Good morning and welcome to Agios Pharmaceuticals third quarter 2026 conference call. At this time, all participants are in a listen-only mode. There will be a question-and-answer session at the end. Please be advised that this call is being recorded at Agios' request. I would now like to turn the call over to Morgan Sanford, Vice President of Investor Relations at Agios. Thank you. Please go ahead.
Thank you, operator. Good morning, everyone. Thank you for joining us to discuss Agios Pharmaceuticals third quarter 2026 Financial Results and B usiness Highlights. You can access the slides for today's call by going to the Investors section of our website, agios.com. Next slide, please. Please note, we will be making certain forward-looking statements today. Actual events and results could differ materially from those expressed or implied by any forward-looking statements because of various risks, uncertainties, and other factors, including those set forth in our most recent filings with the SEC and any other future filings that we may make with the SEC. On the next slide, we have the agenda for today's call. With me today from Agios are Brian Goff, Chief Executive Officer, Cecilia Jones, Chief Financial Officer, Tsveta Milanova, Chief Commercial Officer, and Dr. Sarah Gheuens, Chief Medical Officer and Head of Research and Development.
Following prepared remarks, we will open the call for questions. With that, I am pleased to turn the call over to Brian.
Thanks, Morgan. Good morning, everyone, and thank you for joining us. Next slide, please. The third quarter delivered record product revenue for Agios and is a clear demonstration of our commercial execution. We delivered $55.4 million in total net revenue, more than 4x the third quarter of last year. U.S. net revenue was $48.7 million, driven by the continued strong U.S. launch of AQVESME in thalassemia. To put that in perspective, in a single quarter, we generated more total revenue than we did in all of 2025. This performance reflects what we are building, a focused rare hematology company with a scalable commercial foundation. Thalassemia is the first launch to leverage that foundation. Sickle cell disease, our largest opportunity, is next, and I will speak to the status of our mitapivat sNDA in a moment.
We ended the quarter with $907 million in cash equivalents, and marketable securities, and are well capitalized to support commercial launches and development of our focused pipeline. Next slide, please. As I mentioned, we have the pieces in place to deliver on the commercial launch of mitapivat in sickle cell disease. Let me take a moment to directly address our recent update on our sNDA. As we disclosed last week on October 9th, the FDA asked for additional information to evaluate whether a Risk Evaluation and Mitigation Strategy, or REMS, is necessary for mitapivat in sickle cell disease. We responded within 10 days, including approximately nine months of additional safety data from the RISE UP open-label extension period. The FDA classified our response as a major amendment, which procedurally extends the review timeline by three months to February 1, 2027.
Let me be clear on why we remain confident in a potential approval in sickle cell disease. With this additional follow-up, there continues to be no cases of liver injury in sickle cell disease similar in pattern or severity to those seen in thalassemia. The benefit-risk profile for mitapivat in sickle cell disease is unchanged. The FDA granted this application priority review, recognizing the serious unmet need, and that urgency has not changed. We are in ongoing labeling negotiations with the agency, including elements of a potential REMS, and we are launch-ready. Our commercial, medical, market access, and patient support teams are in place, and we continue to engage closely with the sickle cell community. Our focus is on bringing mitapivat to patients as quickly as possible. Next slide, please. Looking ahead, we are sharpening our focus to drive the next phase of growth. Our strategy is clear.
First, maximize the mitapivat franchise, which is now approved in PK deficiency and thalassemia, with sickle cell disease serving as another growth driver from early 2027. Second, advance a focused rare hematology pipeline. That includes AG-236 in polycythemia vera, where we plan to initiate a phase II/III program by year-end, and cevidoplenib in immune thrombocytopenia, with a phase III trial planned for the first half of 2028. Importantly, both programs have clinically validated and de-risked mechanisms of action. To support that focus, we have right-sized our operating model. Over the course of 2026, we will have reduced R&D headcount by more than 35% compared with 2025, or more than 100 roles, and we expect associated cost savings to be realized in 2027. We are concentrating our clinical investment on differentiated rare hematology programs, and we are pursuing opportunities to unlock value from non-core assets, including our vorasidenib royalty and AG-181.
As a result, we will continue to manage operating expenses as we prioritize investment behind our commercial launches and rare hematology pipeline opportunities, and are targeting non-GAAP profitability in 2028. With that, please advance to the next slide, and I'll turn the call over to Cecilia to discuss financials. Cecilia?
Thank you, Brian. Next slide, please. Turning to our third quarter financial results, total mitapivat net revenue was $55.4 million, including $48.7 million in the U.S. and $6.6 million outside the U.S., compared with $12.9 million in total net revenues in the third quarter of 2025. Cost of sales for the quarter was $2.5 million, compared to $1.7 million in the prior year period. Research and development expense was $73.5 million, compared to $86.8 million in the third quarter of 2025, primarily reflecting reductions in spend associated with mitapivat and tebapivat process development and certain clinical trials. Selling, general, and administrative expense was $56.5 million, compared to $41.3 million in the prior year period, reflecting commercial activities supporting the AQVESME U.S. launch in thalassemia and preparation for a potential U.S. sickle cell disease launch.
Net loss for the third quarter of 2026 was $65 million, compared to a net loss of $103.4 million in the third quarter of 2025. We ended the quarter with $907 million in cash equivalents, and marketable securities, which we believe provides the financial strength to support the AQVESME launch, a potential sickle cell disease launch, and progression of our focused pipeline into non-GAAP profitability in 2028. Turning to our 2026 outlook, full-year operating expenses are expected to remain approximately flat versus 2025, excluding the $25 million upfront payment associated with the cevidoplenib in-licensing, which was recognized in the second quarter, and an approximately $11 million one-time expense associated with the headcount reduction to be recognized in the fourth quarter. Please advance to the next slide, and I'll turn it over to Tsveta to cover commercial highlights.
Thank you, Cecilia. Next slide, please. The third quarter was a record quarter for mitapivat, and I'm proud of the execution across the teams, with total mitapivat revenues increasing more than 4x the third quarter of last year. In the U.S., net revenue was up 20% sequentially, driven by AQVESME demand across the broad thalassemia population, which I will cover in more detail shortly. Outside the U.S., net revenue increased 74% versus the prior quarter, driven by early access programs in Europe following the European Commission approval for thalassemia in the second quarter. This is an early signal of the global opportunity for mitapivat, which we are pursuing through a capital-efficient model with our partners, Avanzanite in Europe, and NewBridge Pharmaceuticals in the GCC. Next slide, please. Now, turning to U.S. demand for AQVESME in thalassemia.
As a reminder, an Agios Start Form is submitted with an AQVESME prescription when the patient and physician opt into our support program. In the third quarter, we added 177 prescriptions from REMS-certified physicians with completed start forms, bringing the total to 619 since launch, which is roughly 15% of our target launch population of about 4,000 patients, only three quarters into launch. This is the last quarter we'll report this metric, so for a complete picture, another 48 prescriptions had start forms in process at quarter end. We communicated previously that first quarter start forms benefited from pent-up demand built during the extended thalassemia FDA review periods. We are now seeing the steady broadening we planned for into community practices and non-transfusion-dependent patients, where treatment decisions take more time. On persistency, approximately 75% of patients remain on therapy at about six months.
This is exactly the foundation we want, a durable base of patients that build over time. Looking ahead, we are focused on two things. On persistency, making sure prescribers know the long-term clinical data we have generated so patients stay on treatment long enough to benefit. On demand, we are expanding our reach in the community setting, deepening adoption in transfusion-dependent patients, and driving uptake in non-transfusion-dependent patients. We are also activating patients themselves through the first direct-to-consumer campaign. Next slide, please. In August, we launched LEVEL UP with AQVESME, our first direct-to-consumer campaign, a targeted omnichannel effort. This month, we are expanding with multilingual assets to reach the diverse thalassemia community. Earlier results are encouraging, and after the launch, we saw a 65% increase in engagement on our patient website. Please move to the next slide. Feedback from treating physicians continues to reinforce the value of AQVESME in thalassemia.
Recent market research shows broad enthusiasm across both transfusion-dependent and non-transfusion-dependent segments. We are encouraged by the momentum three quarters into launch. As the first medicine approved for the broad thalassemia population, AQVESME is well-positioned for continued growth, and I'm confident in our team's ability to deliver. Next slide, please. Turning to sickle cell disease. As Brian said, we are launch-ready and will use the additional time to prepare even further ahead of our February 1st PDUFA goal date. There are approximately 75,000 diagnosed patients aged 16 and older in the U.S. Our initial launch focus is approximately 25,000 patients who are actively treated or in need of therapy, and we will prioritize these patients with hemolytic profile, defined by low or declining hemoglobin. This focused approach is designed to drive speed of adoption. This launch builds on the commercial foundation we established for thalassemia.
In an initial launch population more than six times larger, roughly 25,000 patients compared with approximately 4,000 in thalassemia. Our dedicated sales, medical, and patient support teams are hired and trained. Our manufacturing and supply chain are staged for day one availability, and we have mapped priority physicians. Pending FDA approval, we are well-positioned to bring mitapivat, the first oral PK activator, to people living with sickle cell disease. Please move to the next slide. With that, I will hand the call over to Sarah to cover R&D highlights.
Thank you, Tsveta. Next slide, please. Our pipeline is focused on advancing our leadership in rare hematology. Mitapivat anchors the portfolio with broad global approvals in PK deficiency and thalassemia. In sickle cell disease, we are in labeling discussions with the FDA, including elements of a potential REMS, and we have filed for approval in Saudi Arabia. We also continue to advance our pediatric thalassemia program. ENERGIZE-Kids and ENERGIZE-KidsT have the potential to expand our addressable U.S. thalassemia population by approximately 2,000 pediatric patients. Beyond mitapivat, we are advancing cevidoplenib in immune thrombocytopenia towards a phase III trial planned for the first half of 2028, and AG-236 in polycythemia vera towards a phase II/III program by year-end. Finally, we look forward to proof of mechanism data for AG-181 in phenylketonuria before the end of the year as well. Next slide, please.
We're excited to share new clinical data at the 2026 American Society of Hematology Annual Meeting next month across our rare hematology portfolio, which were highlighted by abstracts released yesterday. In December, we will present new clinical data from the RISE UP phase III trial that we believe meaningfully differentiates mitapivat's profile in sickle cell disease, both on hemoglobin and beyond, potentially driven by mitapivat's unique mechanism of action targeting both PKR expressed in red blood cells and PKM2 expressed in organ tissues.
First, durability. In the open-label extension period, hemoglobin increases are maintained, and more patients continue to show response with continued treatment. 62.7% of patients achieved a hemoglobin improvement in the open-label extension period, including 39.7% of patients who were initially non-responders, and hemoglobin response reaching up to 115 weeks in the open-label period. Second, we are seeing emerging kidney and cardiac data from post-hoc analyses of RISE UP.
In sickle cell disease, hyperfiltration, as measured by an abnormally high eGFR, is an early sign of kidney damage. In patients with hyperfiltration, mitapivat reduced eGFR towards normal, a mean change of 14.7 versus 4.9 with placebo at week 52. Importantly, this kidney effect was independent of hemoglobin response, suggesting the potential for a PKM2-mediated effect beyond anemia correction. In the heart, hemoglobin responders showed favorable remodeling, with a mean reduction in left ventricular mass index of 5.9 grams per meter squared, compared with increases of 5.8 in non-responders and 4.6 on placebo. Left atrial volume was also reduced, supporting the potential for a disease-modifying benefit. Taken together, these data suggest mitapivat, through its unique action on PKM2, may address organ damage, a key driver of premature mortality in sickle cell disease. Next slide, please.
Also at ASH 2026, we will present the first clinical data for AG-236, our siRNA targeting TMPRSS6 inhibitor for polycythemia vera, from our phase I study in healthy volunteers. AG-236 is designed to raise hepcidin and limit the iron available for red blood cell production, which can control hematocrit in polycythemia vera. A single dose increased hepcidin by up to 24 micrograms per liter at day 29 compared with a decrease on placebo. AG-236 also reduced transferrin saturation in hematocrit, with effects on iron, transferrin saturation, hemoglobin, and hematocrit sustained through month six. AG-236 was well tolerated with all adverse events grade 1 or 2 and no serious adverse events or discontinuations. This single-dose durability supports the potential for every six-month dosing, and global key opinion leader feedback described it as a potential paradigm shift in the treatment of polycythemia vera.
We look forward to presenting the full six-month data at ASH next month and updating you on the progress of this program with phase II/III initiation anticipated by the end of this year. Next slide, please. Ahead of phase I-B proof of mechanism data, we are sharing for the first time preclinical data for AG-181, our novel PAH stabilizer for the treatment of phenylketonuria, or PKU. In our preclinical model of classical severe PKU, AG-181 produced significant dose-responsive reductions in blood phenylalanine, and at 300 mg / kg, we achieved the clinical target of below 360 micromolar without diet modification. In our phase I healthy volunteer study presented at the Society for the Study of Inborn Errors of Metabolism 2026 Annual Symposium, human exposures at our phase I-B doses were comfortably within the range of efficacious exposures in mice.
AG-181 was well tolerated with no serious or grade 3 or higher adverse events and no discontinuations, and its pharmacokinetic profile supports twice-daily dosing in our ongoing phase I-B study in PKU patients. We believe AG-181 offers a meaningfully differentiated mechanism for the treatment of PKU, supported by compelling preclinical data and phase I data in healthy volunteers. We look forward to building on that foundation with phase I-B proof of mechanism data in PKU patients before the end of the year, which we believe will position the program for further development and its potential to become a transformative medicine for this community. With that, please move to the next slide, and I will hand the call back to Brian for closing remarks.
Thank you, Sarah. Next slide, please. Agios is a focused rare hematology company approaching its next phase of growth. In thalassemia, AQVESME is the first medicine approved for the broad thalassemia population, and the U.S. launch delivered record net product revenue this quarter. With strong momentum, AQVESME continues to drive growth heading into year-end. In sickle cell disease, we are launch-ready in advance of our PDUFA goal date of February 1st, with a growing body of data supporting mitapivat's strong anti-hemolytic profile and differentiated organ health benefits. Behind mitapivat, we have a focused pipeline with AG-236 in polycythemia vera and cevidoplenib in immune thrombocytopenia, both with clinically validated de-risked mechanisms of action, and we have strategic optionality with AG-181 in PKU. We are executing with discipline, right-sizing our operating model, and allocating capital to the opportunities where we believe Agios can create the most value for patients and shareholders.
Before we open the call for questions, I would like to thank the entire Agios team. Their focus and dedication delivered a record quarter while preparing for our next potential launch. With that, thank you all for joining us today. Operator, we are ready to begin the question-and-answer session.
Thank you. We will now begin the question-and-answer session. If you would like to ask a question on the phone, please press star, followed by one and one on your telephone, and wait for your name to be announced. To cancel your request, please press star, one, and one again. One moment for the first question. Our first question comes from the line of Alec Stranahan from Bank of America. Your line is open. Please go ahead.
Hey, guys. Thanks for taking my questions, and congrats on the progress in the quarter. I guess two questions, one on the PDUFA delay and one around the ASH presentation. Has the FDA raised anything maybe outside of the REMS, such as the age range or any of the clinical endpoints? And I guess if a REMS is required, how would this maybe change your launch expectations around the curve versus what you've seen in thalassemia? Then, just around the ASH updates, I guess, the durable hemoglobin gains, I think it was up to two years, plus the kidney and heart signals seems incremental to prior presentations. I guess, how do you think these benefits maybe stack up versus competing drugs, especially around the PKM2 activation that you highlighted? Thanks.
Thanks, Alec. We'll take that in sequence then. We'll start with your question on the PDUFA, and that's going to be a two-parter. Sarah can begin comment on where we are with FDA, and then Tsveta can talk about commercial aspects, and then we'll take the second question separately.
Thanks, Alec. In regards to the PDUFA delay and the potential other questions raised, no. The engagement with the agency is going very well. We highlighted we are in labeling negotiations. We feel confident in the benefit-risk profile of our drug and are looking forward to work as quickly and as expeditiously as possible with the agency to get this very much needed drug to patients.
Absolutely. The way that we see the mitapivat delay is really a change of timing and not a change in the commercial opportunity. As we know, sickle cell disease affects approximately 100,000 patients in the U.S., and it's going to be the largest indication that we're pursuing today with 25,000, which we identified as an initial launch target. We are ready to launch in any scenario, and we have already a very well-established commercial infrastructure to do so.
Yeah, I will put an exclamation point on the last thing Tsveta said too. Tsveta and her team always prepare for multiple scenarios. Now, I think this quarter in particular is a good demonstration of all the preparation that went into thalassemia with AQVESME, and here we are with continued progress, and we will do the same with sickle cell.
Regarding your other question around incremental data, I am actually very proud of the data. I think this is new data highlighting that mitapivat has potential benefit to improve organ health, both on kidney and cardiac, which of course are two major organs that contribute to killing patients with sickle cell disease. Seeing this data for us was very exciting. It highlights also the potential of PKM2, which of course is a unique mechanism that we have. We are pan-PK activator, so there is not really any competitor that has this mechanism available. We are going to continue to highlight these data, differentiate via the dual mechanism of action, and we are very much looking forward to ASH.
Very good. Thanks. Thanks again.
Thank you.
For the question. Our next question comes from the line of Samantha Semenkow from Citi. Please go ahead.
Hey, good morning. Thanks very much for taking the question, and congratulations on all the AQVESME launch progress. I have two questions as well, but both on sickle cell disease. I am wondering if we can just maybe elaborate a little bit more on some of the potential scenarios for what a REMS could look like for sickle cell disease. Our understanding is that there is varying degrees for those requirements. Then just on the competitive side, can you just talk a little bit in more detail about how you see mitapivat positioned commercially? As we look forward into ASH, and when we go and make our cross-trial comparisons versus competitors, is there anything we should keep in mind in terms of trial design considerations when we do that exercise? Thanks very much.
No, thanks. Thanks, Sam. Sarah, you want to start with actually both of those questions, I think you can-
Yeah, I can start and then maybe hand it to Tsveta as well for the positioning. So in regards to your first question, Sam, around potential scenarios for REMS, you are right that there is a huge range of different REMS. Some of them are focused on just educational components, so a medication guide, for instance, versus then you have a whole range that goes to a REMS with elements to assure safe use, and the ETASU REMS, which is more like the AQVESME-style REMS. As we have highlighted, we are in negotiations with the FDA for a label which includes elements of potential REMS, and that is really all that we can comment on at this point in time.
In regards to ASH and cross-trial comparisons, when we're looking at any trial for sickle cell disease, then of course we would be looking at baseline demographics of a patient population where patients were enrolled, baseline VOC rates to be able to understand treatment effects that have been discussed. Those are things that I would definitely recommend when you're doing cross-trial comparison. Then, of course, one of the other aspects beyond efficacy is safety data, because ultimately it's about a benefit-risk profile for a drug. Then in regards to competitive positioning, I'll actually hand that over to Tsveta.
Absolutely. As I said, we are launch-ready, and we're excited about the potential approval for sickle cell disease. As I mentioned, we have identified about 25,000 patients, which are our initial launch targets. We are benefiting from very good data in sickle cell disease, and these are patients that are actually actively engaged with their healthcare system, seen by hematologists, and have potential shown need of therapy, which is fantastic. The three elements that we are going to look to position the drug around are starting, of course, with the clinical data. The clinical data is very well recognized and accepted by the treating hematologists. We have a very positive feedback both on the consistency and the strength of the anti-hemolytic profile. As Sarah mentioned, we continue to generate data both in the open-label extension and additional data to substantiate the clinical differentiation.
A second very important element is also our market experience and the totality of our safety exposure accrued throughout the years. That's important, of course, for clinicians to have confidence in the profile, but it's critically important in disease like sickle cell disease, where patients themselves are very safety conscious, and we see that as a strength. Last but not least is the trust that we have built with this community. We've been on the market with mitapivat for several years now, and we have a well-established not only medical and clinical development, but commercial infrastructure, which is in place in engaging with these customers, and we'll leverage all of that.
Thanks very much.
For the question. One moment for our next question. Our next question comes from Eric Schmidt from Cantor. Your line is open. Please go ahead.
Thank you for taking my questions. Maybe on the financial side and the R&D cost savings for Cecilia. Can you share an estimate for the degree of cost savings or where you think this R&D spend might end up on a 2027 basis, or even what type of revenue you need in 2028 to achieve that non-GAAP break-even profitability?
Great. Thanks, Eric. On the OpEx front, what we've highlighted is we'll be reducing our R&D headcount by approximately 100 heads or 35% during the course of 2026, and we will see a one-time charge in Q4 of 2026 of $11 million. The impact of the cost savings from those reductions will be seen in 2027, since the majority was towards the end of 2026. We're not providing guidance yet. It's a little early for 2027. On the 2028 target non-GAAP target profitability, we are including the potential launch of sickle cell in 2027 and a disciplined approach to managing our OpEx.
Okay. Maybe if I could add a maybe somewhat technical question for Sarah on the elements of the REMS program and sickle cell that are being discussed. Is it possible to have a different REMS program in sickle cell versus what you have in thalassemia and still be approved under the same brand name of AQVESME, or would that require sort of, yeah, a third brand name if you had a slightly different REMS? Thanks.
Thanks, Eric, for the question. Like any options of those are always possible. There is a whole range of the brand names and the types of REMS. We can't comment at this point on ongoing label negotiations. We will really look forward to completing these. I think Sam touched upon the range of potential REMS, and so all of those are possibilities.
Okay. Thank you.
Thanks, Eric.
One moment for our next question. The next question comes from the line of Gregory Renza from Truist Securities. Your line is open. Please go ahead.
Hey, team. It's Anish on for Greg. Congrats on the progress this quarter and for taking our questions. First on AQVESME, just how much of the 177 completed start forms and 48 new ones came from NTD versus TD patients, and what is driving the sequential moderation? Second, on AG-236 in the therapeutic window, what gives you confidence that the six-month effects in healthy volunteers can translate into sustained phlebotomy control in PV without excessive iron restriction or anemia? Thanks so much.
Tsveta, do you want to start with AQVESME and our continued progress?
Absolutely. We are very encouraged by the first three quarters of the launch. We are building the thalassemia market, and really, AQVESME is the first medicine approved for this broad thalassemia patient population. We're not giving the split on TD and NTD, but I'm very pleased to see the demand continue to broaden in both segments, the transfusion-dependent patients as well as the expansion in the non-transfusion-dependent patients, and that is great. When I look at the performance in totality, it's 619 prescriptions that are coming from start forms, that is the completed start forms, which is about 15% of the total launch patient population. The additional 48 prescriptions are really the upstream demand, which still are in process and are part of the demand funnel. For us, that's very, very encouraging. Very importantly, moving forward, I just want to emphasize the point on persistency.
We reported that the initial kind of persistency that we see right now for patients every six months is 75%, and that is probably one of the most important elements given that thalassemia is a chronic disease, and revenues moving forward will be really comprised of course, of new patients starting on therapy, but more and more as patients continue on therapy.
Anish, we talk a lot internally about health of the launch and building on our rare disease experience. I think what Tsveta just described is what we look for, which is we're three quarters in, we're making continued really good progress into a very significant opportunity. We're seeing breadth of prescribers, breadth of patient types. As Tsveta just said, we gave some color on that today. Persistency and all of that stacks together for very healthy dimensions that we're quite pleased about. Of course, all these learnings we're going to look to amortize into a potential sickle cell disease launch as well. Sarah?
Yep. In regards to your question on AG-236 and iron restrictive anemia from healthy volunteers going into patients, this is obviously we're running the phase II to do proper dose finding in patients. We're very excited about the data that are going to be presented at ASH, which allows us to move forward into patients. We believe, based on that data, we have really an opportunity to bring this dosing frequency to an every six months dose.
That will be the goal of the phase II, to test this across a range of doses and a range of frequencies. We're very excited, once we have that data, to move seamlessly into phase III.
Thanks so much.
Please hold for our next question. The next question comes from Douglas Tsao from H.C. Wainwright. Your line is open. Please go ahead.
Hi, good morning. Thanks for taking the questions, and congratulations on the progress. I guess maybe just on the AQVESME launch, I am just curious, in terms of the 75% persistence, which is really impressive, is there any difference between the non-transfusion-dependent and transfusion-dependent patients right now?
Absolutely. We are very encouraged by the initial signs on persistency with the 75% of the patients continuing beyond the six-month mark. We are seeing a strong persistency across patient segments, and that was actually also true for the PK deficiency indication, so it is wonderful to see that also in thalassemia as well.
As a follow-up, I am just curious, in terms of the data that was presented at EHA last year, have you had a sense that clinicians are more willing to sort of extend trialing with patients than perhaps they were ahead of that dataset?
Yeah, absolutely. I think in the real world, the benefit from AQVESME is defined a lot broader than what we see in the clinical trial. The clinical trial criteria are very, very specific and well-defined for regulatory purposes. But people are looking, of course, at how patients feel, as well as also their hemoglobin increases. Here, I just want to highlight also the fact that we have an excellent payer coverage. The team has done a phenomenal job, and within six months of launch, we have payer coverage policies for 75% of covered lives, and they are very, very favorable for AQVESME. So, we have no payer restrictions.
Okay, great. Thank you so much, and congrats on the progress.
Thank you for the question. Please hold for our next question. Next question comes from Andrew Berens from Leerink Partners. Your line is open. Please go ahead.
Hi, this is Amanda on for Andrew Berens. A question that I think you've touched on a little bit already, but just to get a little bit more color, could you outline the potential options around pricing and brand strategy if you do get a REMS during the sickle cell review? Thanks.
Thanks, Amanda. Tsveta, do you want to take that? Of course, we never get specific on pricing, but I think we can dimensionalize how we think about it.
Absolutely. When you think about sickle cell disease from a payer perspective, it is still a rare disease, a rare disease with very high unmet need and no treatment options. We are preparing, as we said, for all the launch scenarios, but irrespective of the launch scenarios, we think we can maintain a what level of rare disease pricing, which is very similar to what we have with PYRUKYND and AQVESME, given the strength of the value proposition of mitapivat in the sickle cell disease indication. Of course, sickle cell disease has a little bit more Medicaid patient population, and that will impact the gross to net, but we are very well positioned from a pricing perspective.
Thank you for the questions. One moment for our next question. The next questions will come from the line of Joseph Thome from TD Cowen. Please go ahead.
Hi there. Good morning, and thank you for taking my question. Actually, one on the pipeline. What should we expect from the upcoming proof of concept data in PKU? What would be encouraging there? Given your updated R&D focus and headcount reduction, is this something that remains in your focus, or would you look to out-license this asset? Thank you.
In regards to proof of mechanism data in PKU patients, obviously, we are looking for safety because it is a phase I-B, but then also looking at Phe reductions, the classic way one would look at it from a PKU perspective. We believe this program then gives us the potential for further development, and so we are excited about that.
Yeah, and Joe, I will just add, this is, as I mentioned in my comments earlier, it is obviously PKU is high unmet need, though not hematology. First step, of course, is get the data, which we are eager to see. And I had noted that we maintain optionality. So, we have certainly the option of keeping that in our portfolio. We know that there is also a lot of interest in PKU in general as a market that continues to develop and grow, and so we feel like we are in a position of strength to have that option.
Great. Thank you.
You bet.
One moment for our next question. Our next question will come from the line of Tess Romero from JP Morgan. Your line is open.
Hi, Brian and team. Thanks for taking our question this morning. I wanted to ask a question to Tsveta here. In the third quarter, 177 AQVESME prescriptions was completed. Agios Start Forms were written. What is the right way to think through the run rate for that script add per quarter as we move ahead in your launch? My second question was just around the 75% of patients that remain on therapy after six months. What are you seeing in the marketplace in terms of why patients discontinue if they do? Thank you.
Sure.
Absolutely. On the first question, what I will highlight is, look at the first quarter first in totality. We recorded 619 prescriptions with completed start form and additional 48 in progress, which positions us roughly about 15% of the total addressable patient population for thalassemia for our launch target, which is a very good start for a chronic, not imminently life-threatening disease. When you look at the quarter-over-quarter evolution, Q1, as we already have highlighted, and to a lesser extent, Q2, really benefited from that pent-up demand, which was built during the extended FDA period. We are now seeing the broadening, which we always expected and planned for, into the community practices as well as the non-transfusion-dependent patients, where treatment decisions take more time. Looking ahead, the 177 is probably the more appropriate run rate as we continue to penetrate these markets.
I am going to highlight it again, given the chronic nature of the disease, an important element for us that we are very excited about is also the high persistence that we are seeing in the initial stages of the launch, because moving forward, of course, the revenues will be driven by both the new patient starts and patients on therapy as well.
Thank you for the questions.
Okay.
Our next questions will come from the line of Salveen Richter of Goldman Sachs. Your line's open. Please go ahead.
Thank you. Good morning. Ahead of the PDUFA for sickle cell disease, could you just speak to the physician overlap with thalassemia and their comfort around a potential REMS inclusion here?
Absolutely. We are obviously in regular contact with the physician community. The team is in place, and we are doing an extensive account profiling. Brian, Sarah, and I, in the last few months, had an opportunity to connect with the sickle cell disease KOLs at different forums. I can tell you that there is a very high level of engagement and excitement, both on the profile and the potential approval for the product. When we think about the hematologists that treat hemolytic anemias, really what we call an overlap will exist mainly in the academic setting.
We haven't given specifics on the overlap, and this is mainly driven by the fact that if in the same center you might have hematologists who are focusing on hemolytic anemia, but some of them might be specializing on thalassemia, some of them might be specializing in sickle cell disease. Otherwise, in the community, every hematologist treats both conditions, both thalassemia and sickle cell disease.
Thank you for the questions. Our final question comes from Luca Issi from RBC Capital. Please go ahead.
Oh, great. Thanks so much for taking my question. Congrats on all the progress. Maybe it's better. Again, congrats on the 619 cumulative prescription here for AQVESME and the additional 48. Are all of these prescriptions coming from thalassemia, or are there any of them actually coming already from sickle cell disease? We spoke to a doc the other day, and she claimed that she already has put 10 to 15 of her patients, her sickle patients, on this drug, and she had actually little pushback from Medicaid versus she claims that there's much more pushback on Medicare and commercial. So, wondering if that doc is just kind of one-off or there is a meaningful proportion of that 619 that actually is already coming from sickle cell. So any call there, much appreciated. Then maybe Cecilia, circle back on Eric's question.
As the P&L continues to mature here and you're starting to see non-GAAP profitability on the horizon for 2028, is there a plan to actually guide the top and maybe the expense line in 2027, or would that be maybe too premature? Thanks so much.
Start with, Tsveta, let's start with the question around the 619 and the 48.
Absolutely. I just want to be very clear. Both the 619 and the 48 are on-label thalassemia prescriptions.
Yep. Cecilia, question around the P&L and future guidance and so forth.
Yeah, so it's a little early, Luca, to guide on 2027, but we look to provide guidance at the appropriate time.
Got it. Thanks so much.
Thank you.
With that, we conclude our Q&A session, and I would like to turn the call back to Brian Goff, Chief Executive Officer, for closing remarks.
Great. Thanks a lot. Thank you, everyone, for joining us today. As we talked about, the third quarter delivered record product revenue for Agios. AQVESME is building a durable, growing base of patients in thalassemia and in sickle cell disease, which is our largest potential opportunity. We are launch-ready ahead of our February 1st, 2027, PDUFA goal date. We have over $900 million in cash, a disciplined operating model, and we are well-positioned to execute as we target non-GAAP profitability in 2028. We look forward to updating you on our progress, including at our upcoming virtual ASH investor event.
That will be on December 14th, where we will be featuring new clinical data for mitapivat in sickle cell disease, further strengthening our profile, as well as six-month healthy volunteer data for AG-236, which, as Sarah commented on, supports every six-month dosing, meaning we have the potential to deliver a best-in-class medicine for the treatment of polycythemia vera. Thank you very much, and look forward to speaking soon.
That concludes today's conference call. Thank you for your participation. You may now disconnect your line.