CorMedix (CRMD) Q3 2025 earnings call transcript

Thank you, Operator. Good morning, and welcome to the CorMedix third quarter 2025 earnings and corporate update conference call. Leading the call today is Joe Tedisco, Chief Executive Officer of Cormedix, and he is joined by Liz Hurlburt, EVP and Chief Operating Officer, and Susan Blum, EVP and Chief Financial Officer. In addition, Beth Zellnack-Kaufman, EVP and Chief Legal and Compliance Officer, and Dr. Matt David, EVP and Chief Business Officer, are on the line and will be available during the Q&A session. Before we begin, I would like to remind everyone that during the call, management may make what are known as forward-looking statements within the meaning set forth in the Private Securities Litigation Reform Act of 1995.

These statements are statements other than statements of historical fact regarding management's expectations, beliefs, goals, and plans about the company's prospects and future financial position. Action results may differ materially from the estimates and projections on which these statements are based due to a variety of important factors, including the risks and uncertainties described in greater detail in Cormedix filings with the SEC, which are available free of charge at the SEC's website or upon request from Cormedix.

Cormedix may not actually achieve the goals or plans described in these forward-linking statements, and investors should not place undue reliance on these statements. CorMedix does not intend to update these forward-linking statements except as required by law. During this call, the company will discuss certain non-GAAP measures of its performance. GAP to non-GAAP financial reconciliations and supplemental financial information are provided in CorMedix earnings release and the current report on Form 8-K filed with the SEC. This information is available on the Investor Relations section of CorMedix website. At this time, it's now my pleasure to turn the call over to Joe Tedisco, Chief Executive Officer of Cormedix. Joe, please go ahead.

Thank you, Dan. Good morning, everyone, and thank you for joining us on this call. This has been an exciting quarter in the evolution of Cormedix as we announced and closed the acquisition of Malenta Therapeutics in a combination cash and stock transaction. This deal is transformational for CorMedix, creating a diversified specialty pharmaceutical company with a broad portfolio of commercial and late-stage pipeline products.

Integration of the legacy CorMedix and Malenta operations has progressed faster than originally expected. As we announced in October, we expect to capture approximately $30 million of the projected $35 to $45 million of total synergies on a run rate basis before the end of 2025.

I'm excited to announce today that as part of our integration, Cormedix Inc will be rebranding as Cormedix Therapeutics, and all employees will unify under this company name. We're also adopting a new logo to signify the go-forward organizational commitment to develop and commercialize novel therapies for the prevention and treatment of life-threatening conditions. This past quarter marks the most successful quarter from a financial perspective in company history, registering record levels for revenue of $104.3 million, net income of $108.6 million, and adjusted EBITDA of $71.8 million. Our revenue performance was largely driven by faster-than-expected adoption by our DeFenCath LDO customer, utilization growth from our existing customer base, as well as partial quarter contribution from the Malenta portfolio assets.

Based on the recent momentum, today we are raising our pro forma combined full-year revenue guidance from a minimum of $375 million to a range of $390 to $410 million. In addition, we are increasing our previous guidance for pro forma fully synergized adjusted EBITDA for 2025 from a range of $165 to $185 million to a new range of $220 to $240 million.

On the business development front, we also successfully closed our strategic minority investment in Telferra, Inc. This small strategic investment gives us a foothold in a late-stage critical care product that is highly complementary to CorMedix acute care portfolio. As part of the transaction, CorMedix is granted a right of first negotiation to acquire Telferra following the announcement of Phase III results, which we anticipate to be available in the first half of 2026. We will continue to evaluate Telferra in the coming months as their clinical trial progresses toward completion. With respect to DefendCast, we are very pleased overall with the utilization of DefendCast and the outpatient hemodialysis segment during our initial phase of Tadapa, and we have now begun planning with customers for the post-Tadapa add-on periods, which we expect will begin in July of 2026.

In line with our strategy to increase patient utilization of DefendCath during our post-Adapa add-on periods, we'll be working over the coming months to finalize supply pricing with customers under existing contracts based upon the final post-Adapa add-on framework, as well as engaging in conversations with Medicare Advantage payers following the publication of our real-world evidence data later this year.

Lastly, as CorMedix evolves, I think it's important for investors to begin focusing on important near- and medium-term catalysts and value drivers for the company beyond the hemodialysis sector. First and most importantly, the second quarter of 2026 is expected to bring top-line data for the use of Reseo as prophylaxis of invasive fungal infections. We believe the total addressable market for immune-compromised patients that are currently undergoing antifungal prophylaxis is more than $2 billion.

The Phase III RESPECT study is running head-to-head against the current standard of care, which is a combination of posiconazole and antifungal and Bactrim, an antibiotic that also has antifungal activity. Positconazole demonstrates severe drug-to-drug interactions with many medications the target patient population is currently taking, including immunosuppressive drugs like tacrolimus and cyclosporine, as well as numerous therapeutics used in treating hematological malignancies such as leukemia, multiple myeloma, or non-Hodgkin's lymphoma, all patient populations that may undergo bone and marrow transplantation as part of their therapy. For these patients, Roseo, used as prophylaxis against these invasive fungal infections, could represent a new standard of care that may allow patients to experience less drug-to-drug interactions, less frequent dosing, and more flexibility in their setting of care for treatment.

Our second near-term catalyst outside of hemodialysis is the expected expansion of DefenCast into the prevention of CLABSI for adult patients receiving total parenteral nutrition, or TPN. Our most recent market research continues to highlight the critical unmet medical need and pervasively high bloodstream infection rates in this patient population. Prophylactic intervention is urgently needed for these vulnerable patients. We have previously guided to a total addressable market in this indication of up to $750 million and anticipate Phase III completion as early as the end of 2026 or beginning of 2027. I believe that Cormedix has done an exceptional job of maximizing the value of the initial Tadapa period afforded to defend CAS, has a long-term strategy in hemodialysis for post-Tadapa periods, and has redeployed cash flow into a pipeline that can position the company for long-term sustainable growth.

I am excited about the future. I would now like to turn the call over to our Chief Operating Officer, Liz Hurlburt, to provide an update on clinical activities, operations, and integration. Liz, please go ahead.

Thank you, Joe, and good morning. The combined clinical development and operation teams, along with field medical affairs, have been working diligently on numerous clinical activities. As we shared in late September, enrollment for the Global Phase III RESPECT study evaluating Reseo for the prophylaxis of fungal infections in allogeneic bone marrow transplant patients has completed. This pivotal trial is being conducted by our global partner, Mundi Pharma, and the team has begun to progress the program in anticipation of study closeout. The team continues to work closely with investigators and clinical experts in the field to deepen our understanding of the evolving clinical practices and needs of these patients.

We expect to announce top-line results from the RESPECT study in the second quarter of 2026. Turning to DefendCath I pleased to share that the Phase III NutriGuard clinical study which evaluates the reduction in central line associated bloodstream infections or CLABSI for adult patients receiving total parental nutrition via a central venous catheter has garnered international interest In the coming months we will expand clinical study sites into Turkey to broaden the diversity of patients and potentially expedite enrollment timelines At this time we are still anticipating study completion by the end of 2026 or early 2027 Lastly, our Real World Evidence Study, in collaboration with U. S. Renal Care, has entered the second year of data collection. The team is currently conducting an analysis of the first year of data, and we anticipate sharing those interim results by the end of this year.

This study is designed to demonstrate the real-world effects of the broad use of DefendCast in a real-world setting and examines not only the reduction in catheter-related bloodstream infections, or CRBSI, but also reduction in costly infection-related hospitalizations. Secondary data points of mistreatment sessions, antibiotic utilization, and TPA utilization are also being reviewed.

Now, turning to integration progress, I am heartened by the significant efforts of the teams to both integrate and optimize operations as a unified organization. We have made meaningful strides in merging the teams, identifying synergies, and creatively preserving key elements of both legacy organizations. In addition to our new corporate branding as Cormedix Therapeutics, we have refined our mission, vision, and values as a new organization and are excited to see our integrated teams work together to create a new culture and execute together on key objectives. Currently, all functional areas have fully integrated from a personnel standpoint, which includes clinical, medical affairs, technical operations, supply chain, finance, legal, quality, human resources, and commercial. Systems integration is still underway and expected to complete in 2026 in line with our original estimates.

The legacy contracted hospital sales team for DefendCath will conclude its service by the end of this year, and DefendCath promotion in the hospital setting will transition in January to the post-integration internal field organization. Beginning in early Q1, 2026, our unified sales organization covering acute care, clinics, and hospitals will seamlessly support all promoted portfolio products, including both DefendCast and Roseo, and will offer enhanced capabilities in customer support. The collective expertise of our team positions us to deliver comprehensive solutions to many challenges in the acute care space, and ultimately, with a goal of driving better patient outcomes. We are incredibly proud of the team and their hard work in moving this integration forward while continuing to focus on sales and patient access.

I would now like to turn the call over to Susan to discuss the company's third quarter financial results and financial positions. Susan?

Thanks, Liz, and good morning, everyone. We are pleased to report our third quarter financial results, reflecting continued commercial momentum and a path towards sustained profitability. Our results demonstrate solid growth across the business, including strong performance from Defendcast and growth in the legacy Malenta product portfolio. We closed the Malenta acquisition on August 29, 2025, and therefore, one month of its operations are included in our consolidated financial results for the third quarter. The company has filed its quarterly report on Form 10-Q for the quarter ended September 30, 2025. I encourage you to read the information contained in the report for a more complete discussion of our financial results.

As Joe mentioned, for the third quarter, net revenue was $104.3 million, including the FNCAS sales of $88.8 million, representing a total net revenue increase of $77.5 million year-over-year. The remainder of revenue totaling approximately $15.5 million reflects the contribution from Melinta for the month of September, $12.8 million of which was driven by Melinta portfolio sales. Operating expenses for the third quarter were $42.6 million compared to $14.1 million for Cormedix on a standalone basis in the same quarter last year. The increase of $28.5 million over the prior period includes non-recurring costs of $12.7 million associated with the transaction and integration, as well as severance costs associated with the Malenta acquisition. Other increases in costs were driven by stock-based compensation, OPEX contribution from Malenta's business, and increased investment in R&D associated with expanded indications for DefendCAS, including the Phase III clinical study for prevention of CLABSI in TPN patients.

While costs have increased in these areas this past quarter, they are aligned with our previously communicated expectations and support our strategic priority, which is to position the company for long-term, sustainable growth. In addition, as Joe mentioned, we are working to quickly capture synergies associated with the Malinta acquisition, with approximately $30 million of synergies on a run rate basis expected to be captured from actions taken prior to the end of the year. We expect to realize these synergies in the P&L beginning in the fourth quarter of 2025. Overall, for the third quarter of 2025, we achieved net income of $108.6 million, or $1.26 per diluted share, marking meaningful progress compared to the third quarter of 2024, during which period we recognized a loss of $2.8 million and a net loss per diluted share of $0.05.

A large driver of net income for the quarter was a substantial tax benefit of $59.7 million, due primarily to the realization of deferred tax assets, equating to 100% of the Cormedix historical net operating losses, or NOLs. The recognition of this sizable tax benefit underscores our confidence in sustained future profitability, which will drive the utilization of our NOL carry forwards against taxable income, which equates to cash tax savings and tangible value for the company and for shareholders.

Turning to non-GAAP measures, adjusted EBITDA for the third quarter of 2025 was $71.8 million, up from a loss of $2 million in the third quarter of 2024, reflecting the momentum of our operations over the past year. This non-GAAP measure provides additional insight into our core operating performance and profitability trends, highlights the underlying strength of our operations, and excludes one-time acquisition-related costs, stock-based compensation, and the tax benefit we realized this quarter.

Please refer to our press release that we issued this morning for a reconciliation of this non-GAAP measure to GAAP net income. On the cash front, we raised gross proceeds of $150 million in a convertible debt offering, and those proceeds, together with cash on hand and $40 million in common stock issued to the seller, were used to fund the acquisition of Melinta in August 2025.

This financing strategy supported the transaction while maintaining what we believe to be a healthy liquidity position and flexibility for future growth investments. As a result, our cash flow during the third quarter reflects the timing of these financing and acquisition activities, and we ended the quarter with cash, cash equivalents, and short-term investments of $55.7 million.

Looking ahead, we expect significant cash generation in the fourth quarter, driven by strong operational performance. We anticipate ending the year with approximately $100 million of cash and cash equivalents, supported by ongoing positive operating cash flow and working capital optimization. To drive this balance, we are guiding to fourth quarter net revenue in the range of $115 million to $135 million, reflecting continued momentum from DefendCast and a full quarter contribution from Melinta. And now, I will turn the call back to Joe for closing remarks. Joe?

Thank you, Susan. The third quarter of 2025 marked a period of meaningful progress and disciplined execution. We advanced our strategic objectives, strengthened our financial foundation, and delivered solid results while completing a transformative acquisition. The company now has a diversified product portfolio, multiple late-stage pipeline opportunities, financial flexibility, and a diversified capital structure to support future growth. We remain confident in the outlook for the remainder of this year and the path to sustained growth and profitability.

And now let the operator open up for questions.

So in terms of third quarter stocking, I think our smaller customers from what we've seen are holding on average about two to three weeks on hand. The LDO is somewhere between three to four weeks, and I think that's what we still normalize. I'd say there was probably a couple million dollars shipped at the cutover that, you know, if you're trying to kind of back into third quarter versus fourth quarter defend cash revenue and kind of where we're, you know, where we're trending.

So there was a couple million dollars right on that cutoff that probably ended up getting captured in Q3 that, you know, a day later is going to be in Q4.

But for the most part, I wouldn't say there's a significant amount of stocking in Q3. Just normal stocking that they hold on hand. The second question I believe was about quarter to quarter guidance and seasonality. The business certainly, we'll separate the Defendcast business from the Malenta business, doesn't have a historic seasonality in terms of times of year where patients receive hemodialysis more than others. As we've been progressing over the last two years and we've added new customers, we've added new cohorts, we've continued to see an increase in utilization and growth in overall revenue. Obviously, I think there's a lot of eyes focused on next year.

I don't know at what point we're going to be ready to provide financial guidance for 2026. I think everyone's aware just by the nature of Tadapa and the change that comes in July, there should be a little bit of front-endedness to the overall revenue, Not necessarily utilization for the overall year, and we're still trying to figure out what the full year is going to look like. Now, in the Malinta portfolio, again, a large number of them are anti-infectives.

They're not cough-cold type products, so you wouldn't see that type of winter seasonality. I think there is always a small amount of December stocking into January of all products. I don't know that it's going to be overly material to the business case, but we wouldn't expect to see significant seasonality there as well. In terms of cohort expansion, you know, I do believe that there's still opportunities with all of the customers that – I think that was on the – that question is specific to DefendCast, that there is still an opportunity to grow with our existing customer base, and that's something that we are continuing to focus on over the coming months, and even in the post-ADAPA period.

A big part of our post-ADAPA strategy is the engagement with Medicare Advantage. You know, we currently believe the overwhelming majority of the patients in which DefendCath is being used in the outpatient setting are Medicare fee-for-service patients. Medicare Advantage is now the largest cohort of patients and a big part of the opportunity for our future expansion post-TDAPA. And you had a follow-up, Les?

Well, look, and you have to separate. The real-world evidence, in our view, is going to be most applicable and useful with Medicare Advantage. Medicare Advantage is not bound by the post-TDAPA add-on. They have the flexibility to contract separately. That's the strategy we want to employ. We have very little market share right now of Medicare Advantage patients, and we think it's a compelling value proposition for the MA plan. Ultimately, they are the payer of those downstream costs, those hospitalizations that drive so much cost in the healthcare system. So we want to, obviously, with data, make the argument that investing in prevention, right, is going to save them a significant amount of value. On the traditional Medicare side, there's not much of an opportunity for negotiation less.

It's really based on when the ESRD final rule publishes, you know, what they ultimately determine is going to be the fee-for-service adjustment, and we'll work around that once it's published.

All right. Thanks, Jason. So, yes, so the LDO, it wasn't just a matter of ordering, right, faster, right? The data we're getting from inventory on hand demonstrates that the utilization is also faster than what we expected in the ramp. And I know that we had guided previously that the expectation was to target initial rollout of 6,000 patients. We don't have today an exact number of where we are. We believe we are significantly higher than 6,000 patients. And, you know, we're pleased with the rollout, but we don't have the ability to give a patient number at this time.

In terms of kind of the stratification, I don't know if you were asking about high risk or type of insurance. You know, we don't have great visibility into that data. I think our expectation is that it's mostly fee-for-service patients at this time and that there's an opportunity with Medicare Advantage. On the real-world evidence question, I'm going to ask Liz to address. Sure.

Hi, Jason. So we are expecting the year one results to come out later this year. It's approximately 2,000 patients, so we're double what we had in our Phase III Lock-It study. And we expect that we're going to read out data on the reduction in actual CRBSI, reduction in hospitalizations due to CRBSI. There are some secondary endpoints we're looking at as well, mistreatment sessions, utilization of TPA, and antibiotic utilization. And those are all being compared to the historic infection rates. So we should have that out sometime in the next six to seven weeks.

Thanks, Rowana. You know, as I think I said, you know, we're not in a position to give a lot of clarity right now on that back part of 26. Obviously, we do know there's going to be price compression, right, because it's going to shift from the AASP method into the post-Tdappa add-on. Absent the passing of legislation that is currently pending before the Senate. But the pushes and pulls would be related to how CMS does the calculation for utilization. The method that they had proposed in the proposed rule, which we commented on, would have created or will create a dynamic where the adjustment for Q3 and 4 of 26 is lower than the adjustment for 27.

And if that's the framework, I think we're prepared to work around that. We're just waiting for a final determination in the final rule, which was expected a couple weeks ago. I know the government shutdown has delayed quite a few things. We're expecting it to come, you know, any day now. And, you know, once we have that, we'll be able to finalize things with customers and just continue moving forward.

Well, look, I think the real-world evidence data is going to be critical, right? And that should be, you know, even though it's interim midpoint data available by the end of the year. And I think the ability to demonstrate the impact on the healthcare system is an important one. You know we gotten anecdotal feedback from multiple customers that they seen a noticeable difference right in their infection rates I know that not data but if they are feeling it and visually seeing it certainly that a positive and something that we want to build on Got it.

Thank you, Brandon. Thank you, Brandon. So, look, on the inpatient side, I think we're continuing to, you know, over the course of this year, we've seen good progress. You know, I'd say it's a drop in the bucket compared to the magnitude of what we've seen outpatient, but it has been good, steady growth over the course of the year. As Liz mentioned in the script, starting next year, you know, as we are migrating from the legacy contracted field team that was inpatient for Cormedix into the new combined field team post-Malinta integration, we'll be training that team in December on the FENCAS, and in January they'll begin promoting in the inpatient segment. So I do expect to continue to see lift there as a good opportunity for growth.

And as we've talked a lot about over the last two years, while the inpatient volume might be lower, right, the pricing there is a little bit better and the revenue per patient higher, right? So it's a good profit opportunity, right, for DefendCats in the inpatient setting. On NIAD, obviously, we did the strategic investment because we like the product. We like the fit with us from a commercial infrastructure standpoint. We're going to continue to watch the clinical results and evaluate the opportunity. I don't know that I'm prepared to comment that no investment would be required, Brandon, if we were to acquire the business. Obviously, there's an investment, if we were, to acquire Telferra. I imagine there's some amount of marketing expense related, but I think from a sales deployment standpoint, our current expectation is it fits very well with our existing call points.

Great. Thank you very much.

All right. Thanks, Serge. In terms of specific pricing on the FENCAS, obviously we don't give that. You know, we have guided historically that quarter over quarter is slight erosion based on the structure of the agreement. We track, you know, typically our ASP is, you know, a discount off, our selling price is a discount off government ASP, which is kind of tracked down, you know, quarter over quarter. But volume has obviously grown significantly to more than offset, you know, the changes in price. So I think the Tadapa rule and the methodology will inform, you know, we set agreements in place with all of our customers, right, and there were formulas laid out for how pricing needs to be determined.

I think one of the things we're waiting to see is that dynamic, whether or not, you know, CMS uses a methodology where the Q3 and Q4 of 26 will be lower than 27, and if that's the case, we may try to negotiate a blended price over a period of time. But, you know, that's really the only nuance that we're looking at. I don't – again, don't know that I would want to give any customer-specific pricing, but we should be able to talk a little bit more directionally in the early part of next year about what we're going to see for the back part of the year. And then lastly, in terms of the legislation, there is a bill that was proposed by Senator Booker, Marshall Blackburn, bipartisan bill that would make significant changes to Tadapa in terms of incentivizing innovation.

I think, you know, most importantly, it would expand the ASP-based pricing period from two years to three years. It would make the post-ADAPA add-on permanent, but also have that add-on track drug utilization in terms of follow drug utilization. Right now, the methodology CMS uses, they bundlize based on market share of total dialysis, irrespective of whether drug is dispensed. The proposed methodology in the legislation would allocate that market share based on percentage of drug claims submitted over time, and I think that's certainly a better measure and hopeful that legislation can make its way into law in the early part of next year. I know the government shutdown has stalled quite a few things, but hopefully the new Congress in early 26, you know, can advance that forward.

Thank you, Operator. Joe, we had quite a few here, but it looks like a lot of them were covered during the live Q&A. I do have one additional one, though. That you might help us out with here. What do you think is misunderstood regarding the Malinta transaction? And why are investors not crediting the value of Malinta?

I mean, thanks, Dan. You know, I just chuckled a little bit because as I was going through all the analyst questions, it struck me we didn't get a single question on Roseo, on the potential impact, on how we're viewing Malinta, right? And I think there's obviously a lot of historic focus on DefendCath, and for good reason, right? It's the largest revenue driver in the business currently.

But when I look at, you know, why we did the acquisition for Melinta, what it brings to the table, I certainly do think there's a lot of things that are not currently being appreciated, you know, one of which is the, you know, the stabilizing factor of the base business that was acquired, you know, from a risk mitigation standpoint, right? We got quite a few questions around what's going to happen in the back part of the year next year with FenCath, and the momentum-based business gives us a good, stable base of revenue from which we're able to take operating synergies and really entrench the business.

In a second, I think Roseo Prophylaxis as a pipeline opportunity is certainly not being valued appropriately. This has the potential to be a larger peak sales product than even DefendCast. You've got a total addressable market over $2 billion. You've got a market segment that is already getting prophylactic antifungal therapy, these patients that are immune compromised. So it's not as if we have to change patterns, similar to the launch of DefendCath, where nothing was being done prophylactically. We really had to change mindsets. This is a different situation where prophylactic action is already being taken, and the standard of care has some deficiencies with it, right? The severe drug-drug interactions I don't think should be discounted. The ability to shift to weekly dosing to perhaps increase convenience for the patients, as well as a large amount of the dosing or administration would be in an outpatient, you know, hematology, oncology clinic setting, which is buy and bill reimbursement, right?

So I think there's a lot of favorabilities and opportunity around Roseo prophylaxis as a future growth driver of the business, as well as TPN, right? I think we're excited about the opportunity for TPN. We've just done some updated internal market research, right, that has confirmed, you know, how high the infection rates are in that patient population, how much the doctors are looking for an intervention.

So I think, you know, we're excited about the future growth prospects for the business outside of hemodialysis, and I think those are important catalysts that I think investors need to start focusing on.

Excellent. Okay, thank you, Joe. Operator, you may now close the call.