Welcome to BioArctic Q3 Report 2025. For the first part of the conference call, the participants will be in listen-only mode. During the Q&A session, participants are able to ask questions by dialing pound key five on their telephone keypad. Now, I will hand the conference over to CEO Gunilla Osswald, CFO Anders Martin-Löf, and colleagues. Please go ahead.
Thank you. Good morning and welcome to BioArctic's presentation for the third quarter of 2025. BioArctic is continuing in a great way in our new era, with yet another quarter where we see more and more patients getting access to LEQEMBI. We are broadening our collaborations utilizing our brain transporter technology, and we are also broadening our portfolio with new projects and new modalities. We will talk more about that in today's presentation. Next slide, please. BioArctic is listed at nasdaq.com, large cap, and this is our disclaimer. Next slide, please. I am Gunilla Osswald, and I am the CEO of BioArctic, and I will share today's presentation with our CFO, Anders Martin-Löf, and our Chief R&D Officer, Johanna Fälting, and our Chief Commercial Officer, Anna-Kaija Grönblad. Next slide, please. I will start our presentation today by giving some key highlights. We go to next slide, please.
Before I come into this quarter and the presentation, I just want to give a high-level introduction to BioArctic if we have any new listeners today. BioArctic is among the world's leading innovators in precision neurology, and we have two key platforms. The first one is about innovation and generation and development of highly selective antibodies targeting aggregated misfolded forms of toxic proteins. Examples here are, for example, LEQEMBI and Exidavnemab. The second one is when we are utilizing our brain transporter platform in innovative ways to deliver antibodies and different modalities to come better into the brain. In today's presentation, we will talk about both selective antibodies like LEQEMBI, Exidavnemab, and our new project for Huntington's disease with Huntington, as well as our brain transporter technology, which we have utilized now for all our internal targets. We have also started to use it for external projects.
We now have three different partnerships utilizing the brain transporter technology, including the recently signed deal with Novartis. Next slide, please. During the second quarter this year, we held our first Capital Markets Day, and then we presented our ambitions for 2030. I'm really pleased to say that we are already delivering on our ambitions. If we start with the first one, LEQEMBI, to be an established treatment in Alzheimer's disease, I'm really happy to see how LEQEMBI's demand continues to grow. The second one is to have a balanced and broader pipeline with projects in all stages of development. Our pipeline is already broader and continues to increase and develop. The third one is additional successful global partnerships. Of course, we are very happy with the new collaboration with Novartis, and we have more positive discussions ongoing.
The fourth one is our aim to be profitable and to have recurring dividends in the future. We expect to be highly profitable this year, and Anders will come back to this. Next slide, please. As I said, we are already delivering on our ambitions, and now I will go through a bit about how. We start with LEQEMBI, and I think now we are really well on our way to get LEQEMBI established as a treatment for Alzheimer's disease, a disease-modifying treatment affecting the underlying disease. Thanks to our partner Eisai, their great work with LEQEMBI, it's now approved in 51 countries around the world, with Canada being the latest one. The IQLIK, the subcutaneous auto-injector, like a subcutaneous pen, was called IQLIK, was approved for maintenance dosing in the U.S. during the quarter.
Eisai has already initiated a rolling submission for initiation dosing as well, and launch has already started for maintenance dosing in the U.S. after the quarter. Next thing I want to say is about Europe, and there the launch has been initiated in Germany and Austria. We're really happy to see that Finland has got the first patients that have been treated in a private clinic. Of course, this is great news from us from a Nordic perspective since we are preparing for launch together with Eisai in the Nordic countries. Anna-Kaija will come back and talk more about this. There have been several presentations on LEQEMBI during the period and after the period, and those have shown that long-term data over four years' treatment show continued increasing benefits over time.
It's also really reassuring to follow the real-world data coming for LEQEMBI when it's being used in clinical practice. We have heard presentations both from the U.S., Japan, and China, and the data have shown that the benefit and the safety profile are at least in line with the phase III results, which I think is great and encouraging. Subcutaneous administration data has also been started to be presented, and that supports this great further opportunity for patients to, in a more easily way, get the injection by an auto-injector and possibly to do that at home in an easier way. I also want to mention that we, of course, follow with great interest the fantastic progress with the blood-based biomarkers, and the guidance was launched earlier or during the quarter about how to utilize the blood-based biomarkers.
They can now be used both for confirmation and for triaging, and we'll come back to that. If we then look at the second part of the pipeline, which is progressing really well and growing with new projects, I want to mention Exidavnemab, our alpha-synuclein antibody currently in phase II-A, with a second part of the study ongoing in both Parkinson's disease patients and in multiple system atrophy patients. I'm also really happy to be able to communicate that we're also now working on another misfolded protein target called Huntington for Huntington's disease. Here we are working with antibodies, but we are also broadening it into other modalities utilizing our brain transporter technology, and Johanna will talk more about this in today's call. The third one is to have additional successful global partnerships.
As I said, we are very happy about the new collaboration with Novartis regarding an undisclosed target for neurodegenerative diseases. We will re-engineer that antibody to include our brain transporter technology and enabling then a better penetration into the brain. I also want to mention the other brain transporter collaborations that we have so far. One with Eisai on BAN2802, where we're generating great data, and BAN2803, which we are completing now the tech transfer to Bristol Myers Squibb. It's also great to see that we have continued strong interest for our projects and for our brain transporter technology for antibodies as well as for other modalities. The fourth part about the financials, we have strong financials, and we are highly profitable this year with increasing royalties as well as several milestones from Eisai and upfront payments from Bristol Myers Squibb and Novartis. Next slide, please.
If we think about the Alzheimer's field, it's evolving in a very nice way, and I want to highlight five different areas. The first one is that we see that we're getting easier and easier diagnosis by blood-based biomarkers. I think this is important in helping to build the market in an easier way and to help to get the right patients to come to specialists to get a treatment initiated. The first tests are now available as confirmatory for specialists as well as for triaging for primary care. If we then look at the second one, we see more and more data that shows that earlier initiation of treatment of LEQEMBI shows better effect.
When we're looking at the earlier patients in the phase III Clarity AD open label extension study, where now 48 months' data are available, we see that the majority of LEQEMBI-treated patients were stable or even improved after 48 months' treatment. I think this is very encouraging, and I think it also further supports the ongoing head 345 study in pre-symptomatic individuals with amyloid pathology, but yet without symptoms. The third one is also really important, and that is the data that are being presented show the importance with maintenance treatment to maintain retreatment and the benefit of continued treatment with LEQEMBI even after the plaques are cleared in order to continue to clear the toxic protofibrils. That's possible due to the mechanism of action and the low immunogenicity that we see with LEQEMBI. The fourth one is about more convenient dosing with LEQEMBI IQLIK, the subcutaneous auto-injector.
I think this is a really important next step for LEQEMBI, and it's making dosing so much easier for the patients and the care partners to handle the dosing at home. We are also pleased to note that it was awarded as one of the top innovations for 2025 by Time Magazine. The fifth one is that in the future, we expect to see more combination treatments for even better outcomes. There is currently an ongoing study with LEQEMBI and Eisai Tau antibody, and I think in the future we will see more and more combination treatments. To summarize, the key is to identify patients at an early stage, and here we can use the blood-based biomarkers, and we can start LEQEMBI treatment early and continue treatment with convenient dosing with LEQEMBI IQLIK. Great progress in this field for LEQEMBI. Next slide, please.
Now we come to the R&D update, and I hand over to our Chief R&D Officer, Johanna Fälting.
Thank you so much, Gunilla. Next slide, please. As Gunilla mentioned, BioArctic is among the world's leading innovators in precision neurology, where we have two key platforms: the antibody platform with highly selective antibodies targeting aggregated forms of toxic proteins. These are intended to treat severe neurodegenerative diseases with high unmet medical need, such as LEQEMBI in Alzheimer's disease, Exidavnemab in synucleinopathies, Parkinson or MSA, and also the TDP-43 project for ALS. BioArctic is also developing a brain transporter technology that facilitates the passage of antibodies and other drugs across the blood-brain barrier. The aim with this platform is to improve the brain exposure and distribution of the drug, and thereby allow for lower dosing, improved convenience, reduced manufacturing costs, and potentially also better efficacy.
In addition, now we are also further developing our brain transporter technology and expanding this into new modalities other than antibodies, such as enzyme proteins and even genetic medicines, and the development of the platform that will enable us to address different diseases by tailoring the modality target combination with the highest potential clinical benefit. Next slide, please. This is an overview of our R&D portfolio with the two platforms, antibodies and brain transporters, and the cross-program synergies. The portfolio is a combination of fully funded projects run in partnership with global pharmaceutical companies, innovative in-house projects, and technology platforms with significant market and out-licensing potential. So far, our brain transporter platform has generated three collaborations with Eisai, Bristol Myers Squibb, and Novartis, and all of these collaborations are progressing really well.
They are all with different targets, but importantly, the brain transporter technology is BioArctic's own proprietary and has the potential to generate more collaborations in the future. You will also note a new brain transporter project in the portfolio, the HDBT 4801 for Huntington's disease, and I will come back to this specific project later in the presentations. To summarize, we are both advancing and broadening our R&D portfolio with new projects into new disease areas and with new collaborations. Next slide, please. Exidavnemab is an antibody that selectively targets the pathological alpha-synuclein aggregates while sparing the physiological monomers, and Exist is a phase II-A study testing the safety and tolerability of Exidavnemab.
In this study, we're also exploring a wide range of biomarkers, both biochemical and digital, and we have a quite unique approach in including the right patients in the study with a smell test that is an early sign of Parkinson if you have an impaired smell, and also a CSF seeding amplification test to really make sure that we have the correctly diagnosed patients with the alpha-synuclein pathology in the study. The high-dose cohort is currently ongoing both in Parkinson and multiple system atrophy, and the results are expected mid-2026. Following this Exist study, there are several potential possibilities for future development in different synucleinopathies such as Parkinson, MSA, and DLB, and we're currently preparing for the next stage of development. Next slide, please.
This is very exciting to me that we are now expanding our portfolio into a new neurodegenerative disease, the Huntington's disease, and this is an inherited progressive neurological neuropsychiatric disorder that is caused by impaired function and degradation of nerve cells in specific areas of the brain. Huntington's disease is caused by a toxic mutant Huntington protein in the brain, and the mutations in this gene result in a buildup of toxic aggregated Huntington protein causing Huntington's disease. The disease onset is between 30 and 50 years of age, and it's fatal within 10-30 years. Current treatments are only symptomatic, and there is a large unmet medical need for better treatments. Next slide, please. Targeting the Huntington protein in the Huntington's disease is an excellent strategic fit into our portfolio at BioArctic and with our capabilities.
This project is built on BioArctic's extensive experience in developing antibodies against misfolded aggregated toxic proteins and also our brain transporter platform that will enable us to increase the brain delivery of the drug. In this project, several modalities are being explored in parallel: antibodies as well as genetic medicine approaches. Since this is a brain target, we have, of course, also combined it with our brain transporter technology. We are excited that we now expand our portfolio with yet another neurodegenerative disease in addition to Alzheimer, alpha-synucleinopathies, ALS, and Gauchers, with the potential to bring hope for even more patients. Next slide, please. With that, I will hand over to our Chief Commercial Officer, Anna-Kaija Grönblad, for a commercial update.
Thank you, Johanna, and you can go to the next slide, please. I will go back to LEQEMBI again, and I'll start with the regulatory update for all of you. Since the last quarterly report, LEQEMBI IV has now been approved in three additional countries. That is in India, Australia, and in end October, also in Canada. In total, LEQEMBI is approved in 51 countries and territories. As of October, in addition to the U.S., the IV maintenance treatment, meaning once every four weeks, is also approved in China, in Qatar, United Arab Emirates, and India. Anders will soon present the sales numbers, but in short, I would say that the LEQEMBI growth really continues steadily. In Q3 versus Q2, when you adjust to China's actual demand, the growth was 14%.
We have seen recent launches in Mexico and Saudi Arabia, and as of August and September, as Gunilla mentioned, LEQEMBI was launched also in the EU, in Austria and Germany, where patients have started treatment. What we hear is that within the first two months, around 350 centers were registered in the system for the controlled access program, and as educational activities are being rolled out in the two countries, registrations and prescriptions continue to increase at major specialist clinics. Finally, in the Nordics, of course, as Gunilla mentioned, there is a private clinic in Finland offering LEQEMBI treatment to patients willing to pay out of pocket, and we know that a few patients have received treatment in October. This is an important milestone for us in our ambition to also become a fully fledged pharmaceutical company.
In the meantime, the price and reimbursement and the dialogue continues with all the Nordic countries, and we aim to launch gradually across throughout 2026. Next slide, please. Additionally, I would like to spend a few minutes again on the LEQEMBI IQLIK, this subcutaneous auto-injector, which was approved in the U.S. in August and launched as of early October. As Alzheimer's disease is a progressive disease where neurodegeneration and cognitive decline continues even after plaque removal, it is important to offer both healthcare professionals and patients the possibility to choose between continuing on once-monthly infusions in the hospitals or to switch to once-weekly at-home injections after the 18-month treatment. This obviously could be a benefit for the patient who might want to travel and feel less bound to the hospital, but also to healthcare providers in reducing the resources related to the infusions.
Reimbursement for the IQLIK is expected to be included on formulary in the beginning of 2027, but individuals can seek insurance coverage via the medical exception process, which is something that is quite common in the U.S.. ASIC staff is providing information on this process, and nurse educators provide support on dosing and demonstration kits, etc. This is truly a major step in the treatment of Alzheimer's disease patients, and recently, LEQEMBI IQLIK was selected by Time as one of the best inventions in the medical and healthcare category. In addition, ASIC has also a rolling SPLA ongoing, also for the weekly initiation treatment in the U.S. since September, which is planned to be completed in the last quarter of this year. Potential approval may be in Q2 or Q3 next year.
Finally, submissions for the subcutaneous weekly initiation treatment are also planned for Japan before the end of this year. Next slide, please. Moving on to my final slide, this is to highlight again the true advancements we are seeing with the LEQEMBI IQLIK and with the parallel development in the usage of diagnostic blood tests. If you remember, U.S. clinical guidelines were presented at the ADPD Congress in July this summer, saying that blood-based biomarker tests showing more than 90% sensitivity and specificity can be used for confirmatory diagnosis in patients with cognitive impairment. The first blood-based confirmatory tests are available in several countries, in the U.S. and China, for instance, and for Fujirebio's test, Lumipulse, for instance, has been granted IVD clearance, and C2N is another company that has submitted for regulatory filing in the U.S. for their confirmatory test.
Meanwhile, Roche Phospho-Tau 181 blood test was granted IVD clearance from the FDA for use in the primary care test as a triage test. More tests will be done. 350,000 tests are expected to be used in 2025, and a new CMS payment rate is coming up from January next year. Of course, as more patients are being tested, more patients will receive a diagnosis. As we see, these advancements will contribute significantly to the LEQEMBI growth going forward, especially in the U.S., China, and Japan. That is all from me, and with that, I will now hand over to our CFO, Anders Martin-Löf.
Thank you, Anna-Kaija. If we start to look at the LEQEMBI numbers, the global Q3 sales came in at JPY 18 billion, or roughly $121 million.
At first glance, that looks quite negative since there was a 22% decrease from the second quarter of 2025, but that is all due to a large stockpiling effect in China in this second quarter. ASIC calculated what the growth would have been from the second to the third quarter without the stockpiling effect, and then the growth would have been 14%. We recorded a royalty of SEK 117.2 million. That's also then down from SEK 162.5 million in the second quarter, but we have also estimated what the royalty would have been without the stockpiling effect, and then we would have been around SEK 125 million in the second quarter and SEK 135 million in this quarter. I think that that's a better reflection of the actual development of the LEQEMBI sales in the world.
Turning down to China, actual recorded sales were JPY 0.2 billion, or $0.6 million, so a 97% decrease from the second quarter. Basically, the clinics in China are receiving LEQEMBI from inventory right now in the third quarter. The actual demand was roughly $18 million, and that's a 10% increase from $16 million in the second quarter. All in all, this means that there is still quite a significant inventory left in China, so we expect very low sales in China also during the fourth quarter, and that was reported by ASIC. Turning to the U.S., there the sales are increasing well. They were up to JPY 10.2 billion, or roughly $69 million, representing a 12% increase from the second quarter.
Here, BioArctic is really trying to leverage the developments that Anna-Kaija was talking about with the blood-based biomarkers that are now being used more and more, and the acceptance of IQLIK for maintenance therapy this year and for induction next year. To really get the full effect of this, you have to target the primary care practitioners. That is what BioArctic is doing now. They're targeting roughly 3,500 primary care practitioners. They're running very big educational programs and running large awareness campaigns straight to the patients. They're really building momentum now to start to see an impact from IQLIK and blood-based biomarkers starting probably more from next year, but they're really starting to do the groundwork now. Here, you can say that they're mimicking Japan a little bit. Japan is the market that has come the furthest along in the demand expansion phase.
Sales here were $42 million, representing a 13% increase from the second quarter. Here, they have really succeeded in setting up a good treatment chain where roughly 4,200 doctors are referring to 800 initial treatment centers, and there the patients stay for a while, and then they are moved over to follow-up facilities. That is a system that has worked incredibly well, and that is what they are trying to achieve now in the U.S. as well. I think it is also really interesting to see that the disease awareness campaigns that they are running for mild cognitive impairment in Japan are significantly increasing recognition rates, because we all know that mild cognitive impairment, which is the earliest phase of the disease, is really where you want to treat the patients with the disease-modifying therapy.
You can have the most effect if you start as early as possible, but today, those patients aren't really diagnosed to a large extent. These awareness campaigns can really start to build momentum for more patients getting the drug when they really should have it. As Anna-Kaija Grönblad mentioned, the EU launch has been initiated in Austria and Germany. It's really exciting to see that that is starting well. However, it will take some time before you see any significant impact in our royalties from the EU, which is a slightly slower market than the U.S. and Japan. If we then turn to the LEQEMBI Global Sales Forecast, they have a forecast of JPY 76.5 billion for their fiscal year 2025 for LEQEMBI.
If you look on the right-hand side of the graph, you see that they have already, in the first two quarters of that fiscal year, achieved 48% of the forecast in the U.S. and 49% in Japan, and already 83% in China. All in all, if you also include the other countries, they have achieved roughly 52% of the overall annual forecast in the first two quarters of that period. Since they are growing, we have a very high confidence that they will reach the forecast for the year. Everything is looking really, really good for LEQEMBI, and it seems to reach their forecast with some margin. If we then turn to our own numbers, you see that the Q3 net revenues were SEK 133 million, and this quarter, that was mainly based on the recurring revenues with royalties of SEK 117 million and co-promotion revenues of SEK 5 million.
It's exciting to see that we're becoming more and more like a normal company with recurring revenues that make up a larger share of our revenue base. We also recorded some revenues from the new Novartis agreement. As you know, we got $30 million upfront when we started that collaboration, and now we recorded $9 million out of that in the third quarter, and we will record the rest during the remainder of that collaboration. Looking at our operating expenses, they increased to SEK 150 million this quarter compared to SEK 95 million a year ago. This time around, that was basically just normal cost. We have had large currency effects in the previous two quarters, but not this quarter. The underlying operating costs were SEK 146 million, and that's slightly over than our recurring revenues.
We have operating costs that are SEK 24 million higher than our recurring revenues, but we are approaching a point where we will have recurring revenues that are larger than our operating expenses. We are getting closer and closer to long-term profitability. If we look at our costs for the remainder of the year, we expect them to keep increasing since we have a more mature project portfolio and we have built up our commercial organization. I have previously stated that I expect our full-year cost to be roughly 50%-70% higher than the cost of last year. Now, we think we will be in the lower range of that interval, so I would say roughly 50%-60% higher than the cost of last year. On the right-hand side, you see that operating loss was SEK 29 million for the third quarter.
We expect something similar in the fourth quarter, so the operating profit for the year should be well above SEK 1 billion. On the next slide, you see our net result on the left. It is then, of course, a lower loss or bigger loss than the operating loss, but that is mainly explained by the accrued taxes of SEK 65 million, but we have a positive financial net of SEK 8 million, so that ameliorates a little bit. The operating cash flow, you typically see one very big bar, and that is the payment of the $100 million upfront payment that we received from Bristol Myers Squibb in the second quarter. The $30 million upfront payment, $30 million, I should say, from Novartis had not been received in the third quarter. It was received in October.
The bar you see on the left-hand side with our cash balance right now of SEK 1.9 billion does not include the Novartis payments, so our financial position will continue to be strengthened in the fourth quarter. We are going to end the year with a very, very solid position. I think that was all for me, and now I hand back to Gunilla for some closing remarks.
Thank you so much, Anders. We are coming towards the end of today's presentation with some upcoming news flow and some closing remarks. Next slide, please. We are now in the fourth quarter of 2025, and I think it is great to see that more and more patients are getting access to LEQEMBI around the globe. Also, really pleased to see that we are also starting, even if it is small, so we are starting in the Nordics.
We see continued regulatory processes on LEQEMBI with the Canada approval, and I think it's great to see the IQLIK being approved for maintenance dosing in the U.S.. Our partner, Eisai, are working hard to conclude the supplementary BLA filing for LEQEMBI IQLIK in the U.S. for initiation dose, and also to file in Japan for both initiation and maintenance dosing with IQLIK. We are, of course, looking forward to the next Alzheimer's Congress. It's CTAD in San Diego in the beginning of December, and there we note several presentations on LEQEMBI, including subcutaneous data and more real-world evidence data from, for example, U.S. registered. This is something I'm really looking forward to. Come to the next slide.
The key takeaways from today's presentation are that BioArctic is now in our new era, and we see great progress both on LEQEMBI as well as the rest of our portfolio and the brain transporter technology. We have already started to deliver on our 2030 ambitions. LEQEMBI is well on track to become an established treatment for Alzheimer's disease. Sales continue to show increasing demand on a global level. Further regulator approvals, launches, reassuring data from long-term treatment, and real-world evidence. Our portfolio has increased, and we have initiated a program for Huntington's disease with different modalities. Our brain or our business development efforts continue to deliver with a third brain transporter collaboration now having been initiated during the third quarter. This was the first of its kind, and it shows that we are also expanding to becoming also a platform company.
The last point is that we have strong financials, as Anders described, with great cash flow, with milestones and record royalties during this year, growing more than 180% year on year. I think the future looks very bright for BioArctic, and it's bringing hope for many patients. Next slide, please. By that, we say thank you so much for your attention, and we're happy to take some questions.
If you wish to ask a question, please dial pound key five on your telephone keypad to enter the queue. If you wish to withdraw your question, please dial pound key six on your telephone keypad. The next question comes from Joseph Hedden from Rx Securities. Please go ahead.
Good morning. Thanks for taking my questions. Firstly, on the LEQEMBI IQLIK, do you have any visibility on when regulatory filings might be made in Europe or China, or what the strategy there is? Then, secondly, it's great to see a Huntington project. Just on the brain transporter technology, I know that first program is an antibody, and you've mentioned genetic medicine. Is brain transporter capable of, for instance, using an AAV vector like Huntington's? The UniQure therapy has made a lot of noise recently. Does any significant modification need to happen with your current platform to be able to carry a vector such as AAV? Thanks.
Thank you so much, Joseph. Excellent questions. I think the first question on LEQEMBI IQLIK in Europe and China, we cannot comment on that. I mean, right now, we are really happy about the progress in the U.S. and Japan.
We know our partner is doing everything they can to help as many patients as possible around the world, so we'll come back to that. Your question with regard to Huntington's disease and where we are, also really happy to see the brain transporter. I didn't understand any specific question. I understand. If there's anything I can take up. Just end, and then I hand over to you, Johanna. For the brain transporter, I think it's really, really good to see that we can utilize that for several different modalities and definitely help to get different modalities better into the brain. I think it's important to point out that brain transporter is not one thing. It's the platform with many different tailor-made ways to handle, depending on what kind of target and what kind of modality.
We have several different approaches that we utilize, depending on if it's an extracellular target, intracellular target, or what kind of modality we have. I hand over to Johanna, who understands the question I missed.
Thank you so much, Joseph, for that excellent question. We are, of course, following the competitive landscape very well, and we understand, and we have seen the uniQure data. I think it's excellent data, but that's a treatment that is not for everyone. It's a quite invasive treatment, and you actually need maybe a 15-hour surgery for one patient to administer that drug, and you do it with intrathecal administration and injections in different sites in the brain right now.
Our approach is a bit different, and I can't speak too much of it today before we have the patents in place and so, but we have another approach, and we are not primarily targeting AAV with our brain transporter technology.
Okay. Thank you very much. I hope that responded to your question. Thank you, Johanna.
Yes, thank you. The next question comes from Suzanna Queckbörner from Handelsbanken. Please go ahead.
Hello. I'd like to ask a question regarding LEQEMBI subQ. Listening to the Eisai Conference Call, there was talk about the IQLIK being listed in formularies only by 2027. There seems to be a medical exemption program which would address something like 80% of patients. To me, it sounds like there's likely to be more paperwork associated with that, which sounded like it was going to be limited or access was going to be limited at least until 2027. Maybe you can just sort of explain that to me, and then also how does that impact your competitive advantage versus Eli Lilly's Remternetug , which is also expected to read out data in 2026, and they have the subQ formulation as well.
Yeah. We start with your question on IQLIK, and the process in the U.S. with the reimbursement agency or CMS is that it's certain times of the year that you need to submit in order to come into the next year. That's the reason for why we expect LEQEMBI IQLIK to be on the formulary from January 2027.
Right now, just as you said, Suzanna, there is a possibility to utilize the medical exemption program, which I think many of these physicians are used to do for other treatments. What we have understood from Eisai is that it's not overwhelming paperwork. It's a fairly easy process that can help most patients to already be reimbursed right now. I'll also go on the differentiation part a little bit and then hand over to Anna-Kaija. I think, I mean, we see then the IQLIK as a really good differentiator versus competitors. We will follow with great interest when also Ternaturg comes with some efficacy data. We haven't seen much yet, so I think each compound has to show itself before we can comment too much, and we haven't seen much of it yet.
I think meanwhile, we are really happy for LEQEMBI IQLIK, which all the data we have seen so far looks really, really promising, and more data is expected to be shown at CTAD. I do not know, Anna-Kaija, if you want to add something.
No, not really. I think, again, I think we have not seen that much data on Remternetug yet, so I think it is too early to say anything about it. We, of course, understand that they also see the need of a subcutaneous autoinjector because we think that this will be a key driver for patients also having an easier treatment. We see the need from Eli Lilly as well. They see this as a competitive advantage.
If I can have a follow-up question. Also, I saw that Takeda discontinued their alpha-synuclein antibody, which they reported they had, say, two results on. Maybe you can talk about the differentiation to your alpha-synuclein antibody.
Yeah. I think it's really important to understand that every antibody is different from each other, and we think that we have a clearly superior antibody, much more selective, the most selective antibody that we know for alpha-synuclein between the pathological forms and the physiological forms. We have more than 100,000-fold selectivity, which is a huge difference from competitors. Also, I think it's important to see the design of the clinical studies and that we also think that we are designing better studies for the future. I will hand over to Johanna.
Thank you, Gunilla. No, I totally agree, and thank you for the question. Of course, it's always sad when a clinical study that brings hope to patients does not read out, but I think that we have a differentiated profile both in terms of the selectivity for what we believe is the toxic species, the aggregated species, and the very high affinity for those species. We also have a superior human PK profile as compared to the AstraZeneca Takeda that recently read out. It was also a fairly small, I would say, phase II clinical trial, and I think that we can have a clear differentiation versus both in terms of human PK study design and selectivity for the toxic species. Not much read over, I would say. No, absolutely not.
Okay. Thank you.
The next question comes from Natalia Webster from RBC. Please go ahead.
Hi, there. Thanks for taking my questions. Firstly, I was wondering on Eisai's full-year LEQEMBI guidance to March. This is implying a slowdown in growth for LEQEMBI sales for calendar Q4 into Q1 2026. Just curious to hear if you think this is conservative, appreciating that there may be some further impact from the China inventory adjustment in Q4. My second question is on the European launch. Appreciate its early days, and it could take some time to see a more meaningful contribution here, but are you able to provide a bit more feedback on how this is progressing and if you're accounting any of the initial challenges that you saw in the U.S. around capacity or otherwise? Finally, just on profit, you've maintained your long-term ambition for sustainable profitability.
I was wondering if you're able to touch on any key considerations for cost phasing in 2026 and if you are able to confirm that you still expect to reach sustainable profitability from 2026 as well. Thank you.
I think it's Anders who should start on these questions.
Right. If you look at the ASI's forecast, I think you're specifically asking whether they will reach it for China. All in all, they are already at 52% of the full-year forecast after two quarters, 87% in China. I think it's correct that the Chinese sales would be very low in the next quarter as well, but I think more or less the inventory should be used up, so they should have a strong first quarter next year. We remain very confident that they will reach their forecast for the full years, and so are they. That's what they communicated on their call. As for the profit for next year, we will not comment on our cost for next year until we finish the year, so you'll hear more about that in February when we communicate our year-end results.
There was a question for Anna-Kaija.
Yes, regarding the EU launches. What I can say is that, of course, I mean, EU consists of 27 countries, and all of these countries have their national market access processes on price and reimbursement. I would say that after Germany and Austria, typically being the early launch countries, it takes quite some more time before each country has gone through this process. I would say that we can be cautious when it comes to the sales coming from Europe next year.
I think we are, let's say, infrastructurally wise in a better situation than in the U.S., but still, I mean, this is a new treatment paradigm also that is being implemented. Each clinic has to really go through and have a checklist on what to have in place in order to start the treatments on patients. I think we should be kind of cautious and understanding of the changes that need to be in place in the clinic. It will be rolled out gradually throughout Europe next year.
I just want to remind also that we have said all the time that Europe is a small, small proportion out of the global sales, especially, I mean, the coming two years, but also long term. It is really U.S., Japan, China, and other parts of Asia and other parts of the world that also contributes, yes, a lot.
Great. Thank you.
The next question comes from Viktor Sundberg from Nordea. Please go ahead.
Yes, hi. Thanks for taking my question. So, yeah, I had one first on financials. I just wondered how would you think about the Novartis upfront payment being recognized over 21 months? Will this be in a linear fashion, or how should we think about the revenue contribution of that part going forward? Thank you.
Short answer is yes.
Linear.
Yes, linear. It's very hard to—we are delivering, as we have communicated, we are working on a Novartis compound that we are modifying, and we will deliver it back to them, and that will take some time, and it's really hard to estimate how large a share of that work has been done. You typically do that in a linear fashion over the expected time course of the collaboration. Linear.
Okay. Thank you. Also, I had a question on your competitive position or Eisai's competitive position versus Kisunla. Looking at the curve, it seems that they are accelerating sales. I guess Eisai has done a lot of the groundwork already to prepare for that. I just wonder on your discussions with Eisai, why are some patients choosing Kisunla over LEQEMBI, or why are some patients choosing LEQEMBI over Kisunla? What's your feedback here so far in the launch? Thank you.
Would you like to take it, Anna-Kaija?
Yes. I mean, of course, LEQEMBI is still the number one disease-modifying treatment for Alzheimer's in the U.S. as well. As you say, I mean, of course, Kisunla is having some advantage as being a front runner in establishing these kinds of treatments on the market.
What we can see is that, and what Eisai reports is that it is not kind of reducing the LEQEMBI market, but it is growing the kind of total market as such. Of course, I mean, there is a difference in the—they have once monthly today, and we have twice monthly in the 18-month treatment phase, and then you can choose to go over to once monthly or IQLIK. Of course, every patient is an individual and has to kind of decide what works best for that patient. Otherwise, I think LEQEMBI is still showing a strong growth and driving. In total, it is growing the total markets.
Okay. Thank you very much.
The next question comes from Sebastiaan van der Schoot from Kempen. Please go ahead.
Hi, team. Congrats on the progress, and thank you for taking my question. Just one from our side. Could you maybe give some color on what would be your go or non-go decision for further development of the Parkinson's program? What type of signals do you want to see against placebo to push the development forward, and what could next steps for the program look like? Thank you.
Yeah. I will start and just say that Exidavnemab, which is currently in a phase II-A study, and the main task for this study is to look at safety tolerability. We have two doses. We have had first a lower dose where we had a safety review that supported us to go into the higher dose part in exactly the way that we had planned and wanted. We have also broadened it not only for Parkinson's disease, but also for multiple system atrophy where we also have got orphan drug designation.
I think, I mean, we are doing a lot of biomarkers, but that is really in order to prepare also for next step for phase II- B. I think it is really important to see that the expectation here is really to look at safety tolerability for this program. So far, what we have seen, it looks really good. I think that is—but the readout there will be just after summer next year is what we expect. The study is ongoing and still recruiting, so it is a little hard to say exactly when it happened, but the best estimate is a little bit after summer next year. There is a lot of opportunities for this asset. As we have described before, it can be Parkinson's disease dementia, it can be Lewy body dementia, it can be different parts of Parkinson's disease, it can be MSA.
There is a lot of opportunities. At the moment, we are evaluating different of those kinds of indications and preparing for the next step. I think this is a very interesting asset, very exciting with a lot of opportunities. I do not know if you want to add something, Johanna.
No, I have nothing to add to that. Just to say, to echo what Gunilla said, this is a quite small study and a short study, so not too much should be expected in terms of biomarker readouts. It is a safety and tolerability study. It is three months, and that is a bit too short to see efficacy on biomarkers related to disease modification. That should be the next study.
Got it. Thank you, guys.
Thanks.
As a reminder, if you wish to ask a question, please dial pound key five on your telephone keypad.
There does not seem to be any people in the phone queue right now, but we have some written questions that have been posted during the call, so I will read them out loud, and then Gunilla can direct who should take the question. Although I think the first one is maybe Anders' one, but it is from Peter who wonders, looking forward, when we start to record sales for LEQEMBI in the Nordic countries, how are we going to report that going forward?
In our profit and loss statement, you have our total revenues, and then in the notes, we will have our different revenues split up by line, and we already do, actually. The revenues from the Nordics will not be seen straight away. They are part of what is called co-promotion revenue, which is the reimbursement we get from Eisai for our profit sharing. Over time, yes, I think we will comment on how things are going in the Nordics. I hope that answers the question. Thank you.
A follow-up question from Peter as well regarding OpEx and the difference in OpEx. If you compare Q1 and Q2, it is down in Q3, and he wonders what were the reasons for this, and going forward also, what is the level that we can expect? Anything you can say there?
Right. No, our costs are quite lumpy. If you deduct the other operating expenses, which is mostly currencies, yes, our costs were down a little bit in the third quarter, but we expect them to go up again in the fourth quarter, and then we will see what happens next year, especially what happens after the EXIST trial. If we enter into significant larger clinical trials with Exidavnemab, you should expect increasing R&D spending next year. It's too early to tell exactly what that would look like. Of course, with a maturing R&D portfolio, you incur larger costs, which is a great thing for a company like ours. Thank you.
We had a question from Frederick, but I think we answered that because it came from somebody else as well. Eric from Carnegie has a question regarding the EVOKE trials that are coming up soon in just the next couple of weeks. The expectations on results for the EVOKE trial where semaglutide is tested in early AD in EVOKE and EVOKE Plus. What's our thoughts on that if that study is positive and how that could potentially impact or not impact LEQEMBI? Gunilla?
Yeah. I think I'm really looking forward to seeing the results, and it's quite imminent now. I think it's two well-designed clinical trials in phase III. They did not have a proper phase II, so it's very hard to say anything about what to expect here, I think. If positive, then I think that it's a complement to LEQEMBI. I don't see this as a competitive treatment. I see it's a complementing treatment because it has a completely different mechanism of action and potentially then could help patients together with LEQEMBI.
Okay. Thank you. I think the last one about the risk regarding China, you touched upon it, Anders, but maybe you want to clarify once again what we think about the stocking effect in China and how long that's going to last and when we can expect more new sales coming in in China.
Yes. The stockpile that was built up in Q2, I expected to run out during the fourth quarter. You should see an effect of that on the sales in the fourth quarter, but not beyond that. That would be my estimate.
Yep. Thank you. Those were all questions in the queue. I do not believe, operator, that we have any more questions waiting in line either. If so, I think that concludes today's call. Thank you so much for listening, and we will see you back in a quarter from now. Thank you so much.
Thank you. Have a good day.