Great. Good morning. Welcome. My name's Jess Fye. I'm a biotech analyst at J.P. Morgan, and we're continuing the 44th Annual Healthcare Conference today with Crinetics. You're going to hear a presentation from the management team, and then we're going to go into some Q&A. So if you're in the room and you want to ask a question, raise your hand. Someone will bring you a microphone. Or if you're listening online, you can always send questions to me over the portal. So with that out of the way, I'm excited to turn it over to Crinetics CEO, Scott Struthers.
Thanks, Jess. And thank you all for coming. It's great to see you. Thanks to you online that I know are listening. And I appreciate seeing some of our fellow shareholders and new shareholders and future shareholders. I've been coming at this podium here with Jess since, what, 2018? And we started with telling you about CRN808, which was our first molecule and first in human data. And then as 808 evolved into paltusotine for the treatment of acromegaly, we updated on that. And then we started to talk about building a pipeline behind it and building a company behind it. And today I want to talk about building a business behind it. Reference our forward-looking statements. So 2025 was a breakthrough breakout year for us. In many ways, it's a culmination of the many years of work that we've done since 2008 when we started the company.
One of the bigger achievements, of course, was managing to get approval of a broad label for Palsinify for the treatment of acromegaly on its PDUFA date. And what I must say was a, perhaps the right word is dynamic time at the FDA. And I'm very proud of the team that managed to do that. But then we followed through with a successful launch. We reported on that last week. I'll give you a little bit more details on that today. We reported positive phase two data on atumelnant, our second internally discovered compound that I think has the potential to transform the treatment of CAH. We initiated phase three studies in carcinoid syndrome for a second indication for paltusotine in adult CAH with atumelnant and a new compound, 9682, in a phase one two study in NETs. We're building a fully integrated company at this point.
Last week we added to our balance sheet and we're funded through 2030 with roughly $1.4 billion in the bank. This is a solid foundation for us to build a business. This funding carries us through the potential approvals for carcinoid syndrome, CAH, the approvals for atumelnant, and gets us through the rest of the decade. I think we've seriously de-risked the company with that. So here's our pipeline. Excuse me. Here's an overview of our pipeline leading with paltusotine, followed by atumelnant and its indications, 9682, and what you can see from the populations of patients on the right that in these rare and orphan diseases, there is significant potential both to help people and to build significant value from this pipeline.
And if you scroll this pipeline forward a few years, we begin to see when those approvals may hit and the depth of the late stage pipeline we'll have as we go through the rest of the decade. And we continue to work on our internal discovery efforts. I should mention every one of these molecules has been internally discovered. The patents go into the 2040s at the earliest and continue on from there. And we continue to work on a number of different things shown on the lower left that I think some will be emerging next year or, sorry, this year, 2026, into the clinic. And in some cases, we found it better to work with some of our partners. So Sanwa or SKK, we licensed paltusotine for Japan rights.
The technology for non-peptide targeting that led to 9682 is also very intriguing for the delivery and targeting of radiopharmaceuticals. And so we spun out Radionetics Oncology for that. And then endocrinology touches every cell on every animal on the planet. And we're a dog lover company, and we thought we could help dogs in some way too. So we partnered with Loyal to use the tools of endocrinology to extend the lifespan of large breed dogs. That may come out of the blue to some of you, but if you'd like to learn more, Celine, the CEO, is right over here in the second row, and you can catch her after the meeting. But endocrinology has so much potential to change human health that I just look at this and think about all the new things we can be doing as well.
But first, let me spend a moment on the business. So we got the approval September 25th for Palsinify for the treatment of acromegaly. It was a broad label for newly diagnosed patients, patients switching from standard of care. And I'm very pleased that now as a company, we've been able to conceive of, develop, get approval, and actually deliver a drug to patients. And that doesn't happen very often. I think there was, what, 31 NCEs, small molecules last year. And we're proud to be one of them. But we're more proud that now there's more than 200 patients have enrolled in the last quarter for Palsinify. And all our OLE patients rolled over into a commercial drug. We've had patients in the open label extension for four years plus, and 90% plus percent of people in the trials have enrolled into the open label extensions.
And just a good acceptance of the drug from the patient population. And this came with a broad set of prescribers, more than 125 unique prescribers. And getting that experience with the initial patients is important because they've got a lot more patients that I think they will begin to switch and/or treat. And this is from a broad group, not just in the academic centers, but about half the scripts are coming from the community endocrinologists. And we find that the community endocrinologists sometimes are much more accessible than, say, at the pituitary centers where you may need to wait for six months or a year to get your annual appointment. But some of the community endocrinologists have been calling patients, telling them about Palsinify, or manage their patients every few months. So that's been a great source of support for us.
Also, our payer group has done a great job of telling the payer community about the value that Palsinify can bring. And we have an extensive patient services program, including a Quick Start program. So if there's any delay in getting an approval for their drug within the first few days, if they can't get that approved, we send them a Quick Start program while we help them work with their insurance company on getting approval. And roughly half the bottles are getting approved and shipped to patients before they need to get on the Quick Start program. So we found that a good evidence of payer acceptance. And this is all through the medical exception or mostly through the medical exception. We did have a nice announcement from CVS Caremark covered us on formulary last week.
But when we are getting these prior authorizations, the vast majority of them tend to be for 12 months. So that is also good evidence of payer acceptance. And you put all this together, and last year we achieved somewhere around a little over $5 million. We'll report the full audited data in our quarterly earnings call. But a successful launch by the numbers. But more importantly, from Crinetics' point of view, is what this means for people. And we've gotten to know we've had patients as part of our development and design program in all our programs. And these three patients are the first of our patient ambassador program. Some have been on the drug only weeks or a few months. Some have been on for four years. And the stories that we're hearing from them and others are really gratifying.
Megan went down several ring sizes because of the reduction of the swelling of her hands, which allowed her to wear a wedding ring again. That's kind of a big deal. David is a musician and loves playing, but was inhibited from that, either guitar or piano, just because of hands and swelling, and Ashley's been on for more than four years now and has been eager to complete the OLE shift to commercial supplies and is now going to be one of our ambassadors, and we'll expand this program. These are just the first three, but patients want to hear from patients, and they'll be out helping and teaching not just about Palsinify, but what it's like to manage acromegaly and how to help navigate the healthcare system. We've got a broad set of services, both to help patients manage this.
We've got a hub called CrineTicare.com where you can call and get support from nurses. We've got nurse educators. We've got field reimbursement specialists. We're really trying to provide a comprehensive solution to patients and their providers. And part of that is because I guess one of the realizations, for those of you who don't know me, I'm a discovery guy at heart. And as we started approaching the launch, what we realized is that making a good drug is just a small start of the whole problem. So if you look at this, there's 36,000 patients with acromegaly in the U.S. And our initial phase one of the launch is focused on these folks, less than 10,000 patients who are actively being managed. And surprisingly, so the standard of care for acromegaly are what are called these injectable SRLs, which are large gauge needles each month.
There's a variety of challenges with it. It's a standard of care, and only 3,000 of those 36,000 people are on that drug. Some remain untreated, this 4,500 remain untreated. I don't think they've all been cured by surgery. We can do a lot just in this initial phase, but perhaps more troublesome is in the center, the next phase that we're just beginning later this year. There's another 9,000 patients who have dropped out of care for one reason or another. Sometimes they've maybe given up on the drug, or maybe they think they've been cured, even if they're not. The other part at the end in phase three is that there's roughly 17,000 patients walking around in the U.S. today that have not yet been diagnosed. It takes five to 10 years to be diagnosed with acromegaly.
And it's really easy once you suspect acromegaly to diagnose it. But that five to 10 years, they're accumulating damage from uncontrolled hormone levels. And so we're going to launch efforts to try and improve that diagnosis. And I've been asked flat out if Palsinify can ever be a blockbuster drug. And I think most people think it's a niche little market because of that 3,000 people of injectables, and they think maybe we'll get some share of that. And I'll just say here today very clearly, if it's not a blockbuster someday, I think we've screwed up. Look at this number of patients. At the price that we have with this, it's roughly somewhere less than 5,000 patients per $1 billion of revenue. If we can't help more than 5,000 patients, we've not done our job. So the second indication for Palsinify is the treatment of carcinoid syndrome.
We reported some great phase 2 data a little while back where you could see the reduction in the symptoms, which is flushing and severe diarrhea, and some individuals going from 6, 7, 8, 10 flushing episodes or diarrhea episodes a day down to normal levels, which is essentially zero for flushing and a couple of times a day, a few times a day for bowel movements, and reduction in the severity. And we've launched a phase 3 trial in this with more than 20 sites activated. The first patient enrolled last November. It'll have an OLE to look at real-world evidence. But here's another 18,000-34,000 people in the U.S. with carcinoid syndrome. And we know this mechanism of action works. So there is a potential here for another large indication and frankly, to help a large number of people.
A second molecule which we internally discovered is atumelnant, which is an ACTH antagonist. For those of you who don't know, a guy named Harvey Cushing discovered a disease called Cushing's disease in 1910. We discovered ACTH in the 1930s as the main driver of adrenal activity. All of us in endocrinology have known that an ACTH antagonist would have some very powerful uses, but it wasn't until we managed to come up with atumelnant that we've been able to test that in the clinic. This is the first and only, and it's once daily oral again. It's an MC2R antagonist, which is the ACTH receptor, and it selectively blocks the ACTH receptor on the adrenal, which is the only place this receptor is expressed and the only thing it does. It's a principal regulator of the adrenal cortex, and excuse me, the ACTH is made by the pituitary gland.
It controls the stress response pathway. It controls metabolism, and when it gets out of control in things like congenital adrenal hyperplasia, where the adrenal starts making androgens instead of glucocorticoids, and the androgens are things like A4 that are marked down here, we believe that then atumelnant can block those and help treat some of the symptoms of the disease, and I'll get into that in a little bit in the next slides, so with CAH or congenital adrenal hyperplasia, as I said, the adrenal is not really working anymore. It's not making cortisol, which you need to survive. So you've got to take some cortisol back. But it's making these precursors to cortisol, much of which are androgens, and in women, these cause infertility issues, hirsutism, and both men and women, it causes infertility. In men, it leads to testicular adrenal rest tumors.
And until recently, the only tool we've had to manage it is giving them more glucocorticoids. And if you give too much glucocorticoids to try and push down those adrenal androgens, well, then you start getting Cushing's disease because you have too much glucocorticoids and you start getting loss of glucose control, weight gain. There's a variety of other problems with glucocorticoids like osteoporosis. So there's a wide range of patients out there with CAH. Some have high adrenal androgens, but they've maintained normal glucocorticoids. Some have normal adrenal androgens, but they can only do it with high glucocorticoids. And many are very high in both still. Now, this is routinely diagnosed at birth, so it's not a question of finding patients. It's a question of treating them.
Our vision for atumelnant is to have an uncompromising path to controlling both dimensions of these hormones so that a single pill once a day can eliminate that excess ACTH-driven adrenal byproducts and allow the patient to just take normal physiologic replacement doses of glucocorticoids. We're well on that path with our phase two data. Earlier last year, we showed the dose response in three cohorts from 40-120 milligrams. You can see dramatic reductions in this biomarker A4 with nice dose-dependent suppression. These were all given with a dose of atumelnant in the evening, measured A4 in the morning. We were very pleased with those results. While we were getting ready for phase three, we had a little extra time.
And so we decided to test 80 milligrams again, but in a different paradigm, giving it in the morning when it is a little more convenient for some people. But also in the first three cohorts, we kept them on a stable dose, whatever dose they were on of glucocorticoids. In this fourth cohort, we reduced the glucocorticoids as best we could to normal levels. And what you can see is that even despite the morning dosing and despite the glucocorticoid reduction, you essentially have the same data you had if you kept the glucocorticoids high. So the glucocorticoids weren't mattering for the effect of the drug. And that's shown perhaps a little more clearly here where I focus just on the time course for cohort four.
In green, you can see the serum adrenal androgens going down dramatically within two weeks and then maintaining that reduction throughout the 12-week treatment period of the study. At the same time, we're lowering the glucocorticoid dose to where 7 out of 10 of these patients are getting to normal levels of glucocorticoid replacement, and there's no rebound in the adrenal androgens, so like we hypothesized, we've now been able to dissociate adrenal misactivation from the glucocorticoid replacement, and our goal for phase three then is to look at the ability of atumelnant to let people achieve normal hormone levels on both dimensions, studies designed as a responder analysis so that those people who get there on drug compared to placebo will tell us the answer. Now, of course, we've got a variety of secondary endpoints.
I was super pleased in the phase two program that we're also seeing some clinical outcomes. We had multiple women who had been amenorrheic or oligomenorrheic return to normal menses. We had testosterone lowering in women. We had reductions in polycythemia, which is excess red blood cells due to excess androgens. I think now, as we go into phase three with longer treatment periods and glucocorticoid reductions, that perhaps we'll be able to see some of the effects on the reduction of excess glucocorticoids, which should result in weight loss or waist improvements or HbA1c reductions. And so we're very excited and moving as fast as we can to ramp this study up. It's already active and going. Importantly, though, excuse me, atumelnant continues to be well tolerated throughout the whole program with stable glucocorticoid doses.
And if the glucocorticoid doses are reduced, we've seen no additional elevations of liver function tests in the cohort four or in the open label extension. We now have over 750 weeks of cumulative CAH patient exposures from the phase two and the OLE. We have more than 200 overall participants who've received Atumelnant to date across the clinical program, including CAH. We have a parallel Cushing's study going on that I'll talk about another day and all the healthy volunteer and clinical pharmacology studies. So we're very pleased with that drug. Excuse me. And then coming back to its potential, roughly 12,000 patients in the U.S. and 5,000 kids. The data we've shown so far shows rapid and sustained reductions in these adrenal androgens despite reducing glucocorticoids to normal levels in 7 out of 8 patients. And overall, we're very happy with the benefit-risk profile.
The pediatric trial is getting underway in the first half of this. The phase two open label extension has now got roughly 25 patients enrolled in it. Those patients will continue to provide a cohort that we can follow and monitor both biochemical and clinical outcomes. We'll be reporting on that as the data becomes available. 9682 is our newest entry into the clinic. This is a whole new platform similar to what we did with the Radionetics platform, where we're using small molecules as drug targeting agents instead of like antibodies in an ADC. Small molecules come with a variety of advantages over antibodies for drug targeting. For one, you can tune every dimension of chemical space to get the pharmacology or PK or biodistribution you want.
You're not limited just to an antibody, which is typically difficult to have a short half-life on because really you want to deliver your payload and then get out of the way. And it allows for chemical synthesis rather than bioconjugation reactions and fermentation. But 9682, we've extensively optimized to target the somatostatin 2 receptor. The targeting ligand is not Palsinify. It's a separate molecule we've optimized to bind with high affinity and drive internalization of the receptor. The linker has been optimized to be stable in plasma and only cleaved inside the intracellular compartments. The payload is a payload we borrowed from the ADC world. And we're starting now a phase 1/2 trial in this in patients with SST2-positive expressing solid tumors. Now, if you look just at the neuroendocrine tumor space, there's probably 11,000-21,000 people that are being treated now with various anti-tumor agents.
A large number more with neuroendocrine tumors are not. The standard of care in neuroendocrine tumors is to use a somatostatin-targeted PET scan to stage and characterize the disease. So all of these patients are getting tested for somatostatin expression. So we'll go into patients who we know express the target in the tumors at a level we think is adequate. But as that field has been developing, I think we saw Aktis today or this week or last week and the success of the other radiotherapies like Lutathera. Many of these are targeting SST2 receptors. And what we're seeing is that as you start looking at other types of tumors, many of those also express somatostatin receptors. The vast majority of head and neck, paragangliomas, meningiomas, small cell lung cancers are high-grade neuroendocrine tumors. There's a population of ER-positive breast cancers that are somatostatin positive.
So the potential for this could go well beyond neuroendocrine tumors. And we're just figuring that out now. But I think the difference between this and the radiopharmaceuticals is it democratizes therapy. You don't need to go to a center. You don't need to be radioactive for a couple of days and not go back to your family. This is something that any infusion center in any community oncology clinic can manage. So very excited to see this. The screening queue has been full since we opened the study. We're working our way up dose escalation cohorts. Then we'll get into expansion cohorts. I'm really excited to see that progress this year. So wrapping up, if I look forward to 2030, I think you'll see us emerging as a premier endocrinology business. This is a business that will be sustainably growing and funded by revenue, not just equity capital.
We should have two marketed products with four approved indications. And I showed you the potential for those indications. Moreover, our efforts in discovery and development should result in another seven clinical pipeline candidates working their way in. Some will be late stage by this time. And finally, we continue to invest in our discovery labs. And there's a bunch of new targets that I'm very excited for the group to get started on that we'll tell you about someday in the future. But put all this together, and I think it's a fairly unique profile for a company. And I've been very privileged to lead a great group of people with a very unique company and culture. But I've also been grateful to the support of many of you who've been longstanding supporters and owners of the company along with us in management.
Just take a moment to thank all my staff who's delivered all this, the patients, the investigators, you, and others. Take your questions. I've got Toby, our Chief Financial Officer, and Isabel, our Chief Commercial Officer, to help if I don't know the answers. Thank you.
Great. So as a reminder, if you're in the room and you want to ask a question, just raise your hand. Someone can bring you a microphone, or you can also submit them to the portal online. But I guess maybe starting with Palsinify and just expanding on the launch a little bit, can you talk about the top priorities to drive Palsinify's growth in 2026? And maybe I'll add on to that a little bit. When you have north of 200 enrollment forms across 125 unique writers, what's your interpretation of kind of the interplay of those two numbers?
Go ahead, Isabel.
Thank you. Well, our goal is to become the newest standard of care in acromegaly. And we are very pleased with the very strong beginning in that journey. So for 2026, our priority is to expand our prescriber base and penetrate more into the community segment, but also into the PTC centers and get breadth of utilization. We really want to have champions for our drug. We are transforming the lives of patients. And as the product continues to deliver, sometimes above the clinical trials in the real world, we want to also disseminate more of that data in real-world publications and case studies as we go in 2026. Second, we really want to activate the patients. Many patients in rare diseases, and particularly in acromegaly, have settled with their current conditions or have given up hope and are not in any treatments. We think we can bring them back.
We have a drug that delivers a fast onset of action, great control of the disease, meaning symptom control and IGF-1 control, and it's easy to take. It's a once-daily dose. So we have the full package to bring them back, and at the beginning of that journey of activating the patients, it's really a start with our peer-to-peer program and really for the patients to hear from other patients, and last but not least, we are going to be focusing on execution with payers. We have been successful in these medical exceptions, and we had gotten many of our prescriptions reimbursed. We're going to get to more of that, and we are very actively presenting our value proposition with payers. We have several meetings set up. We want to be in as many formularies as possible, really convert to label.
As Scott mentioned, we started this year with CVS covering us over 27 million lives, to label, no step edits. That's what we want to achieve in the execution of 2026. Our goal is to continue to grow and to have as many patients as possible benefiting from this great therapy. In terms of your second question, well, we are very pleased to see that there is no one prescriber driving the market, that we have many physicians that are giving the opportunity to their patients to be on drug. Every one of those physicians will see the experience. They are in a trial period, and they have a second patient and a third patient. That will help us grow. We're very pleased that it's not coming from three or four prescribers, but that we see a broad base of prescribers associated to those enrollments.
Okay. And you mentioned CVS. So can you talk a little bit more about just how patient access to Palsinify has played out so far, how you anticipate payer coverage access, and frankly, gross to net dynamics evolving from here?
We have a very strong payer team. And in general, the commercial organization and the medical affairs organization, I'm very pleased that they are so focused on execution and are true advocates of the patients. So our market access team has a very strong hub with a set of services. One of them is, of course, benefit verification and accelerating and partnering with our specialty pharmacies to ensure that as many of those claims get reimbursed right after the enrollment is received. And as Scott shared, about 50% of those have been covered in a short period of time, many of them within 72 hours. We have a very strong label. We have a right package for those prior authorizations. And we are moving relatively fast through those medical exceptions.
If the patient doesn't have the coverage or it takes a little bit longer to get that through, we go through the Quick Start program. And once they are in the Quick Start, we, of course, continue to partner with their physician or the specialty pharmacy to move that to a reimbursed claim. One thing that has been positive for us is because the drug works so fast within two or four weeks, we submit that data in addition to other additional clinical notes. So the average movement between Quick Start and reimbursed timelines in rare diseases is about 57 days. We're trying to stay within that or less. And we'll continue to proceed on that. And of course, we have several meetings set up with payers. And we have a very strong value proposition to deliver. And it's resonating well with them.
Yeah. I think for your second question in terms of gross to net, right now, we have no plans to discount to commercial payers. So our gross to net is driven by two things, basically, the mix of business between the commercial payers and the government pay. And then secondly, sort of the mix of business that's happening in 340B institutions and non-340B institutions. So those are kind of the key drivers of where the gross to net will play out over the next year. And right now, it's pretty early innings, but we'll see how that plays out. But we're really comfortable with our early estimates.
Can you say where you see the mix of those two, either so far or in the future?
Yeah. Right now, based on sort of our early estimates and sort of prior mix, we thought about 60% of patients would be commercial pay, and about 40% would be Medicare and Medicaid. And it's really early to say on the PTC mix right now, primarily those are driving the 340B institutions. So that's the big swing factor.
Gotcha. Maybe we can touch on carcinoid quickly. But what are the next key milestones for the carcinoid program? And when could we expect pivotal data?
We're actively enrolling now and enrolling sites still around the world. The next big milestone will be completion of enrollment. That'll start the clock ticking to when we expect to report data. Typically, don't want to guide to exactly when we expect that enrollment to finish because you never know. You never know when that last patient is going to come in. One of the things we've done is our Chief Operating Officer, Jeff, and his team have been working on a variety of different things that many of you may find boring but are really important in terms of accelerating our clinical trials. Some include that we've now started monitoring and doing all the contracting work in the U.S. ourselves rather than through CROs, which starts the relationship earliest in the clinical trials with the people that will end up being our prescribers.
Others are how we construct these contracts and incentive schemes with CROs and with sites.
Okay. Maybe shifting to Atumelnant and thinking about that cohort four data you recently released, what are the arguments to expect or not expect similar results in phase three?
Look, I think we've shown throughout the development program that Atumelnant can completely block the ACTH receptor for most patients and most people, excuse me, and we've shown this in multiple ways, and so cohort four data was not a surprise to me and shouldn't have been a surprise to the community because I've been explaining why we expected it. Even in our phase one, when we took healthy volunteers and we challenged them with massive doses of ACTH, they still maintained very low adrenal activity, and so between that and in our Cushing study at the NIH, where every patient is getting to very low glucocorticoid levels, this is a disease where they have excess glucocorticoids, and everybody is getting down into the normal range.
And now, with all the data in CAH, everything points towards, from an efficacy point of view or pharmacology point of view, that we should have a very high degree of response and responders. The wild card in CAH really comes down to compliance issues and managing high-quality clinical trials, which, again, is something to easily underestimate how hard it is to do that. But what we showed in our phase three program for Palsinify was very high-quality data with making sure we got the right patients in without protocol violations and a very solid data set to work with. So we're trying to replicate that as part of building a company that can do good global clinical trials.
So that kind of takes me to my next question, which is it sounds like you're emphasizing almost a methodical approach to executing the study to kind of ensure the best results. So how should we think about the timelines for phase three enrollment and data? And I guess related to that, how does the availability of crinecerfont factor into that thinking?
Yeah. So the reality in rare disease clinical trials is that the bulk of patients entering the trial come from outside the US. It's a cultural thing in the US. So the short answer is that I don't expect the launch of crinecerfont to hinder our ability to recruit the trial, primarily because most of the patients will be ex-US. But in the US, maybe it'll even help us a little bit because we're building, we, meaning the endocrine community, are building an awareness that you can treat your CAH in ways other than glucocorticoids. And I think that's important. Crinecerfont has been a big advance for the field. And people really have been benefiting from it. But not everybody's getting to the level of hormone control that I think they could get to with atumelnant.
We're more than welcome to recruit patients who are on crinecerfont into our phase three program. We specifically were requested that by our investigators. We'll see if we get enough to have a decent cohort for a post-hoc comparison. But I think from a recruitment rate, I don't think it makes a difference one way or another.
Okay. What about on the kind of safety side? Have you seen any other elevations in liver enzymes with Atumelnant since what you disclosed last January?
Yeah. So just for those who don't know the story, we had one LFT last year that was reported as an adverse event that we couldn't rule out as being drug-related or not. And it got a few people a little anxious. Did not get the regulators or us particularly anxious. But the short answer to your question is nothing else new in the cohort four or the OLE or that whole population of people that we've been studying the drug in that I described in the slides.
What about thinking about taking Atumelnant outside the U.S.? What's your kind of international strategy?
From development or commercial?
Commercial.
Commercial. We have done clinical trials around the world, typically 20-25 different countries. The endocrine community is very international and close-knit. In the long run, we need to serve people well beyond the United States. But I think, as you all know, right now is a complicated period. It's a complicated period because of MFN and drug reimbursement things. I think that we'll have much more clarity in how that all plays out by the time Atumelnant gets approved and it's launching in the US. We're developing it around the world. We even have sites in Japan. We'll have a Japanese population for Atumelnant as well.
Okay. Great. I think we are out of time. So we'll stop it there. Thank you.
Thanks again, Jess. Thank you, everybody.
Thank you.