Pharming Group (PHAR) Q1 2026 earnings call transcript

Transcript, summary, guidance, and what analysts pressed on from the Pharming Group N.V. call on May 7, 2026.

Held
May 7, 2026
Length
50 min
Tone
Positive0.45
Analysts
6
Words
6,603
2026 revenue guidance
$405 to $425 million8% to 13% year-on-year growth
Ruconest inventory headwind
8%Q1 revenue decline impact
Ruconest new enrollments
approximately 50Q1; prescriptions, not treated patients
New Ruconest prescribers
23Q1
Joenja U.S. patients
127on paid therapy at quarter-end
CVID Phase II enrollment
20 patientsfully enrolled
Genetic PID Phase II enrollment
12 patientsfully enrolled
CVID expanded-access exposure
median of 1.4 yearssix patients

Summary

Management framed Q1 weakness as expected channel normalization and portfolio exits, while emphasizing new growth catalysts for Joenja and resilience in Ruconest’s high-burden segment.

  • 50 Ruconest enrollments were prescriptions, not patients yet on therapy, with a lag before treatment starts.
  • Full competitive effects may take three to four reorder cycles to emerge, with further pressure expected in Q2.
  • The FDA agreed on a two-step pediatric resubmission path that management said requires no additional clinical trial.

Guidance

  • $425M2026 revenue $405–$425 million, representing 8%–13% year-on-year growth
  • Germany Joenja launch expected toward the end of Q2 2026, with paid patients anticipated in Q2
  • Japan Joenja launch expected in August 2026
  • Higher-dose pediatric sNDA FDA decision expected in six months or sooner
  • Lower-dose pediatric sNDA planned for summer 2026, with a six-month review
  • CVID and genetic PID Phase II readouts expected later in 2026

What analysts pressed on

  • 01Ruconest Q2 pressure and H2 recovery: management cited reorder-cycle effects, continued new enrollments, and anticipated second-half inventory building.
  • 02Ruconest inventory reversal: CFO expects second-half inventory build consistent with the normal annual cycle, without quantifying its revenue impact.
  • 03Joenja European ramp: management identified Germany as the first launch toward late Q2, but did not quantify country-level reimbursement timing beyond paid patients anticipated in Q2.
  • 04CVID and genetic PID endpoints: management pointed to lymph nodes, spleen size, blood counts, and other organ manifestations, without setting quantitative success thresholds.
  • 05Pediatric submission scope: about 50% of identified 4–11-year-old patients fit the high-dose submission; management said FDA feedback did not change dosing strategy.
  • 06Ruconest switching: management declined to quantify the share trialing competitors or return rates, citing limited switching interest and high-burden patients returning.

Notable disclosures

  • 50 Q1 Ruconest enrollments were new prescriptions, not patients already receiving the drug.
  • Six expanded-access CVID or CVID-like patients had median leniolisib exposure of 1.4 years, with exposure ranging from half a year to two and a half years.
  • The two leniolisib Phase II studies are fully enrolled: 20 patients in CVID and 12 in genetic PID.
  • The pediatric FDA path splits doses across two submissions, and management said the lower-dose package requires no additional clinical trial.

Risks raised

  • Ruconest faces further Q2 pressure as competitive trialing and switching effects emerge over three to four reorder cycles.
  • Ruconest revenue remains exposed to inventory timing and the planned exit from ex-US markets.
  • The six-patient CVID expanded-access evidence is clinician-reported and not a prospective clinical study.
  • Joenja’s pediatric contribution depends on FDA review timing, while the lower-dose submission remains planned for summer.

Tone: Positive 0.45

Management acknowledged near-term Ruconest pressure but expressed confidence in portfolio growth, FDA alignment, and the planned launch sequence.

Who spoke

Company

  • Fabrice SharrakiChief Executive Officer
  • Liburn MarchChief Commercial Officer
  • Anurag RelanChief Medical Officer
  • Unidentified Management

Analysts

  • Benjamin JacksonAnalyst, Jefferies
  • Unidentified AnalystAnalyst, Oppenheimer
  • Jeff JonesAnalyst, Oppenheimer
  • Whitney IjemAnalyst, Canaccord
  • Natalia WebsterAnalyst, RBC
  • Simon ScholesAnalyst, First Berlin

Full transcript

Analyst questions are marked with a bar. Timestamps are into the recording.

Prepared remarks

00:00

Fabrice SharrakiChief Executive Officer

Good morning and good afternoon everyone and welcome to our Q1 2026 earning call. I'll be joined on this call today by Liburn March, our Chief Commercial Officer, Anurag Relan, our Chief Medical Officer, and Kenneth Linus, our Chief Financial Officer. Next slide.

In this call, we will be making forward-looking statements that are based upon our current in site and plan. As you know, these may differ from future results.

Next slide. As you saw in our press release, we made important progress across the business in this first quarter, despite the drop in quarterly revenue driven by weakness. The weakness revenue decline was largely expected due to inventory grow down at specialty pharmacy, which we discussed on our Q4 2025 call in March. The commercial exit from non-US markets also contributed to the year-on-year decline. We announced that decision last year as part of our renewed financial discipline since the commercialization of Reconnaissance in these markets was not financially sustainable. Now if we look at the underlying fundamentals, we see limited interest from patients on Reconest to trial alternative therapies.

Nine months after the launch of a new oral therapy, we have retained the overwhelming majority of Reconest patients, and we continue to see new patients starting Reconest.

Livern will elaborate on this market dynamic in a few moments. Turning now to Joenja, this product is an important growth driver till early in its life cycle. JoinJA revenues grew by 34 percent, reflecting strong momentum both in the U. S. where the number of patients increased by 25 percent year on year, but also in international markets. We've also made meaningful regulatory progress this quarter, positioning us well to launch joint job in Japan and in Europe later this year, and to extend joint job label to the pediatric population in the US.

After the disappointing CRL, we had a constructive dialogue with the FDA, and we've already resubmitted the SNDA for the two highest dose, covering a meaningful proportion of children from 4 to 11. We are also planning to submit an SMDA this summer for the lowest doses.

Finally, our disciplined cost management helps us to maintain positive cash flow from operations in this quarter, despite the viability in revenues. We are maintaining our revenue guidance of $405 to $425 million for 2026, representing growth between 8% and 13% year-on-year.

Next slide. As you can see, the durability of the Rookan-Ext franchise and the strong momentum and growth potential of Joentja underpin the transformation of farming into a profitable high-growth biotech with two late-stage pipeline programs offering billion-dollar sales potential.

Ruconest is the foundation of our portfolio and a reliable cash engine for the future, even in an ever-more-crowded HAE market, given its differentiated value proposition for the difficult-to-treat patient subpopulation and its highly specific manufacturing process. JOINJA is just at the beginning of its life cycle with multiple growth catalysts in APDS through pediatric and geographic expansion and the potential expansion into higher prevalent PID with two phase two readouts later this year. Anurag will discuss an exciting presentation at CIS conference taking place today that summarizes clinician experience treating patients with CIVIT with immune dysregulation and role in our access program.

And last but not the least, NAPA-ZIMONE previously known as KL1333 for primary mitochondrial disease is another billion dollar plus opportunity with the registrational study expected to complete enrollment this year and read out next year.

These commercial assets and high value pipelines, combined with durable source of cash flow, provide a solid foundation for farming to become a leading global rare and ultra rare disease company with substantial near and long-term value creation potential.

Let me now turn it over to to deliver, who will provide deeper insight into the performance of our commercial products.

05:27

Liburn MarchChief Commercial Officer

Good morning, good afternoon, everybody. Let me start with Ruconet's performance in the first quarter. Revenue was down 15% year-on-year. Importantly, as Subrice mentioned, this was anticipated and largely driven by three distinct factors.

First, inventory dynamics which reduce quarterly revenue by 8%. This reflects what we previously stated on our March Q4 call and accounts for the majority of the impact. Second, our planned exit from ex-US markets contributed approximately 3%, and this is consistent with our strategy to focus our resources where we can generate the highest return.

Third, with new treatment options entering the US HAE market, we've seen measured impact from competition, specifically limited patient interest in trying or switching to other therapies with many returning, and this has been in line with our expectations.

Additionally, what's important is what's happening underneath these headline numbers. We added approximately 50 new patient enrollments in the first quarter this year, and we brought on 23 new prescribers onto Rucanest. This is a meaningful signal that clinicians continue to see the value of Rucanest, specifically in the high attack, high severity segment, and are initiating new patients even as the treatment landscape expands. Next slide, please. On this slide, this really gets to the heart of why Rucanest continues to play a critical role in HAE management. We know HAE is not a uniform disease. For patients on the more severe end of the spectrum, meaning those with frequent attacks, rapid onset symptoms, or high anxiety around unpredictability or the attack location, the need is very clear.

They require a treatment that works quickly, consistently, and durably, and that's exactly where Rukinus fits, and it's reflected in what we're seeing in the market today. After nine months into the launch of a new oral competitor in HAE in the US, the overwhelming majority of Rucanest patients have remained on therapy. Among those who had explored alternatives, many high-burden patients are returning to Rucanest, in particular when response to new treatments have not been adequate. This reinforces the importance of having a dependable on-demand therapy like Rucanest underpins our confidence in the long-term role of RUQNEST in this evolving HAE market. Next slide please.

So turning to Joenja, we delivered another strong quarter building on the momentum from last year. Revenue grew 34% compared to the first quarter of 2025 reaching 14.1 million dollars globally. In the United States patient growth is the central driver of performance. By the end of the quarter, we had 127 patients on paid therapy in the U. S. alone, which represents a 25% increase over the first quarter of 2025. And we accelerated the rate of new patient starts to seven during the quarter, an improvement over the additions seen in the previous two quarters. The U. S. full rate remained high at 85%, reflecting our highly effective reimbursement support and patient services process. Equally important, we continue to broaden the pool of APDS patients.

We've identified 187 APDS patients older than 12 years old in the U. S. and an additional 57 eligible patients in the 4 to 11 years old group. And this represents the next frontier for growth in the U. S. In international markets, we continue to see strong patient uptake in the UK and significant growth in the number of patients on government-supported access programs in other countries. This momentum sets us well to drive growth in APDS and other indications to come. Next slide, please. Now stepping beyond the quarter, I want to put Joenja into its broader strategic context. We are building more than a single rare disease product. We are building, indeed, a scalable immunology franchise with multiple clearly defined growth levers.

The first growth lever is continued expansion within APDS itself. We are still early in identifying APDS patients, and there is significant proportion of patients yet to be identified. The second growth lever is further U. S. APDS expansion, which includes the pediatric launch in the United States, and an upside VUS reclassification opportunity across all ages. Thirdly, is international expansion. We are in the early stages outside the United States, and upcoming launches in Europe and Japan will open meaningful new markets for us. And finally, the fourth growth lever is lifecycle and label expansion beyond APDS, specifically exponentially larger patient pools in genetic PIDs, and CVID with immune dysregulation.

Taken together, these four levers create sequential growth engines over the coming years. APDS drives the initial growing foundation, pediatric expansion deepens penetration, geographic expansion broadens reach, and new patients continue to give us access to significantly larger patient segments, which extends our platform. Now to share more about our pediatric submission and lifecycle efforts on JOENJA, I will now hand it over to Dr. Anurag Relin, our chief medical officer.

11:27

Anurag RelanChief Medical Officer

Thank you, Laverne. In addition to the important regulatory milestones in Japan and Europe, we made significant progress in the U. S. in our efforts to expand the JOENJA-labeled pediatrics for children ages 4 to 11 with APDS following the receipt of a CRL from FDA in January. As we previously explained, we believed the clinical pharmacology and analytical batch testing methodology issues outlined in the FDA letter were addressable. We held a Type A meeting with FDA at the end of March, which included two APDS expert physicians, and we were pleased with the constructive dialogue and understanding of the issues raised by FDA and the CRL. The FDA also appreciated the unmet need, including the serious and progressive nature of APDS, as well as challenges with clinical trial recruitment in young children with an ultra-rare disease.

We worked collaboratively with FDA to define the most expedient path forward, and we have that now with the first step being the resubmission of the SNDA for the highest doses specifically 40 and 50 milligrams This took place in April in fact on the same day that we received the FDA meeting minutes and as is typical, we plan to issue a press release upon FDA acceptance of the resubmission.

These doses, as Fabrice mentioned, cover a meaningful proportion of 4 to 11-year-old children. An FDA decision on this is expected in six months or sooner. The second step will be a new SNDA for the doses covering the lowest weight patients, which is planned for this summer. For this SNDA, we also expect a six-month review. Next slide. At the Clinical Immunology Society annual meeting this week, Farming and our collaborators are presenting seven abstracts, five expanding the evidence base in APDS, and two that begin to provide data on the much larger opportunity in other PIDs with immune dysregulation. These include the clinical expanded access experience with leniolisib to treat immune dysregulation in patients with common variable immune deficiency, or CVID, and CVID-like disorders, which I will cover in more detail in a few slides.

As you see, APDS is just the beginning for leniolisib. Next slide. In addition to APDS, we continue to make progress in other PIDs with immune dysregulation, which is based on the observation of the key role of PI3K-Delta as an important regulator immune cells, an imbalance in the pathway which underlies the immune dysfunction across several primary immune deficiencies. This mechanistic understanding forms the scientific rationale for our JoENGIA development program. Chalengia, as you know, is currently approved for APDS where gain-of-function mutations drive a hyperactive pathway leading to immune deficiency alongside broad immune dysregulation.

APDS, in fact, serves as proof of concept for the ongoing two Phase II studies evaluating leninolizib and other PIDs. These have significantly greater prevalence in APDS but share unmet medical needs, underlying mechanisms, and disease pathology. The programs target two similar populations. The first is genetically identified PIDs with immune dysregulation, which represent a prevalence that's five times greater than APDS or more than 2,500 patients in the U. S. alone.

And the second is common variable immune deficiency with immune dysregulation, which is identified independently of genetics. And this is even a larger group of patients, which is approximately 26 times size of APDS, or more than 13,000 patients in the U. S. alone. I'll now talk to you about the studies in the next slide.

Both proof-of-concept studies share a common design architecture, single-arm, open-label dose range finding, allowing cross-study comparability. The CVID study is a multi-center study enrolling 20 patients, and the genetic PID study is a single-center study conducted at the NIH with 12 patients. Both studies are now fully enrolled with trial readouts expected later this year. Both also employ a three-dose escalation design to characterize dose response and confirm the optimal dosing strategy. The studies address two core objectives.

First, of course, to address safety, tolerability, and pharmacokinetics and pharmacodynamics to confirm dosing. Second, and most clinically meaningful, to estimate the efficacy against immune dysregulation, specifically looking at the lymphor proliferation and autoimmune aspects. These efficacy endpoints are aligned with the key disease manifestations, which are focused on these aspects. In addition, we'll also be collecting patient-recorded outcome measures, which were developed through a custom process involving expert input and formal interview studies with CVID patients. Next slide, please. Ahead of these study readouts, we can see some important early clinical evidence supporting leniolisib potential in CVID with immune dysregulation, being presented today at the CIS meeting.

Six CVID or CVID-like patients with immune dysregulation, amongst the sickest patients refractory to other therapies, receive leniolisib through an expanded access program for a median of 1.4 years, with individual exposure ranging from half a year to two and a half years, providing meaningful duration of observation for a small cohort. The clinical signal is encouraging and consistent across disease manifestations.

Clinicians reported improvement with no patient showing progression, spanning cytopenias, splenomegaly, lymphadenopathy, liver disease, and lung disease. Immune profiles showed reduced transitional and CD21 low B cells, confirming the meaningful PI3K delta pathway modulation consistent with the APDS experience. This biomarker data is also being collected in the Phase II studies.

Regarding safety, adverse events were generally manageable and consistent with the disease severity. While this is clinician-reported data and not a prospective clinical study, the breadth and consistency of improvement across these various endpoints is a compelling early signal ahead of the formal study readouts in the second half of this year. So quite a bit to look forward later this year. And with that, I'll turn it over to Kenneth to walk through our financials.

18:23

Unidentified ManagementChief Financial Officer

Thank you, Anorak. I will now briefly cover our Q1 2026 results and our full year outlook. Q1 revenues were $72.4 million, down 8% year on year. Rookanest revenue declined 15%, reflecting the expected U. S. inventory normalization, contributing 8% decline, consistent with our expectation for 7% to 9% headwind that we communicated on the March Q4 call, as well as also our planned strategic exit from U. S. markets, which contributed 3% to the decline. Q1 is also typically the lowest seasonal quarter for Rookanest due to ordering patterns and inventory dynamics.

Joint year revenues were strong and increased 34% year-on-year, driven by strong U. S. momentum, continued patient growth, and expanding international demand. Revenue was modestly affected by inventory timing, and excluding this, growth would have been 1 to 2 million U. S. dollars higher. Total operating expenses were down by 9% year-on-year. Adjusted for non-recurring Oblivar-related acquisition costs in Q1 of 2025, overall expenses were flat. This demonstrates our ability to increase pipeline investments without increasing costs overall.

Adjusted operating profit declined slightly year over year, noting that 7.8 million U. S. dollar of the non-recurring Abliva acquisition-related costs are excluded from the adjusted Q1 25 figure shown on the slide. And in 2026, we had incremental R&D investments for an apacinon of 2.7 billion included. We generated positive operating cash flow in Q1 of $2 million, reflecting continued strong cost management and financial discipline.

Total cash and marketable securities decreased by $9.3 million to $171.8 million, primarily due to a $12.3 million payment related to early termination of the DSP facility lease. For the full year 2026, we are pleased to reaffirm our expectation for total revenues of 405 to 425 million U. S. dollars, representing full year growth of approximately 8 to 13 percent versus 2025. This growth is expected to be driven by continued expansion of Ruconest in the U. S. , partially offset by the exit from ex-U. S. markets and significant and accelerating growth for Durenja.

We deliver the strong exit to Q1, and the low percentage of HAE patients switching to competing oral therapies gives us confidence in our guidance range. Overall, we assume low single-digit annual Ruconest growth at the midpoint of our guidance range, with some pressure expected on Ruconest revenue in Q2 and growth in the second half of the year. For Joangia, we are well positioned for launches in Japan and Europe this year. We also now include expected U. S. pediatric label revenues later this year, previously excluded from our guidance in our outlook. We expect UANJIA growth to accelerate with annual growth over 10 percentage points higher than in 2025.

The pediatric APDS indication remains an important long-term driver, and for planning purposes, we conservatively assume a six-month FDA review period following resubmission with a launch right thereafter. We continue to expect operating expenses between 330 to 335 million US dollars, including 60 million in incremental R&D investment to advance our pipeline. This includes up to 30 million additional for the development of NAPASIMO. This also reflects the $9 million benefit from the 20% G&A structural headcount reduction announced in October 2025, alongside stable marketing and sales spending.

We remain very committed to strong cost management and financial discipline, prioritizing investments that support both near- and long-term value creation. There are no changes made to any other guidance assumptions, including milestone payments or gross margins. As a reminder, for Joenja, we do not assume the $10 million commercial milestone or additional milestone payments this year. Gross margin is expected to be approximately 90%.

Finally, as previously stated, our available cash and future operating cash flows are expected to fully support all pipeline investments, including all pre-launch activities. And with that, I'll now hand over to Fabrice for his closing remarks.

24:00

Fabrice SharrakiChief Executive Officer

Thank you, Kenneth. So in summary, this first quarter demonstrated important progress across the business while reflecting viability in recognized revenues.

We are encouraged by the opportunity we see for JOENJA in the short and long term, and the potential for Reconnaissance to remain a significant cash engine as an important on-demand treatment for the difficult-to-treat patients' subpopulations. We have significant pipeline catalysts later this year.

First, the readout of the two phase two trials for lenulisis in higher prevalence CIDs and second the compilation of the enrollment of the napazimod registrational study in primary mitochondrial disease. As you've seen the decisive steps that we've taken to improve financial discipline including optimizing GNA accounts are starting to deliver tangible results With our strong commercial and development capabilities a growth leadership team and a scalable organization we are committed to driving sustainable revenue growth and value creation to achieve our vision of being a leading global rare disease company.

Let me now open the line for questions.

Questions and answers

25:26

Thank you. To ask a question, you will need to press star 1 and 1 on your telephone and wait for your name to be announced. To withdraw your question, please press star one and one again. We will now go to the first question. One moment, please. And your first question today comes from the line of Benjamin Jackson from Jefferies. Please go ahead.

25:50

Benjamin JacksonAnalyst, Jefferies

Brilliant. Thank you for the question, guys. I've got two, if I may. The first, just on Ruth and S, could you talk a little bit more about why you think you'll see further pressure in the second quarter on that sales line? And then why you think that you, or what gives you the confidence of returning to growth into the second half of the year beyond what you've already described?

And then within that also, are you expecting any reversal of this inventory drawdown at all that may help as a bit of a tailwind in context of that? And then secondly, on Joe Enger, perhaps if you could just help paint the picture about how meaningful you think Europe will be this year and how quickly we should anticipate this ramping.

Perhaps you could touch on which countries will likely come online in Europe when and how quickly you think you can secure reimbursement there. So anything to build out that picture a little bit more for me would be super useful. Thanks so much.

26:48

Thank you, Ben.

26:50

Liburn MarchChief Commercial Officer

Levera? Indeed. So, Ben, thank you so much for the question. I think to your first one on further pressure in Q2 that we may be anticipating. So we're in the early stages of competitive entry, right? Nine months into the several trials that launch followed quickly by prophylactic treatments. What we're seeing is it takes a few reorder cycles, so three to four reorder cycles for us to see the full impact of trialing behavior and switching behavior. And so as we get into essentially the fourth quarter of a launch post-sevit-trial stat, we'll start to see further impact normalized in the second quarter.

The second piece that you asked around, growth in the second half of the year. Today we continue to add both new prescribers and new patient enrollments to Rukines. What that tells us is there is a clearly defined subpopulation of HAE patients who are high-burden patients, so high frequency of attack patients, high attack location patients, where Rucanus continues to have a place. So despite competitive entries, we continue to see new patient generation and new prescriber dynamics in that segment. I'll let Kenneth speak to the inventory drawdown, and I'll talk about, Joenja, the question that you had on European launches. So as you know, we had a positive CHMP opinion earlier this year. We're waiting for final approval.

And our first launch in Europe will be in Germany this year. So we're really excited about that launch coming at the end of toward the second quarter of this year. And that will be meaningful for us because we are anticipating commercial patients, so paid, funded commercial patients, into the second quarter. And then additionally, our Japan approval that we received also earlier this year, we're anticipating that launch in August of this year. So some key growth drivers for us in the second year for Joenja, in addition to the pediatric approval that we are anticipating for the higher doses in the U. S. Kenneth, do you want to respond to the inventory question?

29:00

Unidentified ManagementChief Financial Officer

Yeah, absolutely. And thanks for the question, Ben. So in 2026, we have seen the inventory drawdown, which follows the normal cycle of the year. and compared to last year where in 2025 the inventory drawdown was lower as the previous year's build was lower as well. So we do anticipate that we are in a year that again is more reflective of the normal cycle where there will be inventory built during the second half of the year to basically reflect the demand. So that's how we are looking into the rest of the year.

29:40

Benjamin JacksonAnalyst, Jefferies

Great. Thank you so much.

29:43

Thank you. Your next question today comes from the line of Jeff Jones from Oppenheimer. Please go ahead.

29:52

Jeff JonesAnalyst, Oppenheimer

Good morning or good afternoon, guys, and thanks for taking the question. Maybe one follow-up on Rukanest and then on Leniolisib. Can you help us maybe link the 4% drop in revenue not associated with the inventory drawdowns in the planned U. S. or the ex-U. S. exit with the offset of the 50 new patients on therapy that you mentioned during 1Q? And then for Leni Olisib, you talked a little bit about the readouts from the Phase 1-2s that you're running currently for PIDS and CVID. Can you help us link those efficacy-related readouts to expectations around endpoints in Phase 3 and how we can think about expectations and endpoints moving ahead into more pivotal aligned studies? Thank you.

31:12

Thank you, Jeff.

31:16

Unidentified ManagementChief Financial Officer

I'll take the first part of your questions on the enrollment, and then I'll let Anurag cover the lenurisib part. When it comes to the enrollments that Lever mentioned, these are 50 new patients which have been enrolled, who receive a script. These are not yet 50 new patients on the drug. And so there is always actually a delay between enrollment and patient on therapy.

And obviously, we'll be working actively on that. I think you should look at enrollment as patient in the pipes that ultimately will, for a large proportion, be treated by reconness. And so, again, seeing a significant number of new enrollment, new scripts for Reconnest, and a significant number of new prescribers, I think, reinforce the recognition of Reconnest as a distinctive treatment in the HEA on-demand category.

I hope I was able to bring color. Thank you for that. These new patients are expected to offset the small number of patients that may adopt actually. As Yvonne said today, we've seen only a very limited interest from Ruconet patients to try actually and we've seen a very small number of these patients adopting the drug and this is obviously linked to the nature of these patients which are from vast majority of them have a high burden disease and often have already failed a number of treatments.

33:16

Anurag RelanChief Medical Officer

Anne Wright would you like to elaborate on the lenulisib data that are being presented today? Sure. So, Jeff, I think we'll have to zoom out of here a bit and look at what the unmet need really here is in this group of patients. And the unmet need is all centered around immune dysregulation. And the immune dysregulation we're talking about is these aspects, such as lymphoproliferation and autoimmune disease, that isn't being managed adequately by immune globulin replacement therapy that these patients currently receive. So those are the disease manifestations that we're looking at. Those are, in fact, what we see in the expanded access program, these six patients that are being presented today at the CIS meeting.

You can see these same disease manifestations, whether it's improvements in their cytopenias, improvements in lymph proliferation or improvements in some of the other aspects of the autoimmune disease those are the things that we're also going to be measuring in the in both of the phase two studies so we're looking at lymph node size spleen size we're looking at the blood counts we're looking at some of these other markers of end organ disease activity and those will then form the basis for the phase three study but it's exactly you know the endpoints are, I think, very well aligned with the disease manifestation. And again, what we see early from these six patients is improvement or stabilization in all of these aspects.

34:59

Thank you very much. Thank you.

35:02

Unidentified AnalystAnalyst, Van Lanschot Kempen

Your next question comes from the line of Susila Hernandez from Lanshark-Kempen. Please go ahead yes thank you for taking my questions on your revenue guidance what could be key drivers that could make the difference between hitting the top end and the bottom ends of your range what are your assumptions here and could you share more color on the compassionate use experience in CVID how much do these patients resemble the patients in your phase 2 study thank you Yeah, thank you.

35:41

Unidentified ManagementChief Financial Officer

This is Kennedy. I think Susila. So I think the way to think about it is that we are anticipating six months for approval and launch right thereafter for the U. S. pediatric population following the submission. and obviously an accelerated timing of the approval and launch will provide an upside compared to what we are kind of looking into now and therefore would put us higher up in the guidance range.

That would be the primary driver.

36:18

Unidentified AnalystAnalyst, Van Lanschot Kempen

Okay, that's clear. And could you share more color on the data that was presented at CIS on the compassionate use experience in CVID? How much do these six patients resemble the patients in your phase two study? Thank you.

36:31

Anurag RelanChief Medical Officer

Hi, Sashita. So it's actually a great question. It's something I didn't cover, but these CVID patients and CVID-like patients in the compassionate use experience very much resemble the types of patients that are being enrolled in the CVID study, so the 20-patient multicenter study. And the reason for that is that these patients, all of them have those aspects of immune dysregulation. Now, I would say the only difference here is that this is a much sicker group than the general CVID immune dysregulation population, which is already quite ill to begin with, but this is a group that has been even more refractory to other types of therapies. So the fact that we can see improvements here is, I think, quite meaningful and encouraging for us as we look ahead to the results later this year.

37:24

Unidentified AnalystAnalyst, Van Lanschot Kempen

Okay, that's clear. Thank you.

37:26

Thank you. Your next question comes from the line of Joe Pantginnis from HC Wainwright. Please go ahead.

37:35

Unidentified AnalystAnalyst, HC Wainwright

Hi this is Josh on for Joe Thanks for taking our questions So for the first one could you guys provide more color around the proportion of the identified 4 to 11 APDS patients in the U. S.? So, specifically, how many could be covered by the initial 40 and 50 milligram resubmission? And then for the type A meeting, did the FDA feedback change how you're thinking about pediatric dosing more broadly, or has your overall strategy remained largely unchanged?

38:13

Unidentified Management

On the first part of the question, Livran?

38:13

Liburn MarchChief Commercial Officer

Sure. Thanks, Josh. On the first one, on the 4 to 11 age group, you can assume approximately half, so roughly 50% of that population would be eligible for the high-dose linealicib, and half would be on the lower end. And so, Josh, on the type A meeting and the feedback that we got, and actually all of the discussions that we've had, I think it really has not changed our dosing strategy. And in fact, what I think, you know, based on this constructive dialogue that we had with FDA, they were, we shared with them the efficacy that we'd observed across the doses, And that has allowed us to maintain the same doses in our resubmission strategy. So the lower weight patients would be maintained on, or proposing to maintain them on the same doses that were used in the clinical trial.

And that really is tied to the efficacy that was observed in the lower weight patients, which was very similar to the efficacy that was observed in the higher weight patients. So I think on that basis, we have not changed the dosing strategy, and I think we've come to an agreement with FDA on what the contents of these two resubmissions would be.

39:40

Unidentified AnalystAnalyst, HC Wainwright

Great. Thank you. Very helpful.

39:43

Thank you. Your next question comes from the line of Whitney Idem from Canaccord. Please go ahead.

39:54

Whitney IjemAnalyst, Canaccord

Hey, good morning, guys. Thanks for taking the question. Just to follow up to clarify for the Phase II linealus of readouts in the second half, just wanted to confirm, will those be read out at the same time, so it's one readout for both, or could they come at different times?

And the right?

40:13

Anurag RelanChief Medical Officer

So the study is completed enrollment around the same time. One of the studies is one month shorter in duration, so it is possible that that one, we have all of the data available slightly earlier than the other study, And once we have the data cleaned and available to evaluate, we'll have more specifics on the exact timing of that readout.

40:35

Whitney IjemAnalyst, Canaccord

Okay, got it. And then headed into those, can you help set investor expectations, I guess, in terms of what would be good data or what you're looking for in both of those studies?

Either quantitatively or more qualitatively?

40:51

Anurag RelanChief Medical Officer

So a lot of the things that we're looking for, first of all, they're aligned with what we observed already in APDS. So we saw lymph nodes shrink. We saw spleens get smaller. We saw improvements in immune profiles. We saw improvements in blood counts, so the cytopenias, autoimmune cytopenias that occur in these patients. So we've seen that already in APDS, and that's why, again, I really think it is a very nice proof of concept for what we've already done.

And then what we know is this is also the unmet need in these other primary immune deficiencies, so really looking for the same things. So we're looking to see if lymph nodes get smaller. We're looking to see if the spleens get smaller. We're looking to see platelet counts or other blood cell counts increase. We're looking for other end-organ disease manifestations to see how they also improve. And I think this is also, again, lines up very nicely with the data that will be presented today that I shared in the slide, is that we see already in this early experience with these six patients, we see those same types of improvements. And I think that is, again, a very encouraging early sign.

It's not a clinical trial, but it's an early sign that both based on the APDS experience as well as the six-patient expanded access experience, the kinds of things that we can expect to see in the readouts of these two Phase II studies.

42:27

Whitney IjemAnalyst, Canaccord

Got it. Thank you.

42:30

Thank you. As a reminder, if you would like to ask a question, please press star 1 and 1 on your telephone. That is star 1 and 1 to ask a question. We will now go to the next question. And the next question today comes from the line of Natalia Webster from RBC. Please go ahead.

42:52

Natalia WebsterAnalyst, RBC

Hi there. Thanks for taking my questions. I have a couple of follow-ups, please. Firstly, on Rookinest, just on the around 50 new enrolments that you've seen and 23 new prescribers in Q1, Do you see this as a sustainable run rate going forward? And then secondly, appreciate it can take three to four real cycles to see the full impact. But are you able to provide any quantification on what sort of percentage of your patient base has tried at early and what sort of return rate you're seeing to date? And then finally on Joenga, you added seven NETS, US patients on paid therapy in Q1, and believe you previously guided to accelerating enrollment this year.

Is this acceleration dependent on pediatric approval, or are you also expecting an acceleration in adult physicians in the coming quarters? Thank you.

43:50

Unidentified ManagementChief Financial Officer

So I'm going to take the – thank you, Nathalia, for your question. I'll take the first part on Rickoness and let Lee Verne elaborate on the second part on Joanne-Jah.

Clearly, we've seen over the past quarters really our ability to see really a sustainable stream of new environments. So despite the launch of new therapies, whether these are prophi therapies, prophylactic therapies or on-demand therapies, we've seen that because of the differentiated profile of Reconest, we've been able to gain quarter after quarter a single number of new patients. And we don't see that changing, specifically as the launch of Actualim is making the on-demand market more dynamic. We see a significant increase of switches and doctors are more prone to engage with their patients on whether they are well controlled. And we see an opportunity for Rukonex to capture even a higher number of patients that would not be controlled correctly on their current treatment.

And to complement what Kenneth said earlier, this is also a significant element to reach the upper end of our guidance. Clearly, reaching the upper end of our guidance is about the timing for the US approval of the Bellatrix extension, but also our advocacy to grow, reconnect, and leverage this market dynamic with more switches.

45:56

Unidentified Management

I will now let Dever comment on the JOANJA, on your questions related to JOANJA.

46:06

Liburn MarchChief Commercial Officer

Thanks Fabrice and thank you Natalia. So on the JOANJA acceleration, we still have significant room for growth in the 12 and above patient population, right? So as we mentioned, we added seven new patients on therapy in Q1 and we're seeing some good sustainable momentum into Q2 already. So as you think about the adult 12 and above opportunity, we continue to identify new patients. We continue to convert those new patients, and that A is a sustainable source of growth for us in the future because there's a lot of room for us to grow.

And then I think the point that you mentioned on the pediatric indication in the second half of the year will be an additional growth level for us in the U. S. , right? And then ex-U. S. , as we mentioned, will be launched in Germany and launched in Japan later this year. So I would think about the year in these sort of phase steps of acceleration in the current population, the pediatric population, and the international expansion in the second half of the year.

47:10

Natalia WebsterAnalyst, RBC

Great. That's very helpful. Thank you.

47:13

Thank you. We will now take our final question for today. And the final question comes from the line of Simon Chollis from First Berlin. Please go ahead.

47:20

Simon ScholesAnalyst, First Berlin

Yes, hello. Thanks for taking my question. I've got a question on Leni Olisib and the Taipei meeting. My impression in March was that you would be able to deliver the additional information that the FDA required and that probably you'd be able to make resubmissions, immediate resubmissions in both the high dose and the low dose. could you just outline what extra work you're going to need to do on the low-dose patients until you resubmit in the summer?

48:01

Anurag RelanChief Medical Officer

Sure, I can answer that. So I think what we really, you know, when we met with FDA, and I think what we tried to define was the fastest way to bring joanja to this youngest group of patients and to try to do it in a way that allowed us to leverage the data we already had. And that's why we went with this two-submission approach that allows this 40 and 50 milligram submission to already occur. In fact, we submitted it, as I said, on the same day that we received the FDA meeting minutes. So I think that was a very important outcome.

For the second group, really, this was just making sure that we had all of the efficacy data and, as I said earlier, the efficacy data that lined up very nicely in both the high-dose and the low-dose groups, the high-weight and lower-weight patients. So it's really just putting that data package together. I think the key piece or the key point to note is that we have an agreement with FDN on what the contents of that submission will be. And importantly, it doesn't require an additional clinical trial, this submission. So I think that's where we are, and that's why we went with this two-submission approach. And we expect to make the second submission in this summer.

49:24

Simon ScholesAnalyst, First Berlin

Okay. Thanks very much.

49:28

Thank you. I will now hand the call back to Fabrice Sharraki for closing remarks. Please go ahead.

49:36

Fabrice SharrakiChief Executive Officer

Thank you so much, operator. I hope we were able to provide clarity on our performance in the first quarter. As we said, we've seen meaningful improvements across the business, despite some revenue viability.

I personally believe, as the rest of the leadership team, that we are, those progress are really positioning farming extremely well for long-term value creation. And so we look forward to updating you on our plan for the short and mid-term and long-term as well. Thank you so much.

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