Good day, everyone. Welcome to MediWound's fourth quarter and full year 2025 earnings call. Today's conference call is being recorded. At this time, I would like to turn the conference call over to Gaia Shamis of LifeSci Advisors. Please go ahead.
Thank you, operator, and welcome everyone. Earlier today, pre-market open, MediWound issued a press release announcing financial results for the fourth quarter and full year ended December 31st, 2025. You may access this press release on the company's website under the Investors tab. I would ask you to review the full text of our forward-looking statement within this morning press release. Before we begin, I would like to remind everyone that statements made during this call, including the Q&A session, relating to MediWound's expected future performance, future business prospects, or future events or plans are forward-looking statements as defined under the Private Securities Litigation Reform Act of 1995. These statements may involve risks and uncertainties that could cause actual results to differ materially from expectations and are described more fully in our filings with the SEC.
In addition, all forward-looking statements represent our views only as of today, and MediWound assumes no obligation to update or supplement any forward-looking statements, whether as a result of new information, future events, or otherwise. This conference call is the property of MediWound, and any recording or rebroadcast is expressly prohibited without the written consent of MediWound. With us today are Ofer Gonen, Chief Executive Officer of MediWound, and Hani Luxenburg, Chief Financial Officer. Barry Wolfson, EVP of Strategy and Corporate Development, is also participating in today's call. Following our prepared remarks, we will open the call for Q&A. Now, I would like to turn the call over to Ofer Gonen, Chief Executive Officer of MediWound. Ofer?
Hi, thank you, Gaia. 2025 was a pivotal year for MediWound. We ended the year with two significant growth drivers firmly in place. A Phase III VALUE trial advancing as planned and an operational expanded manufacturing facility for NexoBrid, positioning us for long-term commercial growth. At the same time, we strengthened our balance sheet and outlined a multi-year revenue trajectory. Despite the ongoing conflict with Iran, we at MediWound are fully prepared and will continue operating with resilience and discipline that have guided us through similar challenges in recent years. Our team remained focused on our clinical milestones and commercial objectives while continuing to support patients and partners worldwide. Let me walk you through the progress. Let's start with an update on EscharEx, our late-stage enzymatic debridement therapy for chronic wounds.
Enrollment is ongoing in the global Phase III VALUE study in venous leg ulcers, with the majority of sites active and enrolling. We are targeting enrollment of 216 patients across approximately 40 sites in the United States and Europe. We expect both pre-specified interim assessment and enrollment completion by year end 2026. Importantly, we are expanding the EscharEx clinical program beyond just VLUs. We have aligned with both the FDA and EMA on the Phase II protocol in diabetic foot ulcers and plan to initiate the study in the second half of 2026. In addition, a prospective investigator initiative study in pressure ulcers is also expected to begin in the second half of 2026. This expansion broadens the clinical footprint of EscharEx across the three major chronic wounds indications. We continue to see meaningful industry validation.
B. Braun has joined the EscharEx clinical development program through a research collaborating agreement and will take part in the planned Phase II study in diabetic foot ulcers. This adds to the existing collaborations with Coloplast, Convatec, Essity, Mölnlycke, Solventum, and MIMEDX. Taken together, continued clinical execution, regulatory alignment, expansion into additional indications and industry engagement support the advancement of EscharEx as a long-term growth driver for MediWound. Turning to NexoBrid. Our expanded manufacturing facility is now operational, increasing the production capacity sixfold to support growing global demand. Commercial availability from this site remains subject to regulatory approvals, which we expect in 2026. In the United States, adoption continues to expand, with utilization across more than 70 burn centers, representing the majority of Vericel's approximately 90 target accounts. To illustrate the driver of demand, here are some of the latest examples.
Recently published real-world data from the Israel Defense Forces, covering nearly 5,000 documented combat casualties, showed that NexoBrid was clinically applicable in 71% of war-related injuries. In addition, a 15-year military analysis across multiple conflicts demonstrated a 50% increase in the proportion of severe burns among wounded soldiers. In parallel, we reported peer-reviewed prospective data showing that NexoBrid reduced embedded particles in abrasion and blast injuries by more than 90%, supporting the role in acute trauma care. More recently, survivors in the tragic bar fire in Crans-Montana, Switzerland, were treated with NexoBrid in medical centers across Switzerland, Italy, and Germany, underscoring the importance of pre-deployment of advanced burn therapy for mass casualty events. Taking all this together, growing clinical evidence from both military and civilian settings reinforces NexoBrid's role in the treatment of severe burns.
Following regulatory clearance of our expanded facility, we intend to prioritize support for national preparedness initiatives, including stockpiling and collaboration with military and emergency response systems. With that overview, I will now turn the call over to Hani. Hani?
Thank you, Ofer. Good morning, everyone. Let's turn to our financial results for the fourth quarter and full year of 2025. Revenue for the fourth quarter was $1.9 million, compared to $5.8 million in the first quarter of 2024. The decrease was primarily driven by lower development services revenue, mainly attributable to U.S. government shutdown, which delayed budget approval and the initiation of new contractual agreements. Gross profit for the quarter was $0.3 million, or 14.9% of revenue, compared to $0.9 million or 15.5% in the prior year period. R&D expenses were $4.5 million compared to $3 million in the fourth quarter of 2024, reflecting continuing investment in the EscharEx VALUE Phase III study.
SG&A expenses totaled $3.6 million compared to $4 million in the same period last year, mainly reflecting lower marketing and share-based compensation expenses. Operating loss for the quarter was $7.8 million compared to $6.1 million in the fourth quarter of 2024. Net loss was $7.2 million or $0.56 per share compared to a net loss of $3.9 million or $0.36 per share in the prior year period. The increase was primarily attributable to lower non-cash financial income from the revaluation of warrants. Adjusted EBITDA loss was $6.5 million compared to a loss of $4.9 million in the fourth quarter of 2024. Looking at our performance for the full year 2025. Revenue for the year was $17 million compared to $20.2 million in 2024.
The decrease was primarily attributable to the U.S. government shutdown and lower product sales to Vericel. Gross profit was $3.3 million or 19.2% of revenue compared to $2.6 million or 13% in 2024. The margin improvement reflects a more favorable revenue mix. R&D expenses increased to $14.3 million compared to $8.9 million in 2024, driven by investment in the EscharEx VALUE Phase III trial. SG&A expenses were $14.2 million versus $13.1 million in 2024, mainly reflecting higher marketing authorization owner expenses. Operating loss for the year was $25.3 million compared to $19.4 million last year.
Net loss for 2025 was $23.9 million, or $2.10 per share, compared to $30.2 million, or $3.03 per share in 2024. The reduction in net loss was primarily driven by $2.2 million of non-cash financial income from the revaluation of warrants in 2025, compared to $10.7 million of non-cash financial expenses in 2024. Adjusted EBITDA loss was $20.3 million compared to $14.8 million in 2024. Turning to our balance sheet. As of December 31, 2025, we had $53.6 million in cash equivalent and deposits compared to $43.6 million at year-end 2024. During 2025, we used $21.4 million in cash to fund our operating activities.
Our balance sheet reflects the completion of a $30 million registered direct offering and $3.5 million in proceeds from Series A warrant exercises. We believe our current cash position provides the financial flexibility needed to advance our key programs and continue execution on our strategic priorities. That concludes my review of the financial. Ofer, Back to you.
Thank you, Hani. Before we conclude, let me briefly address our outlook. We reaffirm our revenue guidance of $24 million-$26 million for 2026, $32 million-$35 million for 2027, and $50 million-$55 million for 2028. This guidance assumes continued support from BARDA and the U.S. Department of War, and the 2028 outlook includes a potential initial contribution related to EscharEx, subject to regulatory approval. These projections reflect the foundation we built in 2025 and in the milestones ahead. In summary, 2025 was a year of infrastructure build-out and clinical advancement. We advanced our Phase III program towards key milestones. We completed and commissioned our expanded manufacturing facility, we strengthened our balance sheet and established a multi-year revenue framework.
As we move into 2026, we are focused on disciplined execution, advancing EscharEx towards pivotal milestones, securing regulatory approvals for our expanded facility, and converting our operational progress into meaningful long-term value creation. Operator?
Ladies and gentlemen, at this time, we'll begin the question-and-answer session. If you would like to ask a question, please press star and then one using a touch-tone telephone. To withdraw your questions, you may press star and two. If you are using a speakerphone, we do ask you please pick up the handset prior to pressing the keys to ensure the best sound quality. Once again, that is star and then one to join the question queue. Our first question today comes from Josh Jennings from TD Cowen. Please go ahead with your question.
Hi. Good morning. Thank you for taking the questions, and hope everyone, MediWound team is safe and we're thinking about you guys. wanted to start with just a question on NexoBrid and the manufacturing expansion project that's been successful. Just maybe review both for the pent-up demand in international regions and the timing. I think you baked this all into your multi-year guidance forecasts, but just the timing of MediWound filling that demand over the next 12, 18, 24 months.
Hey, Josh. Good speaking with you. Our expanded manufacturing facility is now operational and capacity now increased sixfold. The commercial output in this site remains subject to regulatory approvals that are expected later in 2026. Once we approve by EMA or FDA, the product that are manufacturing during the validation process that we are doing now can be released to the market. Our guidance that we have, they assume a regulatory approval clearance in the second half of 2026. I think it's an assumption that we believe is reasonable given where we stand today. As for the demand, it's much larger than we can actually manufacture across the territories. Having said that, I don't know if it will be the case once we can manufacture.
We guided according to what we expect, and I hope it will be better going forward.
Thanks for that. Congratulations on the pace of the VALUE trial and sounds like things are going well there. I wanted to ask about the pressure ulcer trial. It's my understanding that just in terms of your team's assessment of the peak sales in the U.S. down the line for EscharEx does not include, you know, contributions from the pressure ulcer indication. Maybe just talk about review. I think, you know, you've talked about this before, but just review the size of that opportunity in the U.S. and how that will be unlocked with this trial? Thanks for taking the questions.
I have to admit that I didn't hear anything. Is it because of my line or because of yours? Do you hear me?
I'm sorry. Maybe because of my line. Do you hear me now?
I don't hear you. Operator, is it his line? Should I reconnect?
He is being heard into the conference. I am hearing both of you. Are you able to hear me, sir?
Yeah, I hear you loud and clear. Josh, can you speak again?
Certainly. Can you hear me now?
Oh, yes. Yes.
Okay.
Can you repeat the question? I didn't hear anything.
Sorry, sorry for the tech difficulties. Maybe that was on my line. Yes, I was just saying that you guys are making nice progress on the VALUE trial. Sounds, which is a good signal. I just wanted to dive a little bit deeper into the pressure ulcer indications. My understanding that that's not included in your team's assessment or forecast of peak sales in the U.S., which is a little bit of conservatism there. Just wanted to either review just that pressure ulcer indication and the kickoff of this pressure ulcer study later this year. Thanks for taking the question.
Okay. Barry, do you want to take on this one?
Sure. Absolutely. As you know, we're gonna start an investigator-led pressure ulcer study this year. Along with that, we'll have a third-party market research project initiated that will replicate what we did with regard to diabetic foot ulcers and venous leg ulcers. Ultimately, those peak sales, as you mentioned, will increase. I think from a back of the envelope perspective, I would say to think about pressure ulcers as the third of the big three ulcer types, along with the DFUs and the VLUs. There's probably more pressure ulcers than there are the other two. We still need to do the work to see how many of them require debridement and would be applicable to EscharEx.
Back of the envelope, I would anticipate that. When all said and done, it'll be roughly a third of the business.
Thanks for that, Barry, and Ofer. Appreciate it.
Our next question comes from Jeff Jones from Oppenheimer. Please go ahead with your question.
Thank you very much for taking the question, good evening, guys. To echo Josh, I hope everyone's safe there. You mentioned in the 2026 revenue guide that this assumed continued support from BARDA and DoW. Can you clarify how much of that is based on new contracts that aren't currently committed versus the award that you're anticipating? Perhaps give us an update on what you know there.
Hi, Jeff. Good to have you on as well. Let's start with BARDA. In August 2025, BARDA issued an RFP covering stockpiling, room temperature, stable formulation, and trauma and blast injury indications. Vericel, which holds the U.S. commercial rights on NexoBrid, is leading the process in the United States. We will provide the full technical and development support. Now with federal operations normalized, we expect BARDA to resume progress on this RFP and related development and procurement activities, subject, of course, to standard government processes. I cannot add more to that. As for our collaboration with the Department of War, as you know, NexoBrid room temperature stable formulation is being developed for a nonsurgical burn treatment for the U.S. Army.
We have been awarded to date a total of $18.2 million in non-dilutive funding from the U.S. Department of War to support this development. We are moving forward, so part of the revenue is supposed to be from BARDA and part of it from the Department of War.
Thank you for that. You mentioned the B. Braun research collaboration in the context of the DFU study, I believe. Can you speak in a little more detail about what some of these collaborators are providing, and how that guides to sort of your long-term strategy in VLU, DFU and beyond?
Okay. Barry, do you want to speak on this?
Sure. As you mentioned in the call, between the VLU and the DFU study, at this point we have seven of these research collaborations, all with market-leading advanced wound care companies. They include Coloplast, through their acquisition of Kerecis, Essity, Solventum, Mölnlycke, Convatec, MIMEDX, and now the most recent one being B. Braun. A little bit about B. Braun. They're one of the world's leading privately held medical tech companies. They're headquartered in Germany, founded in 1839. They generate over $9 billion in annual revenue, operating in over 60 countries and employing more than 60,000 people globally. They're known for products that are used daily across hospitals, surgical centers, dialysis clinics, and outpatient settings. They're a perfect partner when it comes to wound care.
They have a big wound care franchise. Specifically with B. Braun, they're taking part in the DFU Phase II study. As with the other collaborators, they will be supplying one of the key products that's necessary for optimal care of wounds, which will be used in both arms of the study. Specifically, they're supplying their market-leading antimicrobial wound cleanser, Prontosan, to be used during dressing changes. Each of these collaborators are putting in one-.
Kind of product, whether it be a wound dressing, in the VLU study, compression therapy is required. Post-wound healing, there's a different kind of compression device that keeps everything in place. They all supply things that are needed for the standard of care in wound care, and it allows for the study design to be that only one thing needs to be changed between the two arms, and that's the active and the control. It reduces any sort of variability in the study, and we get cleaner results. For the companies, the collaborators, you know, they get the benefit of having their product used as standard of care in these very, very large, hopefully successful studies. It also provides the opportunity for relationship building between MediWound and these collaborators.
As we get closer to the product making it to the market, and if there is any, you know, partnering transactions, to consider, all these companies will be up to date with the program, know the details of it intimately, and it will just facilitate conversations at that time.
Great. Thank you very much for the detail. Back in queue.
Thank you.
Our next question comes from Swayampakula Ramakanth from H.C. Wainwright. Please go ahead with your question.
Thank you. This is RK from H.C. Wainwright. Good afternoon, Ofer and Hani. I'm glad to hear your voice and just a couple of quick questions. On the VALUE trial, which is, which includes the provision of adaptive adjustment that you could do at a 65% enrollment mark. What clinical scenarios, you know, would there be if you had to increase your sample size? If you end up doing that, you know, what sort of an impact would it have on your timeline?
Hi, RK. Thank you for joining. Yes, as you mentioned, the pre-specified interim sample size assessment will be conducted after approximately 65% of the patients complete the treatment. Based on this assessment, the study may continue as planned, which means that the sample size stays 216 patients. The sample size may increase if necessary. We want to preserve the approximately 90% statistical power. As you know, in MediWound, we succeeded in all the 14 clinical trials that we conducted and all the three Phase II studies that we conducted with EscharEx. We have no intention not to make it to the finish line in this study as well.
The outcome could be the study, we should finish the enrollment as planned between 216 patients, as we guided, it will be by the end of this year, the end of 2026. If, let's say, we are at 80% statistical power, not good enough, we will increase the number of patients. If it's increasing by 20, 40 patients, it means adding another couple of months to the study and another few millions of dollars , which is not a drama. If the outcome is that we need to increase it by 100 patient, it will be at least six months, and it will cost us another $10 million.
Let's hope that the data will be very similar to what we saw in the Phase II studies, and we will be able to finish the enrollment by the end of this year.
Thank you for that. I have a question on supply chain for the clinical studies. You know, as we understand how things are in and around Israel at this point, because of what's going on in the geopolitical world, is that impacting anything in terms of supplying clinical product to the various centers? If so, how are you managing it?
It's a great question because we just had a discussion about it this morning. We checked, and across the sites in Europe and in the United States, there is enough EscharEx that can support continuation of the trial for the next at least six months, so we're in a good place. On top of that, the other ancillaries are from global companies, so all of them should be in the sites. We don't anticipate any issue regarding the supply chain that will impact the clinical study.
Okay. Thank you for that. The last question from me is, you know, the revenues for 2025 were, you know, below what was expected. You know, Is that partially stocking issue by through Vericel or is it the pull-through in some of these active burn centers?
Hi, RK, the revenue for 2025 total, $17 million, as you said, less than the $24 million that was expected. The decrease was primarily due to the U.S. government shutdown, which delay, as you imagine, the budget approval and the initiation of new contractual agreement. There was a small part of a, that, belong to the sale to Vericel, but the main part is the U.S. government shutdown.
Can I ask a quick follow-up? When you say that, I was just wondering about the 2026 revenue guidelines, guidance. How much of that, how much of the BARDA RFP award expectation is in that, in the $24 million-$26 million that you are talking about?
We are not sharing the split. We have, we have potential of getting from BARDA, potential from, or indirectly by Vericel. We have potential to get it from the DoW, we have revenue from product. We feel comfortable of achieving the $24 million-$26 million, we are not giving the split.
Thank you. Thank you both for taking all my questions.
Thank you.
Our next question comes from Chase Knickerbocker from Craig-Hallum. Please go ahead with your question.
Hello, everyone. This is Jason for Chase. I was wondering if you could provide a little bit more color and just further discuss the decision to move forward with the Phase II for DFU rather than the adaptive Phase II /III design as previously planned. What kind of feedback from the FDA did you receive that indicated that this was the best path forward?
Hi, Chase. Good to have you with us. Our main program, as you know, is the DFUs, and we decided to expand the program into two additional chronic wound indications, as said, DFU and pressure ulcers. There are some changes in the administration. We are not certain that it will be required to execute a very large Phase III study in order to have an approval for DFU indication. We didn't get any clearance about that, but we discussed with the agencies, both with EMA, FDA, asked them what they're expecting to see in order to see the advantage of EscharEx in treating DFU patients. The outcome was this study with 50 patients as we detailed in our corporate deck.
Thank you for that. Same type of question.
If I may, and if I may add.
Yeah.
It's a 50-patient study, which is a kind of Phase II. If we see that we need to have additional, I don't know, 150 study to finalize the Phase III, we will do it study after study. We don't. It's a kind of a timing impact. We are not certain that it will be done before the product is approved.
Appreciate that color, Ofer. That's helpful. Same type of question on the pressure ulcers. Is it your understanding that the pressure ulcer would require a separate Phase III to get future?
Barry, do you want to speak about... Yeah.
On the potential EscharEx label.
Yeah.
So-
Barry, do you want to address it?
Yeah. Thank you for the question. As Ofer intimated in his answer with regard to DFUs, there is a change in the, what we'll call stance of this administration with regard to the FDA and how they are trying to make it, let's say, easier for drugs to be approved. The most notable thing being that they're moving from the need to do two well-designed, well-controlled Phase III studies in order to get approval, and they're moving that to needing only one.
When we look at that, we also look at, if you recall, at the end of last year, the FDA agreed that our second primary endpoint would be the facilitation of wound closure, which basically takes the onus of the closure portion away from EscharEx and puts it into the hand of already approved products like a CTP or an autograft. We intend to have a discussion with the FDA around the necessity of these large-scale Phase III studies for each and every indication, i.e., DFU, pressure ulcers or any other chronic wound indication that's out there. The necrotic material on these wounds is all very similar from wound to wound to wound.
We have excellent data and a growing base of data that EscharEx works on all of that necrotic material owing to its several different enzymes that are in the API and multi different targets towards the necrotic material. We believe in the end that Likely sufficient to have a, as we're doing in the DFU study, a well-designed Phase II study complemented by post-marketing real-world data to expand the pack insert to include additional indications.
Appreciate that additional color, Barry. Thanks for taking the questions.
Thank you.
Our next question comes from Michael Okunewitch from Maxim Group. Please go ahead with your question.
Hey, guys. Thank you so much for taking my questions today. I guess to start off, I would like to ask a little bit about the pressure ulcer program and in particular, the strategic considerations around prioritization in chronic wounds. We know about the prioritization between VLUs and DFUs, but pressure ulcers do seem to be a little bit overlooked in this market. I'm curious if you could comment on the market and why pressure ulcers seems to be prioritized less so than the other two chronic wounds.
Hi, Michael. I don't think it's less prioritized. The largest unmet medical need is definitely at venous leg ulcers because these wounds are extremely painful, you don't have any alternative. The knife, the scalpel is not an alternative for that. Pressure ulcers are very different one of another. They might be very deep. There are all kinds of complications that might be associated. For us, it seems to be the more complicated wounds to treat. We are going to start with relatively mild pressure ulcers. Having said that, it is important for us, as Barry said previously, EscharEx works on burns, it works on wounds. It doesn't care which type of wounds it is applied on.
Our motivation is making sure that when we are very close to the finish line with having data in our venous leg ulcer trial, to make sure that everyone understands, the potential partners, the investors, that everyone understands how large this market is and how big is the unmet medical need. The current trial with pressure ulcer, it will be a very small trial that just demonstrates that EscharEx can debride pressure ulcers. We will do in parallel, as Barry said, by a third-party consultant, a market research. We will understand exactly the portion of the patients that needs to be, to debride their wounds. Only then, we will know how large is our accessible market. I hope I answered your question.
No, thank you. I appreciate that. Could you just provide an update on the status of the head-to-head study? Are there any additional outstanding items before you can get that up and running?
Yes. As you know, the main focus of the company, and this will definitely determine our value, is the Phase III study. In parallel, we need to conduct some supportive studies that we are doing. If one of them is a PK study, for instance, one of them is a human factor study. We are doing all kind of small trials to support the BLA submission. Specifically regarding the head-to-head study versus a collagenase or other types of nonsurgical standard of care, we are doing that in order to support future market access discussions. We guided, and we are going to do that we will start the trial around mid this year, maybe the second part of the year.
For us, it is a very important study since it will enable us to determine what the actual price of EscharEx will be.
All right. Thank you. One last one from me before I hop into the queue. In terms of your enrollment, the complete enrollment targets for the VALUE study and the interim analysis, is that based on the current rate of enrollment, or does there need to be some additional ramps or acceleration at the sites to meet that?
To protect the study integrity, we're not sharing enrollment numbers or trends, but we'll feel very comfortable with the target that we gave, which means, interim assessment and completion of the enrollment of the study by the end of the year.
All right. Thank you very much for taking my questions today.
Thank you.
Our next and final question for today comes from Scott Henry from AGP. Please go ahead with your question.
Thank you and good afternoon. First, just to clarify, as far as the interim analysis, when you talk about year-end, should we expect that to mean Q4?
Hi, Scott. I would expect it to be by year-end.
Okay.
Means in the end of Q4. I don't want to overpromise.
Okay. That's helpful. Thank you, Ofer. With regards to revenue and timing, as far as the BARDA revenues, I assume there were none in fourth quarter of 2025. Should we expect any revenues in the first quarter of 2026? You know, just a couple of weeks left in the quarter. You might have a sense at this point.
Once a BARDA agreement is signed with Vericel, I guess all of us will know. Our revenue guidance assumes that the initial revenue from those specific agreements will be only from Q2.
Okay. Great. When we do model this out, just confirming, we should really expect a pretty significant increase in revenues in the second half of 2026 over the first half of 2026, given the manufacturing capacity coming on stream, given the BARDA revenue. Just, you know, wanna make sure I'm thinking about that correctly. Thank you.
Yes, Scott. Given our history, it was always that the second half is better in revenue than the first half, of course, given the fact that BARDA, we took in our model that BARDA's revenue will be only recorded from Q2, and also the capacity will increase at year-end or the second half. You are very much corrected.
Okay, great. Thank you for taking the questions.
Thank you so much.
Ladies and gentlemen, with that, we'll be ending today's question and answer session. I'd like to turn the floor back over to management for any closing remarks.
Thank you everyone for joining us today. We look forward to updating you again on our next quarterly call.
With that, we'll conclude today's conference call and presentation. We do thank you for joining. You may now disconnect your lines.