decrease in Q4 demand leading to $6.2 million in net product revenue [5][16] - Auryxia sales increased, contributing to overall revenue growth, but the company anticipates a decrease in Auryxia revenues in 2026 due to expected generic competition [23] Market Data and Key Metrics Changes - Vafseo has gained access to 290,000 patients in dialysis clinics, with over 1,000 prescribers at 24 different dialysis organizations writing prescriptions [6][17] - The company noted a shift in prescriber dynamics and improved adherence rates, with first refill adherence rising from approximately 75% to 91% among patients on an observed dosing regimen [18] Company Strategy and Development Direction - The company aims to establish Vafseo as the standard of care in a $1 billion U.S. market opportunity, focusing on generating data to support its benefits over existing treatments [6][10] - Akebia is expanding its pipeline with new rare kidney disease products, including praliciguat and AKB-097, which are expected to drive future growth [11][12] Management's Comments on Operating Environment and Future Outlook - Management expressed optimism about the growth potential for Vafseo in 2026, despite previous challenges, and emphasized the importance of ongoing data generation to support product adoption [5][33] - The company is confident in its ability to fund operations for at least the next two years, with cash and cash equivalents at $184.8 million as of December 31, 2025 [26] Other Important Information - The company plans to host an R&D day on April 2, 2026, to discuss mid-stage assets and provide insights into its pipeline [11][70] - The VOCAL study is expected to provide important data regarding Vafseo's efficacy compared to existing treatments, which could influence its adoption [61] Q&A Session Summary Question: Expectations for sequential Vafseo growth in 2026 - Management noted that while they are not guiding for revenue, they expect growth from current demand levels, which have been flat recently [29][33] Question: Operationalization of Vafseo access at DaVita - DaVita has made Vafseo widely available and is focusing on educating physicians, particularly in the home dialysis population [34][38] Question: Trends in second and third refill rates - First refill adherence has improved significantly, and there are positive trends in adherence rates for subsequent prescriptions [45] Question: Differentiation of AKB-9090 from prior HIFs - AKB-9090 has different pharmacokinetics and broader tissue penetration compared to vadadustat, which may enhance its efficacy in certain indications [51] Question: Expectations for the R&D day on April 2 - The company plans to provide detailed insights into its pipeline, focusing on praliciguat and AKB-097, and will include external experts to discuss the products [68][70]

Akebia Therapeutics Conference Summary Company Overview - **Company**: Akebia Therapeutics (NasdaqCM:AKBA) - **Focus**: Improving the lives of individuals affected by kidney disease - **Commercial Products**: - Auryxia: A phosphate binder nearing the end of its life cycle - VAFSEO: A HIF-PHI for treating anemia in chronic kidney disease patients on dialysis, launched about a year ago [4][5] Key Points on VAFSEO - **Initial Uptake**: Strong initial uptake observed post-launch, but faced challenges due to the unique nature of the dialysis market [7][8] - **Market Dynamics**: Dialysis providers control the prescription process, affecting product availability [8] - **Discontinuation Rates**: Higher than expected due to initial hemoglobin dips in patients; efforts are being made to improve patient retention [10][12] - **Dosing Strategy**: Transitioning to a three times weekly (TIW) dosing regimen has shown promising results in reducing discontinuation rates [12][13] - **Patient Access**: By the end of 2025, access to approximately 275,000 patients was achieved [13] - **Long-term Growth**: Data supporting VAFSEO's potential to become the standard of care for anemia in dialysis patients is anticipated [14][24] Clinical Trials and Studies - **VOCAL and VOICE Trials**: - VOCAL: A study comparing VAFSEO to Mircera, expected to show excellent hemoglobin control [20][29] - VOICE: A randomized comparison against Epogen, with results expected early in 2027 [29][31] - **Economic Perspective**: Demonstrating reduced hospitalization costs could enhance the economic proposition for dialysis organizations [31] Pipeline Developments - **Rare Kidney Disease Pipeline**: - Praliciguat: Phase II study initiated for FSGS, targeting rapid progression to end-stage kidney disease [5][40] - AKB-097: A tissue-targeted complement inhibitor, with a basket study planned for IgAN, C3G, and lupus nephritis [40][58] - **Mechanistic Rationale**: Praliciguat stimulates soluble guanylate cyclase, beneficial for podocytes and anti-inflammatory [42][44] - **Patient Focus**: Targeting primary FSGS and genetic mutation-related FSGS while excluding secondary causes [56] Financial Position - **Cash Reserves**: $166 million as of Q3, with at least two years of cash runway [69] Upcoming Catalysts - **Key Events**: - Continued monitoring of VAFSEO's market performance - Progress on Praliciguat and AKB-097 studies - Results from VOCAL and VOICE trials expected within the next 12 months [70][72] Conclusion - **Outlook**: The next 12 months are anticipated to be critical for Akebia, with significant clinical readouts and potential market shifts for VAFSEO and pipeline products [72]

Core Insights - Akebia Therapeutics has initiated a Phase 2 clinical trial for praliciguat, targeting biopsy-confirmed FSGS, a rare kidney disease affecting approximately 40,000 patients in the U.S. [2] - The trial aims to evaluate the efficacy and safety of praliciguat, with a primary endpoint of change in urine protein-to-creatinine ratio (UPCR) at Week 24 [2][3]. Company Overview - Akebia Therapeutics, Inc. is a biopharmaceutical company focused on improving the lives of individuals affected by kidney disease, founded in 2007 and headquartered in Cambridge, Massachusetts [4]. - The company has a mid-stage pipeline for rare kidney diseases, with praliciguat being a key component [2]. Clinical Trial Details - The Phase 2 trial is randomized, double-blind, placebo-controlled, and multicenter, involving approximately 60 patients already on maximally tolerated doses of ACE inhibitors or ARBs [2]. - Participants will be randomized 1:1 to receive either praliciguat or placebo for an initial 24-week period, followed by an open-label phase for an additional 24 weeks [2]. Safety and Efficacy - No significant safety issues were reported for praliciguat in previous Phase 1 and Phase 2 studies, indicating a favorable safety profile [3]. - Adverse events were infrequent and consistent with the known blood pressure-lowering effects of praliciguat [3].

Market Trends - Capital is shifting from high-multiple mega-cap stocks to small caps, cyclical sectors, and international markets, driven by easy monetary policy and anticipated fiscal policy impacts on the US economy [1] - The S&P SmallCap 600 is highlighted as a preferred investment vehicle for small caps due to its concentration in industrials and financials [1] - Small caps are considered undervalued and historically outperform during rate-cutting cycles [1] Small Cap Performance - The Russell 2000 index reached new all-time highs in September, while the S&P 600 struggled initially, indicating a prior reliance on lower-quality stocks [2] - Recently, the S&P 600 has joined the upward trend of the Russell 2000, nearing its own all-time highs [2] - Small caps are currently at levels similar to those four years ago, suggesting potential for significant upside if the breakout holds [2] Company Insights: Ambev (NYSE:ABEV) - Ambev has a forward P/E ratio of 13.30 and a share price of $2.30, with 20 hedge fund holders [8] - The company reported a normalized net income of BRL 3.8 billion, a 7% increase, and a stated net income of BRL 4.9 billion, a 36% surge year-over-year [11] - Ambev's premiumization strategy led to over 9% growth in volumes for premium brands, capturing nearly 50% market share in Brazil [10] Company Insights: Akebia Therapeutics Inc. (NASDAQ:AKBA) - Akebia has a forward P/E ratio of 8.73 and a share price of $1.66, with 21 hedge fund holders [13] - The company is expanding its pipeline for rare kidney diseases, focusing on two product candidates: AKB-097 and praliciguat [13] - Akebia's Vafseo is an oral treatment for anemia in dialysis patients, approved in 37 countries, with a Boxed Warning for increased risks of serious health issues [14]

Core Insights - Akebia Therapeutics has established a rare kidney disease pipeline, focusing on two main product candidates: AKB-097, a complement inhibitor, and praliciguat, an sGC stimulator [2][3] - The company plans to initiate Phase 2 clinical trials for both AKB-097 and praliciguat in 2026, targeting multiple rare kidney disease indications [1][3] Group 1: Product Candidates - AKB-097 is a tissue-targeted C3d-Factor H fusion protein complement inhibitor acquired from Q32 Bio, expected to address a range of complement-mediated rare kidney diseases [2][5] - Praliciguat is an oral sGC stimulator, with initial clinical trials focusing on focal segmental glomerulosclerosis (FSGS), a rare kidney disease [2][8] Group 2: Clinical Trials - The Phase 2 basket trial for AKB-097 is set to begin in the second half of 2026, with initial data expected in 2027 [6][3] - The Phase 2 trial for praliciguat will enroll up to 60 patients in the U.S., with the primary efficacy endpoint being the change in urine protein-to-creatinine ratio over 24 weeks [10][11] Group 3: Financial Aspects - Akebia paid an upfront fee of $7 million to Q32 Bio for the acquisition of AKB-097, with additional payments tied to development milestones and royalties on net sales [7]