NASDAQ:MIRM Mirum Pharmaceuticals Q4 2024 Earnings Report $98.62 0.00 (0.00%) Closing price 05/22/2026 04:00 PM EasternExtended Trading$98.58 -0.04 (-0.04%) As of 05/22/2026 05:29 PM Eastern Extended trading is trading that happens on electronic markets outside of regular trading hours. This is a fair market value extended hours price provided by Massive. Learn more. ProfileEarnings HistoryForecast Mirum Pharmaceuticals EPS ResultsActual EPS-$0.49Consensus EPS -$0.27Beat/MissMissed by -$0.22One Year Ago EPSN/AMirum Pharmaceuticals Revenue ResultsActual Revenue$99.41 millionExpected Revenue$96.64 millionBeat/MissBeat by +$2.77 millionYoY Revenue GrowthN/AMirum Pharmaceuticals Announcement DetailsQuarterQ4 2024Date2/26/2025TimeAfter Market ClosesConference Call DateWednesday, February 26, 2025Conference Call Time4:30PM ETUpcoming EarningsMirum Pharmaceuticals' Q2 2026 earnings is estimated for Thursday, July 30, 2026, based on past reporting schedules, with a conference call scheduled on Wednesday, August 5, 2026 at 4:30 PM ET. Check back for transcripts, audio, and key financial metrics as they become available.Conference Call ResourcesConference Call AudioConference Call TranscriptSlide DeckPress Release (8-K)Annual Report (10-K)SEC FilingEarnings HistoryCompany ProfileSlide DeckFull Screen Slide DeckPowered by Mirum Pharmaceuticals Q4 2024 Earnings Call TranscriptProvided by QuartrFebruary 26, 2025 ShareLink copied to clipboard.Key Takeaways Merum reported 2024 total net product sales of $336.4 million, including $213.3 million for Livmarli (up 50% YoY) and $123.1 million for its bile acid franchise, and guided 2025 sales to $420–435 million. The FDA approved Citexley (formerly quinadel) for adult cerebrotendinous xanthomatosis, granting seven years of exclusivity and enabling promotional efforts to reach underdiagnosed patients. Key pipeline milestones include the Phase III EXPAND study of Livmarli in cholestatic pruritus, breakthrough designation for velixibat in PBC after positive VANTAGE interim results, and planned Phase II initiation of MRM-337979 for Fragile X syndrome. Merum ended 2024 with $293 million in cash, cash equivalents and investments, achieved cash-flow positivity after non-cash adjustments, and expects to remain cash-flow positive in 2025. Forward-looking statements made on the call are subject to risks and uncertainties that may cause actual results to differ materially, as detailed in the company’s latest SEC filings. AI Generated. May Contain Errors.Conference Call Audio Live Call not available Earnings Conference CallMirum Pharmaceuticals Q4 202400:00 / 00:00Speed:1x1.25x1.5x2xTranscript SectionsPresentationParticipantsPresentationSkip to Participants Operator00:00:00Hello and welcome to Mirum Pharmaceuticals reports fourth quarter and year-end 2024 financial results and provides business update. My name is Elliott, and I'll be your coordinator today. If you would like to register a question during today's event, please press star one on your telephone keypad. I'd now like to hand over to Andrew McKibben, Senior Vice President of Strategic Finance and Investor Relations. Please go ahead. Andrew McKibbenSVP of Strategic Finance and Investor Relations at Mirum Pharmaceuticals00:00:26Thanks, Elliott, and good afternoon, everyone. I'd like to welcome you to Mirum Pharmaceuticals' fourth quarter 2024 conference call. I'm joined today by our CEO, Chris Peetz, our Chief Medical Officer, Joanne Quan, and Eric Bjerkholt, our Chief Financial Officer. Peter Radovich, our President and Chief Operating Officer, could not be with us today as he's at an international launch event in Europe this week. Earlier today, Mirum issued a news release announcing the company's results for the fourth quarter and full year 2024. Copies of this news release and SEC filings can be found in the investors' section of our website. Before we start, I'd like to remind you that during the course of this conference call, we will be making certain forward-looking statements based on management's current expectations, including statements regarding Mirum's programs and market opportunities for its approved medicines and product candidates. Andrew McKibbenSVP of Strategic Finance and Investor Relations at Mirum Pharmaceuticals00:01:13These statements represent our judgment as of today and inherently involve risks and uncertainties that may cause actual results to differ materially from the results discussed. We are under no duty to update these statements. Please refer to the risk factors in our latest Form 10-K and subsequent SEC filings for more information. With that said, I'd like to turn the call over to Chris. Chris? Chris PeetzCEO at Mirum Pharmaceuticals00:01:32Thanks, Andrew, and good afternoon, everyone. I'm excited to start today's call with a recap of Mirum's achievements over the last year and share an update on our strategic goals for 2025. In the short time since our founding, through our focus on bringing important medicines to patients, we have created a strong business in ultra-rare disease that is cash flow positive, with an attractive pipeline and broader patient populations. We are still early in our journey, and we firmly believe that the best is yet to come. Our strategic priorities over the next two years are to, one, further the global growth of our commercial medicines, highlighted by LIVMARLI's continued Alagille syndrome expansion, early PFIC success, and the recent approval of CTEXLI for Cerebrotendinous xanthomatosis, or CTX, in the U.S. Chris PeetzCEO at Mirum Pharmaceuticals00:02:20Two, advance our high-impact pipeline, driving Volixibat, the potentially pivotal data in adult cholestasis next year, initiating our Fragile X program for MRM-3379, and completing enrollment of the EXPAND study for LIVMARLI and cholestatic pruritus. Three, selectively pursue product acquisition and license opportunities in rare disease with potential for significant patient impact and value creation, just as we have since the launch of Mirum, and four, accomplish all of the above with continued scientific and financial discipline. 2024 was a big year for delivering on strategic goals. Total net product sales were $336.4 million, exceeding the upper end of our revised guidance range. LIVMARLI finished the year with total net product sales of $213 million, including approximately $155 million from our U.S. business and $59 million internationally. In the second half of last year, PFIC new patient starts and international uptake were drivers of the step-up in growth. Chris PeetzCEO at Mirum Pharmaceuticals00:03:25We believe the strong demand we are seeing for LIVMARLI and Alagille syndrome and PFIC will continue. Beyond LIVMARLI, we also saw healthy growth in our bile acid medicines. We think we are starting to bend the curve here, with total 2024 net product sales of $123 million. I'm also happy to say that last week, the FDA approved CTEXLI, which is our new brand name for chenodiol, for CTX in adults. With this approval comes seven years of work and exclusivity and the opportunity to begin promotional efforts with our current field team to reach patients in this underdiagnosed condition. Ultimately, the robust growth dynamics across all of our medicines positions us well for 2025, where we expect to add close to $100 million to our top line, with anticipated net product sales between $420 and $435 million for the year. Chris PeetzCEO at Mirum Pharmaceuticals00:04:192024 was also a significant year for our pipeline. We expanded LIVMARLI's label with its approval for PFIC in both the U.S. and Europe. We initiated Phase III EXPAND study of LIVMARLI in broader settings of cholestatic pruritus, a significant growth opportunity for the brand. And beyond LIVMARLI, we achieved positive interim results for Volixibat in both VISTAS PSC and VANTAGE PBC studies, resulting in breakthrough designation in PBC. And finally, we have expanded our pipeline with the addition of MRM-3379 for Fragile X syndrome. This is another high unmet need orphan setting that aligns well with the capabilities we have built in rare genetic neurology for the launch of CTEXLI. Pulling all this together, we are set up for an exciting 2025 and beyond with continued strong execution in both our commercial business and pipeline of potentially high-impact medicines. Chris PeetzCEO at Mirum Pharmaceuticals00:05:13And with that, I'll turn it over to Joanne to give a brief update on the pipeline. Joanne? Joanne QuanCMO at Mirum Pharmaceuticals00:05:17Thanks, Chris. 2024 was a highly productive year for our clinical program. I'm excited to continue this momentum into 2025. Starting with our three potentially registrational studies of our advanced treatments with LIVMARLI and Volixibat, I'm pleased to say that the progress we made in 2024 builds further confidence in the impact of this mechanism on cholestatic pruritus across multiple settings, including Alagille, PFIC, biliary atresia, PSC, and PBC. We've now seen clinical evidence for the potential of IBAT inhibition to have a pronounced impact on this debilitating symptom. Starting with Volixibat and PSC, recall that the VISTAS study was currently enrolling with a single active dose, 20 mg BID. versus placebo, based on the blinded interim analysis we conducted in June of last year. Joanne QuanCMO at Mirum Pharmaceuticals00:06:04Following the positive interim analysis, where we passed both the efficacy and safety thresholds for continuation, we've had great engagement from investigators and patient communities, and we are pleased with the continued progress of this study. We are on track to complete enrollment in the second half of this year, and given that this is a 20-week study, we expect top-line results in 2026. There are no approved treatments for PSC, and we look forward to another opportunity to work with global health authorities to bring a high-impact medicine to an underserved patient community globally. Turning to PBC, enrollment in the VANTAGE study is also progressing well, and we remain on track to complete full enrollment in 2026. Given the results of our interim analysis, where we showed a statistically significant, rapid, and sustained improvement in pruritus versus placebo, we've seen a positive response from the investigator and patient community. Joanne QuanCMO at Mirum Pharmaceuticals00:06:58The majority of PBC patients are able to maintain a good biochemical response with first-line UDCA treatment but do not have adequate options to address their symptoms. The strength of the VANTAGE interim results in both first-line and second-line patients positions Volixibat to be a potentially impactful treatment option for a large portion of patients with PBC. Breakthrough therapy designation we received from FDA last year acknowledges the importance of Volixibat as a potential treatment. We are also excited Phase III EXPAND study with LIVMARLI. This is an excellent opportunity to expand the label for LIVMARLI to include additional settings of cholestatic pruritus, where there's a clear need for an approved effective treatment, and we are encouraged by the enthusiasm we're seeing from investigators. The study is ramping up well, and we are on track to complete enrollment in 2026. Joanne QuanCMO at Mirum Pharmaceuticals00:07:50Shifting to MRM-3379, our new PDE4D inhibitor for Fragile X syndrome, we are preparing to initiate a Phase II study this year, following discussions with the FDA. As a reminder, this mechanism has demonstrated proof of concept in Fragile X, and given the high expression of PDE4D in the brain and the importance of this pathway in learning and memory, we believe MRM-3379's brain penetration profile is potentially differentiating. In summary, we're very happy with the continued momentum of all of our clinical programs and the active engagement we've fostered with investigators and patient communities. We look forward to providing further updates on our progress during the year. I'll now turn it over to Eric. Eric. Eric BjerkholtCFO at Mirum Pharmaceuticals00:08:34Thank you, Joanne. I'm pleased to say that we are in an excellent financial position, supported by our strong performance in 2024, which I will now briefly summarize. 2024 was another year of continued strong growth in net product sales of our three commercial medicines. Total net product sales in the fourth quarter 2024 was $99.4 million, compared to $69.5 million the year before, representing a 43% year-over-year increase. For the full year 2024, total net product sales were $336.4 million, compared to $178.9 million in 2023. For LIVMARLI, total net product sales in the fourth quarter 2024 was $64.1 million. Total LIVMARLI net product sales for 2024 was $213.3 million, representing a 50% increase compared to 2023. Turning to our bile acid medicines, total net product sales in the fourth quarter 2024 was $35 million, representing an approximately 25% growth over the fourth quarter of 2023. Eric BjerkholtCFO at Mirum Pharmaceuticals00:09:51The first full quarter, the portfolio was under observation. Total net product sales for the portfolio for all of 2024 was $123.1 million. Total operating expense for 2024 was $424.5 million, which includes R&D expense of $140.6 million, SG&A expense of $202.2 million, and cost of sales of $81.6 million. Expenses for the year included non-cash stock-based compensation expense of $48.4 million, and intangible amortization and other non-cash items of $31 million. This intangible amortization and other non-cash items expense is largely reflected in our cost of goods sold. In the fourth quarter and full year, R&D expense also reflects the $7.5 million upfront payments we paid to a vendor for the MRM-3379 license. When adjusting for the non-cash items, I'm happy to say the business was cash flow positive in 2024, and we expect this to continue this year. Eric BjerkholtCFO at Mirum Pharmaceuticals00:11:08We ended 2024 with cash, cash equivalents, and investments of $293 million, an increase of approximately $7 million from the start of the year. Looking ahead, we expect net product sales of $420 million-$435 million in 2025, and we are guiding toward positive cash flow again this year. We are well funded, and we have the resources to execute on our plans and progress toward our multiple upcoming pipeline catalysts. Now, I'll turn the call back over to Chris for final comments. Chris PeetzCEO at Mirum Pharmaceuticals00:11:46Thanks, Eric. 2025 is set to be another big year for Mirum. With industry-leading commercial execution, an advancing pipeline, and a disciplined operating model, we have built a leading rare disease company, one that is positioned for sustained growth in the years to come. I'm proud of what we've accomplished and excited for the opportunities ahead as we continue to deliver life-changing medicines for patients and their families. And with that, operator, please open the call for questions. Operator00:12:17Thank you. If you would like to ask a question, please press star followed by one on your telephone keypad. If you would like to withdraw your question, please press star followed by two. When preparing to ask your question, please ensure your device is unmuted locally. First question comes from Gavin Clark-Gartner with Evercore ISI. Your line is open. Please go ahead. Gavin Clark-GartnerManaging Director at Evercore ISI00:12:41Hey, guys. Congrats on the great progress. So I just had one more strategic question. I know that you aren't able to call for redemption of convertible notes until next year, but just bigger picture, as your stock has traded well above the conversion price, the back of really strong earnings performance, pipeline advancement, does this all change how you think about BD and capital allocation in general? Thank you. Chris PeetzCEO at Mirum Pharmaceuticals00:13:04Thanks, Gavin, for the question. I'll make a first comment there and ask Eric to add anything else on the balance sheet. And the thing I'd point out, kind of the dynamic behind what you're pointing out there is that we've been able to navigate Mirum to a really unique position, particularly in this market backdrop for rare disease, where we can take advantage of our financial position and performance to acquire and basically roll up some of these rare disease products that we see as great value creation opportunities for the company. I'll ask Eric to speak more specifically to the financing plans. Eric BjerkholtCFO at Mirum Pharmaceuticals00:13:42Yeah, thank you. The convert matures in four years, so that doesn't really factor into our plans meaningfully. I think our financial and financing flexibility, as we continue to progress the business, is significant and gives us a lot of flexibility to consider BD alternatives that we might find attractive. Chris PeetzCEO at Mirum Pharmaceuticals00:14:14Thanks for the question, Gavin. Operator00:14:17We now turn to Jessica Fye with JPMorgan. Your line is open. Please go ahead. Jessica FyeManaging Director at JPMorgan00:14:23Hey, guys. Good afternoon. Thanks for taking the question. I was hoping you could talk about the underlying assumptions like market penetration or share, potential competition, etc., that are behind the $1 billion revenue potential for MRM-3379 in Fragile X. And I guess while we're talking about that asset, are there any other indications with the mechanistic rationale that could make sense to pursue? Thank you. Chris PeetzCEO at Mirum Pharmaceuticals00:14:52Thanks for the question, Jessica. I'll speak to the market sizing and then have Joanne kind of comment about applicability of the mechanism in other settings. And quite simply, the way to think about the market potential, when we look at just male patients with Fragile X, it's a 50,000 patient market. So a lot of different ways that you can look at the assumptions to see that the total addressable market is $1 billion or more quite easily. So really, when we talk about that number, we're looking at the U.S. opportunity. Do see substantial upside beyond that number even. It's a pretty simple kind of watermark to put there. And Joanne, you want to comment about the mechanism? Joanne QuanCMO at Mirum Pharmaceuticals00:15:38Yeah. Yeah. So actually, I think, Jessica, you sort of kind of rightly kind of asked the question in terms of what are the opportunities. We know that PDE4D is highly expressed in the brain in areas where learning and memory are very important. And so there are a wide number of conditions that this could be you could envision this could be used for. The way we're really approaching this is to kind of use Fragile X as our kind of first entry point, conducting a proof of concept there, identifying a dose, and then once we have that, then I think it opens up the possibility for entering into some other indications associated with intellectual disability. So certainly a lot of potential there that we're excited to access. Operator00:16:25We now turn to Mani Foroohar with Leerink Partners. Your line is open. Please go ahead. Operator00:16:34Hey, guys. You have Ryan on for Mani. Thanks for taking our question. So I'm curious, when you look at the Alagille market, where do you think we are in terms of penetration into the prevalent population? And kind of going forward, is U.S. growth really going to be driven more by new diagnoses or kind of greater penetration into those that are not on a Kasai yet? Chris PeetzCEO at Mirum Pharmaceuticals00:16:54Thanks. Thanks, Ryan, for the question. In terms of overall penetration for the eligible treatment population in the U.S., so Alagille syndrome patients with pruritus that are pre-transplant, we're probably in the range of 40% or so penetrated. So just from that statistic alone, we see a lot of growth potential in the prevalent patients. And thinking about what's driving that growth over time, there are actually several tailwinds on that. One is just the further penetration into the prevalent population. Chris PeetzCEO at Mirum Pharmaceuticals00:17:38There's continued new diagnoses that come along the way, so new patients entering, usually infants, so they're generally lower dose patients, but there are new patients that are diagnosed and start each year. And then behind that, this is weight-based dosing, so you do see some of those dose adjustments over time. So all of that kind of combines for the U.S. to show that there's a long runway of continued growth for Alagille syndrome in the U.S. Operator00:18:12We now turn to David Lebowitz with Citi. Your line is open. Please go ahead. David LebowitzSenior Research Analyst at Citi00:18:18Thank you very much for taking my question. In terms of the recent approval for CTX, congratulations on that. Could you, I guess, elaborate on how you expect this could affect the sales trajectory from this point going forward, given there's already use in that particular population? Chris PeetzCEO at Mirum Pharmaceuticals00:18:42Thanks for the question, David. Yeah. So you're kind of understanding in your question the dynamic here where we already have, we think that there's a substantial number of the diagnosed CTX patients had been on Chenodal. The plan is to have those convert over to CTEXLI in the coming months. And the goal here is to impact diagnosis and getting more patients diagnosed and then to treatment. So we do expect it to be a gradual kind of bending of the curve of bringing new patients to diagnosis earlier and preventing the accumulation and buildup of some of these irreversible effects of the disease. David LebowitzAnalyst at Citi00:19:30Got it. Chris PeetzCEO at Mirum Pharmaceuticals00:19:32Thanks for the question. Operator00:19:35Our next question comes from Mike Ulz with Morgan Stanley. Your line is open. Please go ahead. Operator00:19:42Hi, this is Rohit on for Mike. Thanks for taking our questions. Can you just talk about the patient mix between Alagille syndrome and PFIC for LIVMARLI in the fourth quarter of 2024 and how you expect this to play out in 2025? And then additionally, how many of the patients on the PFIC extended access program are now on paid drug? Thank you. Chris PeetzCEO at Mirum Pharmaceuticals00:20:04Thanks for the question, Rohit. I'll touch on the last one there first. During the year last year, we were able to convert all of the U.S. expanded access patients over to commercial products. So that was complete, really most of it into the third quarter last year. And in terms of the patient mix, we don't post specific numbers, but throughout kind of where we stand today, most LIVMARLI patients by far are Alagille syndrome patients. So that's the vast majority of the contribution today. In terms of new patient starts, since really Q3 of last year, we have seen with the steady Alagille patient starts, we have seen a nice step up in PFIC patient starts. So they are contributing quite substantially to new patient starts going forward. And you see that reflected in the top line performance. Chris PeetzCEO at Mirum Pharmaceuticals00:21:01Thank you. Chris PeetzCEO at Mirum Pharmaceuticals00:21:04Thanks for the question. Operator00:21:10We now turn to Ryan Deschner with Raymond James. Your line is open. Please go ahead. Ryan DeschnerVP at Raymond James00:21:18Hi there. Congrats on the quarter. My question is, how much commercial team expansion would you anticipate doing for expanded pruritus in ultra-rare cholestatic patients pending results of Phase III EXPAND study? And then I have a quick follow-up. Chris PeetzCEO at Mirum Pharmaceuticals00:21:36Thanks for the question, Ryan. For looking at planning for LIVMARLI's potential label expansion with expand, we anticipate that's largely the same prescribing universe as the Alagille syndrome and PFIC prescribers. So it wouldn't be an expansion of the field team that's already in place. So a lot that we can leverage there commercially. And you said you had a follow-up question? Ryan DeschnerVP at Raymond James00:22:04Yeah, thanks. Do you feel at this point, do you have a feel at this point for how many, specifically how much of an impact the growing average patient weights are in impacting sales growth in Alagille? How big actually is this growth component now compared to some of the other tailwinds here? And how do you expect it to grow moving forward? Chris PeetzCEO at Mirum Pharmaceuticals00:22:27I mean, the way that I would describe it is we look at and kind of think about this as the average dispense, and it changes quite modestly over time, in part because you continue to have new diagnoses come in, so there are new infant patient starts along the way, and that kind of tempers the overall effect, but we have seen it kind of gradually increase over the years. Ryan DeschnerVP at Raymond James00:22:57Got it. Thank you very much. Chris PeetzCEO at Mirum Pharmaceuticals00:23:00Thanks for the question. Operator00:23:03We now turn to Brian Skorney with Baird. Your line is open. Please go ahead. Operator00:23:09This is Luke on for Brian. Thanks for taking the question. We were hoping you could just talk a little bit about how the VANTAGE study takes into account prior OCA use and enrollment, and do you think patients recently discontinuing OCA could see an impact on pruritus measurements as compared to a patient not discontinuing? Chris PeetzCEO at Mirum Pharmaceuticals00:23:33Thanks for the question. I'll let Joanne jump into that one. David LebowitzAnalyst at Citi00:23:36Yeah. Thanks for the question. So when the study was started, we actually thought there would be a bigger contribution in terms of patients who are in OCA. It turns out it's really not an issue at this point. And so our enrollment has actually picked up quite nicely since the interim results came out. We're not really seeing that there's an issue in terms of patients, a lot of patients coming forward with OCA who are candidates for the study otherwise. And I think that just reflects overall kind of usage patterns with OCA in general, not really that much of a contender in this space. Chris PeetzCEO at Mirum Pharmaceuticals00:24:16Yeah. Kind of in addition to that, recall that for PDC, the VANTAGE study, about 2/3 of those patients are first line. So that would be before OCA would have been used or before the new PPARs are used. Chris PeetzCEO at Mirum Pharmaceuticals00:24:37Thank you. Chris PeetzCEO at Mirum Pharmaceuticals00:24:40Thanks for the question. Operator00:24:42Our next question comes from Jonathan Wolleben with Citizens JMP. Your line is open. Please go ahead. Jonathan WollebenManaging Director at Citizens JMP00:24:51Hey, thanks for taking the question. Just wondering, piggybacking on a prior expanded question, what do you envision the label looks like if you have success in Phase III trial? And then how do you wrap your heads around that 1,000 patient U.S. and EU prevalence given it's a collection of a bunch of small indications? Chris PeetzCEO at Mirum Pharmaceuticals00:25:11Yeah. Jonathan, thanks for the question. The indication statement is something to nail down, frankly. As you point out, it's a definition somewhat of exclusion. It's a basket of several different causes of cholestasis, excluding PSC, PBC, ICP, Alagille syndrome, and PFIC. So it's all of the many less common causes of cholestasis. So exact wording will need to be ironed out as we get to that label expansion. In terms of how we think about the patient number, though, we think it's quite simply the way to think about it. It's a PFIC-sized opportunity or larger. And as we looked at kind of real compassionate use requests and interest from physicians kind of counting up some of those patient numbers and where that demand was coming from, that's how we landed at that 1,000 patient estimate for the U.S. and Europe. Chris PeetzCEO at Mirum Pharmaceuticals00:26:13So I feel it's a very tangible market estimate as opposed to maybe an epidemiology study, for example. So I feel confident that it's a quite sizable opportunity for LIVMARLI. Jonathan WollebenManaging Director at Citizens JMP00:26:29I see. All right. That's helpful. Thanks, Chris. Chris PeetzCEO at Mirum Pharmaceuticals00:26:32Thanks for the question. Operator00:26:36Our final question comes from Ed Arce with H.C. Wainwright. Your line is open. Please go ahead. Thomas HoffmannManaging Director at H.C. Wainwright00:26:43Hello, good afternoon, everyone. This is Thomas, here asking a group of questions for Ed. Thank you so much for taking our questions. So first, for the Volixibat this study in PFIC, good to hear that it's on target to complete enrollment in the second half this year. Just wonder how many months or when should we expect to see top-line data after complete enrollment is announced? If you can outline some details on the process. Chris PeetzCEO at Mirum Pharmaceuticals00:27:15Yeah. Thanks for the question, Thomas. I mean, the simple way to think of it is it's approximately six-month endpoint and time to close and clean the database. So you can kind of project some amount of time like that after enrollment completion. We do plan to announce enrollment completion when we get there. Thomas HoffmannManaging Director at H.C. Wainwright00:27:34Got it. And then perhaps one question on Phase III on the EXPAND study with LIVMARLI as well. Just wonder if you can share some patient experience that you have received to date and which type of rare cholestatic conditions are most common so far. Chris PeetzCEO at Mirum Pharmaceuticals00:27:56Yeah. Thanks for the question. I'll maybe ask Joanne to speak to some of the data at AASLD last year on that point. Joanne QuanCMO at Mirum Pharmaceuticals00:28:03Yeah. We do actually have a number of patients that were treated through compassionate use for biliary atresia. And those results are quite strikingly positive for treatment of their pruritus. And of note, this is a different patient group than was studied in the earlier EMBARK study. So these are biliary atresia patients that have likely had a Kasai when they were quite young. And then they continue on. We do know that over time, patients will progress in terms of their disease and often require liver transplant. And as part of that progression of disease, they will develop pruritus. And so we do have an abstract with a handful of cases where there's been quite good treatment outcomes using IBAT inhibition. Joanne QuanCMO at Mirum Pharmaceuticals00:28:43So that's partly what gives us confidence in conducting a study like the EXPAND study that ultimately there is a need and also that we do have a product that can really address that. Thomas HoffmannManaging Director at H.C. Wainwright00:28:56Understood. Perhaps one follow-up on that. Should we expect to see some kind of interim data from this study, perhaps in medical conferences, posters? Joanne QuanCMO at Mirum Pharmaceuticals00:29:11Actually, we do not plan to do an interim analysis for the study. Our plan is to complete enrollment in 2026, next year. So if we did an interim, it would actually slow things down. So we do think we're on track to complete enrollment in 2026 and look forward to sharing the results when they're available for the full study. Thomas HoffmannManaging Director at H.C. Wainwright00:29:33Understood. Thank you again for the kind questions. Chris PeetzCEO at Mirum Pharmaceuticals00:29:37Thank you, Thomas. Operator00:29:41This concludes our Q&A. I'll now hand back to Chris Peetz, CEO, for any final remarks. Chris PeetzCEO at Mirum Pharmaceuticals00:29:48Great. Thank you all for joining us today. Have a great afternoon. Thanks. Operator00:29:54Ladies and gentlemen, today's call is now concluded. We'd like to thank you for your participation. You may now disconnect your lines.Read moreParticipantsExecutivesEric BjerkholtCFOJoanne QuanCMOAndrew McKibbenSVP of Strategic Finance and Investor RelationsChris PeetzCEOAnalystsRyan DeschnerVP at Raymond JamesThomas HoffmannManaging Director at H.C. WainwrightJonathan WollebenManaging Director at Citizens JMPAnalyst at Leerink PartnersAnalyst at BairdAnalyst at Morgan StanleyDavid LebowitzSenior Research Analyst at CitiGavin Clark-GartnerManaging Director at Evercore ISIJessica FyeManaging Director at JPMorganDavid LebowitzAnalyst at CitiPowered by Earnings DocumentsSlide DeckPress Release(8-K)Annual report(10-K) Mirum Pharmaceuticals Earnings HeadlinesMirum’s US$600 Million Zero-Coupon Convertible Note Issue Might Change The Case For Investing In Mirum Pharmaceuticals (MIRM)3 hours ago | finance.yahoo.comMirum Pharmaceuticals, Inc. (NASDAQ:MIRM) Given Consensus Rating of "Buy" by AnalystsMay 24 at 2:18 AM | americanbankingnews.comNo. You’re not imagining it…Porter Stansberry, founder of one of the largest financial research firms in the world, says he's breaking the biggest story of his 26-year career - an economic shift not seen since 1776. From the government taking stakes in Intel, Lithium Americas, and MP Materials, to sweeping political changes reshaping the economy, Stansberry argues a rare 'New 1776 Moment' is already underway. One Nobel Prize winner calls it a dividing line for all of society. His presentation covers the stocks to buy, the stocks to sell, and three money moves to position yourself on the right side of this shift. | Porter & Company (Ad)Mirum Pharmaceuticals to Present Data Showcasing Leadership in Rare Liver Diseases at the EASL International Liver Congress 2026May 21, 2026 | businesswire.comWolfe Research initiates coverage of Mirum Pharmaceuticals (MIRM) with outperform recommendationMay 20, 2026 | msn.comMirum Pharmaceuticals (MIRM) price target increased by 16.75% to 149.29May 15, 2026 | msn.comSee More Mirum Pharmaceuticals Headlines Get Earnings Announcements in your inboxWant to stay updated on the latest earnings announcements and upcoming reports for companies like Mirum Pharmaceuticals? Sign up for Earnings360's daily newsletter to receive timely earnings updates on Mirum Pharmaceuticals and other key companies, straight to your email. Email Address About Mirum PharmaceuticalsMirum Pharmaceuticals (NASDAQ:MIRM) is a late-stage biopharmaceutical company dedicated to the development and commercialization of innovative therapies for rare cholestatic liver diseases. The company’s primary focus lies in addressing the unmet medical needs of patients suffering from genetic and progressive forms of pediatric liver disorders, where limited treatment options currently exist. Mirum’s lead product candidate, maralixibat (Livmarli), is an ileal bile acid transporter inhibitor designed to reduce systemic bile acid accumulation and alleviate associated pruritus and liver damage. Maralixibat has achieved regulatory approval in the United States for the treatment of cholestatic pruritus in patients with Alagille syndrome and is under review or in clinical development for other rare cholestatic conditions, including progressive familial intrahepatic cholestasis (PFIC). In addition to its lead compound, Mirum maintains a pipeline of product candidates aimed at expanding the therapeutic options available to patients with orphan liver diseases. Founded in 2016 and headquartered in Brisbane, California, Mirum Pharmaceuticals operates with a patient-centric approach that emphasizes collaboration with advocacy groups and key opinion leaders in hepatology. Under the leadership of President and Chief Executive Officer Derek Chalmers, the company is actively pursuing regulatory approvals and commercial partnerships to bring its therapies to patients in the United States and international markets.View Mirum Pharmaceuticals ProfileRead more More Earnings Resources from MarketBeat Earnings Tools Today's Earnings Tomorrow's Earnings Next Week's Earnings Upcoming Earnings Calls Earnings Newsletter Earnings Call Transcripts Earnings Beats & Misses Corporate Guidance Earnings Screener Latest Articles Ross Stores Earnings Beat Sends Stock To New HighsWas Decker’s Double Beat a Bullish Signal—Or Mere HOKA’s-Pocus?Workday Validates AI Flywheel: Stock Price Recovery BeginsApparel Earnings Winners and Losers: Ralph Lauren Takes OffWhy Walmart, Target and TJX Got Such Different Reactions After EarningsThe Careful Consumer: What Q1 Earnings Reveal—And Where Cracks May AppearOverextended, e.l.f. 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PresentationSkip to Participants Operator00:00:00Hello and welcome to Mirum Pharmaceuticals reports fourth quarter and year-end 2024 financial results and provides business update. My name is Elliott, and I'll be your coordinator today. If you would like to register a question during today's event, please press star one on your telephone keypad. I'd now like to hand over to Andrew McKibben, Senior Vice President of Strategic Finance and Investor Relations. Please go ahead. Andrew McKibbenSVP of Strategic Finance and Investor Relations at Mirum Pharmaceuticals00:00:26Thanks, Elliott, and good afternoon, everyone. I'd like to welcome you to Mirum Pharmaceuticals' fourth quarter 2024 conference call. I'm joined today by our CEO, Chris Peetz, our Chief Medical Officer, Joanne Quan, and Eric Bjerkholt, our Chief Financial Officer. Peter Radovich, our President and Chief Operating Officer, could not be with us today as he's at an international launch event in Europe this week. Earlier today, Mirum issued a news release announcing the company's results for the fourth quarter and full year 2024. Copies of this news release and SEC filings can be found in the investors' section of our website. Before we start, I'd like to remind you that during the course of this conference call, we will be making certain forward-looking statements based on management's current expectations, including statements regarding Mirum's programs and market opportunities for its approved medicines and product candidates. Andrew McKibbenSVP of Strategic Finance and Investor Relations at Mirum Pharmaceuticals00:01:13These statements represent our judgment as of today and inherently involve risks and uncertainties that may cause actual results to differ materially from the results discussed. We are under no duty to update these statements. Please refer to the risk factors in our latest Form 10-K and subsequent SEC filings for more information. With that said, I'd like to turn the call over to Chris. Chris? Chris PeetzCEO at Mirum Pharmaceuticals00:01:32Thanks, Andrew, and good afternoon, everyone. I'm excited to start today's call with a recap of Mirum's achievements over the last year and share an update on our strategic goals for 2025. In the short time since our founding, through our focus on bringing important medicines to patients, we have created a strong business in ultra-rare disease that is cash flow positive, with an attractive pipeline and broader patient populations. We are still early in our journey, and we firmly believe that the best is yet to come. Our strategic priorities over the next two years are to, one, further the global growth of our commercial medicines, highlighted by LIVMARLI's continued Alagille syndrome expansion, early PFIC success, and the recent approval of CTEXLI for Cerebrotendinous xanthomatosis, or CTX, in the U.S. Chris PeetzCEO at Mirum Pharmaceuticals00:02:20Two, advance our high-impact pipeline, driving Volixibat, the potentially pivotal data in adult cholestasis next year, initiating our Fragile X program for MRM-3379, and completing enrollment of the EXPAND study for LIVMARLI and cholestatic pruritus. Three, selectively pursue product acquisition and license opportunities in rare disease with potential for significant patient impact and value creation, just as we have since the launch of Mirum, and four, accomplish all of the above with continued scientific and financial discipline. 2024 was a big year for delivering on strategic goals. Total net product sales were $336.4 million, exceeding the upper end of our revised guidance range. LIVMARLI finished the year with total net product sales of $213 million, including approximately $155 million from our U.S. business and $59 million internationally. In the second half of last year, PFIC new patient starts and international uptake were drivers of the step-up in growth. Chris PeetzCEO at Mirum Pharmaceuticals00:03:25We believe the strong demand we are seeing for LIVMARLI and Alagille syndrome and PFIC will continue. Beyond LIVMARLI, we also saw healthy growth in our bile acid medicines. We think we are starting to bend the curve here, with total 2024 net product sales of $123 million. I'm also happy to say that last week, the FDA approved CTEXLI, which is our new brand name for chenodiol, for CTX in adults. With this approval comes seven years of work and exclusivity and the opportunity to begin promotional efforts with our current field team to reach patients in this underdiagnosed condition. Ultimately, the robust growth dynamics across all of our medicines positions us well for 2025, where we expect to add close to $100 million to our top line, with anticipated net product sales between $420 and $435 million for the year. Chris PeetzCEO at Mirum Pharmaceuticals00:04:192024 was also a significant year for our pipeline. We expanded LIVMARLI's label with its approval for PFIC in both the U.S. and Europe. We initiated Phase III EXPAND study of LIVMARLI in broader settings of cholestatic pruritus, a significant growth opportunity for the brand. And beyond LIVMARLI, we achieved positive interim results for Volixibat in both VISTAS PSC and VANTAGE PBC studies, resulting in breakthrough designation in PBC. And finally, we have expanded our pipeline with the addition of MRM-3379 for Fragile X syndrome. This is another high unmet need orphan setting that aligns well with the capabilities we have built in rare genetic neurology for the launch of CTEXLI. Pulling all this together, we are set up for an exciting 2025 and beyond with continued strong execution in both our commercial business and pipeline of potentially high-impact medicines. Chris PeetzCEO at Mirum Pharmaceuticals00:05:13And with that, I'll turn it over to Joanne to give a brief update on the pipeline. Joanne? Joanne QuanCMO at Mirum Pharmaceuticals00:05:17Thanks, Chris. 2024 was a highly productive year for our clinical program. I'm excited to continue this momentum into 2025. Starting with our three potentially registrational studies of our advanced treatments with LIVMARLI and Volixibat, I'm pleased to say that the progress we made in 2024 builds further confidence in the impact of this mechanism on cholestatic pruritus across multiple settings, including Alagille, PFIC, biliary atresia, PSC, and PBC. We've now seen clinical evidence for the potential of IBAT inhibition to have a pronounced impact on this debilitating symptom. Starting with Volixibat and PSC, recall that the VISTAS study was currently enrolling with a single active dose, 20 mg BID. versus placebo, based on the blinded interim analysis we conducted in June of last year. Joanne QuanCMO at Mirum Pharmaceuticals00:06:04Following the positive interim analysis, where we passed both the efficacy and safety thresholds for continuation, we've had great engagement from investigators and patient communities, and we are pleased with the continued progress of this study. We are on track to complete enrollment in the second half of this year, and given that this is a 20-week study, we expect top-line results in 2026. There are no approved treatments for PSC, and we look forward to another opportunity to work with global health authorities to bring a high-impact medicine to an underserved patient community globally. Turning to PBC, enrollment in the VANTAGE study is also progressing well, and we remain on track to complete full enrollment in 2026. Given the results of our interim analysis, where we showed a statistically significant, rapid, and sustained improvement in pruritus versus placebo, we've seen a positive response from the investigator and patient community. Joanne QuanCMO at Mirum Pharmaceuticals00:06:58The majority of PBC patients are able to maintain a good biochemical response with first-line UDCA treatment but do not have adequate options to address their symptoms. The strength of the VANTAGE interim results in both first-line and second-line patients positions Volixibat to be a potentially impactful treatment option for a large portion of patients with PBC. Breakthrough therapy designation we received from FDA last year acknowledges the importance of Volixibat as a potential treatment. We are also excited Phase III EXPAND study with LIVMARLI. This is an excellent opportunity to expand the label for LIVMARLI to include additional settings of cholestatic pruritus, where there's a clear need for an approved effective treatment, and we are encouraged by the enthusiasm we're seeing from investigators. The study is ramping up well, and we are on track to complete enrollment in 2026. Joanne QuanCMO at Mirum Pharmaceuticals00:07:50Shifting to MRM-3379, our new PDE4D inhibitor for Fragile X syndrome, we are preparing to initiate a Phase II study this year, following discussions with the FDA. As a reminder, this mechanism has demonstrated proof of concept in Fragile X, and given the high expression of PDE4D in the brain and the importance of this pathway in learning and memory, we believe MRM-3379's brain penetration profile is potentially differentiating. In summary, we're very happy with the continued momentum of all of our clinical programs and the active engagement we've fostered with investigators and patient communities. We look forward to providing further updates on our progress during the year. I'll now turn it over to Eric. Eric. Eric BjerkholtCFO at Mirum Pharmaceuticals00:08:34Thank you, Joanne. I'm pleased to say that we are in an excellent financial position, supported by our strong performance in 2024, which I will now briefly summarize. 2024 was another year of continued strong growth in net product sales of our three commercial medicines. Total net product sales in the fourth quarter 2024 was $99.4 million, compared to $69.5 million the year before, representing a 43% year-over-year increase. For the full year 2024, total net product sales were $336.4 million, compared to $178.9 million in 2023. For LIVMARLI, total net product sales in the fourth quarter 2024 was $64.1 million. Total LIVMARLI net product sales for 2024 was $213.3 million, representing a 50% increase compared to 2023. Turning to our bile acid medicines, total net product sales in the fourth quarter 2024 was $35 million, representing an approximately 25% growth over the fourth quarter of 2023. Eric BjerkholtCFO at Mirum Pharmaceuticals00:09:51The first full quarter, the portfolio was under observation. Total net product sales for the portfolio for all of 2024 was $123.1 million. Total operating expense for 2024 was $424.5 million, which includes R&D expense of $140.6 million, SG&A expense of $202.2 million, and cost of sales of $81.6 million. Expenses for the year included non-cash stock-based compensation expense of $48.4 million, and intangible amortization and other non-cash items of $31 million. This intangible amortization and other non-cash items expense is largely reflected in our cost of goods sold. In the fourth quarter and full year, R&D expense also reflects the $7.5 million upfront payments we paid to a vendor for the MRM-3379 license. When adjusting for the non-cash items, I'm happy to say the business was cash flow positive in 2024, and we expect this to continue this year. Eric BjerkholtCFO at Mirum Pharmaceuticals00:11:08We ended 2024 with cash, cash equivalents, and investments of $293 million, an increase of approximately $7 million from the start of the year. Looking ahead, we expect net product sales of $420 million-$435 million in 2025, and we are guiding toward positive cash flow again this year. We are well funded, and we have the resources to execute on our plans and progress toward our multiple upcoming pipeline catalysts. Now, I'll turn the call back over to Chris for final comments. Chris PeetzCEO at Mirum Pharmaceuticals00:11:46Thanks, Eric. 2025 is set to be another big year for Mirum. With industry-leading commercial execution, an advancing pipeline, and a disciplined operating model, we have built a leading rare disease company, one that is positioned for sustained growth in the years to come. I'm proud of what we've accomplished and excited for the opportunities ahead as we continue to deliver life-changing medicines for patients and their families. And with that, operator, please open the call for questions. Operator00:12:17Thank you. If you would like to ask a question, please press star followed by one on your telephone keypad. If you would like to withdraw your question, please press star followed by two. When preparing to ask your question, please ensure your device is unmuted locally. First question comes from Gavin Clark-Gartner with Evercore ISI. Your line is open. Please go ahead. Gavin Clark-GartnerManaging Director at Evercore ISI00:12:41Hey, guys. Congrats on the great progress. So I just had one more strategic question. I know that you aren't able to call for redemption of convertible notes until next year, but just bigger picture, as your stock has traded well above the conversion price, the back of really strong earnings performance, pipeline advancement, does this all change how you think about BD and capital allocation in general? Thank you. Chris PeetzCEO at Mirum Pharmaceuticals00:13:04Thanks, Gavin, for the question. I'll make a first comment there and ask Eric to add anything else on the balance sheet. And the thing I'd point out, kind of the dynamic behind what you're pointing out there is that we've been able to navigate Mirum to a really unique position, particularly in this market backdrop for rare disease, where we can take advantage of our financial position and performance to acquire and basically roll up some of these rare disease products that we see as great value creation opportunities for the company. I'll ask Eric to speak more specifically to the financing plans. Eric BjerkholtCFO at Mirum Pharmaceuticals00:13:42Yeah, thank you. The convert matures in four years, so that doesn't really factor into our plans meaningfully. I think our financial and financing flexibility, as we continue to progress the business, is significant and gives us a lot of flexibility to consider BD alternatives that we might find attractive. Chris PeetzCEO at Mirum Pharmaceuticals00:14:14Thanks for the question, Gavin. Operator00:14:17We now turn to Jessica Fye with JPMorgan. Your line is open. Please go ahead. Jessica FyeManaging Director at JPMorgan00:14:23Hey, guys. Good afternoon. Thanks for taking the question. I was hoping you could talk about the underlying assumptions like market penetration or share, potential competition, etc., that are behind the $1 billion revenue potential for MRM-3379 in Fragile X. And I guess while we're talking about that asset, are there any other indications with the mechanistic rationale that could make sense to pursue? Thank you. Chris PeetzCEO at Mirum Pharmaceuticals00:14:52Thanks for the question, Jessica. I'll speak to the market sizing and then have Joanne kind of comment about applicability of the mechanism in other settings. And quite simply, the way to think about the market potential, when we look at just male patients with Fragile X, it's a 50,000 patient market. So a lot of different ways that you can look at the assumptions to see that the total addressable market is $1 billion or more quite easily. So really, when we talk about that number, we're looking at the U.S. opportunity. Do see substantial upside beyond that number even. It's a pretty simple kind of watermark to put there. And Joanne, you want to comment about the mechanism? Joanne QuanCMO at Mirum Pharmaceuticals00:15:38Yeah. Yeah. So actually, I think, Jessica, you sort of kind of rightly kind of asked the question in terms of what are the opportunities. We know that PDE4D is highly expressed in the brain in areas where learning and memory are very important. And so there are a wide number of conditions that this could be you could envision this could be used for. The way we're really approaching this is to kind of use Fragile X as our kind of first entry point, conducting a proof of concept there, identifying a dose, and then once we have that, then I think it opens up the possibility for entering into some other indications associated with intellectual disability. So certainly a lot of potential there that we're excited to access. Operator00:16:25We now turn to Mani Foroohar with Leerink Partners. Your line is open. Please go ahead. Operator00:16:34Hey, guys. You have Ryan on for Mani. Thanks for taking our question. So I'm curious, when you look at the Alagille market, where do you think we are in terms of penetration into the prevalent population? And kind of going forward, is U.S. growth really going to be driven more by new diagnoses or kind of greater penetration into those that are not on a Kasai yet? Chris PeetzCEO at Mirum Pharmaceuticals00:16:54Thanks. Thanks, Ryan, for the question. In terms of overall penetration for the eligible treatment population in the U.S., so Alagille syndrome patients with pruritus that are pre-transplant, we're probably in the range of 40% or so penetrated. So just from that statistic alone, we see a lot of growth potential in the prevalent patients. And thinking about what's driving that growth over time, there are actually several tailwinds on that. One is just the further penetration into the prevalent population. Chris PeetzCEO at Mirum Pharmaceuticals00:17:38There's continued new diagnoses that come along the way, so new patients entering, usually infants, so they're generally lower dose patients, but there are new patients that are diagnosed and start each year. And then behind that, this is weight-based dosing, so you do see some of those dose adjustments over time. So all of that kind of combines for the U.S. to show that there's a long runway of continued growth for Alagille syndrome in the U.S. Operator00:18:12We now turn to David Lebowitz with Citi. Your line is open. Please go ahead. David LebowitzSenior Research Analyst at Citi00:18:18Thank you very much for taking my question. In terms of the recent approval for CTX, congratulations on that. Could you, I guess, elaborate on how you expect this could affect the sales trajectory from this point going forward, given there's already use in that particular population? Chris PeetzCEO at Mirum Pharmaceuticals00:18:42Thanks for the question, David. Yeah. So you're kind of understanding in your question the dynamic here where we already have, we think that there's a substantial number of the diagnosed CTX patients had been on Chenodal. The plan is to have those convert over to CTEXLI in the coming months. And the goal here is to impact diagnosis and getting more patients diagnosed and then to treatment. So we do expect it to be a gradual kind of bending of the curve of bringing new patients to diagnosis earlier and preventing the accumulation and buildup of some of these irreversible effects of the disease. David LebowitzAnalyst at Citi00:19:30Got it. Chris PeetzCEO at Mirum Pharmaceuticals00:19:32Thanks for the question. Operator00:19:35Our next question comes from Mike Ulz with Morgan Stanley. Your line is open. Please go ahead. Operator00:19:42Hi, this is Rohit on for Mike. Thanks for taking our questions. Can you just talk about the patient mix between Alagille syndrome and PFIC for LIVMARLI in the fourth quarter of 2024 and how you expect this to play out in 2025? And then additionally, how many of the patients on the PFIC extended access program are now on paid drug? Thank you. Chris PeetzCEO at Mirum Pharmaceuticals00:20:04Thanks for the question, Rohit. I'll touch on the last one there first. During the year last year, we were able to convert all of the U.S. expanded access patients over to commercial products. So that was complete, really most of it into the third quarter last year. And in terms of the patient mix, we don't post specific numbers, but throughout kind of where we stand today, most LIVMARLI patients by far are Alagille syndrome patients. So that's the vast majority of the contribution today. In terms of new patient starts, since really Q3 of last year, we have seen with the steady Alagille patient starts, we have seen a nice step up in PFIC patient starts. So they are contributing quite substantially to new patient starts going forward. And you see that reflected in the top line performance. Chris PeetzCEO at Mirum Pharmaceuticals00:21:01Thank you. Chris PeetzCEO at Mirum Pharmaceuticals00:21:04Thanks for the question. Operator00:21:10We now turn to Ryan Deschner with Raymond James. Your line is open. Please go ahead. Ryan DeschnerVP at Raymond James00:21:18Hi there. Congrats on the quarter. My question is, how much commercial team expansion would you anticipate doing for expanded pruritus in ultra-rare cholestatic patients pending results of Phase III EXPAND study? And then I have a quick follow-up. Chris PeetzCEO at Mirum Pharmaceuticals00:21:36Thanks for the question, Ryan. For looking at planning for LIVMARLI's potential label expansion with expand, we anticipate that's largely the same prescribing universe as the Alagille syndrome and PFIC prescribers. So it wouldn't be an expansion of the field team that's already in place. So a lot that we can leverage there commercially. And you said you had a follow-up question? Ryan DeschnerVP at Raymond James00:22:04Yeah, thanks. Do you feel at this point, do you have a feel at this point for how many, specifically how much of an impact the growing average patient weights are in impacting sales growth in Alagille? How big actually is this growth component now compared to some of the other tailwinds here? And how do you expect it to grow moving forward? Chris PeetzCEO at Mirum Pharmaceuticals00:22:27I mean, the way that I would describe it is we look at and kind of think about this as the average dispense, and it changes quite modestly over time, in part because you continue to have new diagnoses come in, so there are new infant patient starts along the way, and that kind of tempers the overall effect, but we have seen it kind of gradually increase over the years. Ryan DeschnerVP at Raymond James00:22:57Got it. Thank you very much. Chris PeetzCEO at Mirum Pharmaceuticals00:23:00Thanks for the question. Operator00:23:03We now turn to Brian Skorney with Baird. Your line is open. Please go ahead. Operator00:23:09This is Luke on for Brian. Thanks for taking the question. We were hoping you could just talk a little bit about how the VANTAGE study takes into account prior OCA use and enrollment, and do you think patients recently discontinuing OCA could see an impact on pruritus measurements as compared to a patient not discontinuing? Chris PeetzCEO at Mirum Pharmaceuticals00:23:33Thanks for the question. I'll let Joanne jump into that one. David LebowitzAnalyst at Citi00:23:36Yeah. Thanks for the question. So when the study was started, we actually thought there would be a bigger contribution in terms of patients who are in OCA. It turns out it's really not an issue at this point. And so our enrollment has actually picked up quite nicely since the interim results came out. We're not really seeing that there's an issue in terms of patients, a lot of patients coming forward with OCA who are candidates for the study otherwise. And I think that just reflects overall kind of usage patterns with OCA in general, not really that much of a contender in this space. Chris PeetzCEO at Mirum Pharmaceuticals00:24:16Yeah. Kind of in addition to that, recall that for PDC, the VANTAGE study, about 2/3 of those patients are first line. So that would be before OCA would have been used or before the new PPARs are used. Chris PeetzCEO at Mirum Pharmaceuticals00:24:37Thank you. Chris PeetzCEO at Mirum Pharmaceuticals00:24:40Thanks for the question. Operator00:24:42Our next question comes from Jonathan Wolleben with Citizens JMP. Your line is open. Please go ahead. Jonathan WollebenManaging Director at Citizens JMP00:24:51Hey, thanks for taking the question. Just wondering, piggybacking on a prior expanded question, what do you envision the label looks like if you have success in Phase III trial? And then how do you wrap your heads around that 1,000 patient U.S. and EU prevalence given it's a collection of a bunch of small indications? Chris PeetzCEO at Mirum Pharmaceuticals00:25:11Yeah. Jonathan, thanks for the question. The indication statement is something to nail down, frankly. As you point out, it's a definition somewhat of exclusion. It's a basket of several different causes of cholestasis, excluding PSC, PBC, ICP, Alagille syndrome, and PFIC. So it's all of the many less common causes of cholestasis. So exact wording will need to be ironed out as we get to that label expansion. In terms of how we think about the patient number, though, we think it's quite simply the way to think about it. It's a PFIC-sized opportunity or larger. And as we looked at kind of real compassionate use requests and interest from physicians kind of counting up some of those patient numbers and where that demand was coming from, that's how we landed at that 1,000 patient estimate for the U.S. and Europe. Chris PeetzCEO at Mirum Pharmaceuticals00:26:13So I feel it's a very tangible market estimate as opposed to maybe an epidemiology study, for example. So I feel confident that it's a quite sizable opportunity for LIVMARLI. Jonathan WollebenManaging Director at Citizens JMP00:26:29I see. All right. That's helpful. Thanks, Chris. Chris PeetzCEO at Mirum Pharmaceuticals00:26:32Thanks for the question. Operator00:26:36Our final question comes from Ed Arce with H.C. Wainwright. Your line is open. Please go ahead. Thomas HoffmannManaging Director at H.C. Wainwright00:26:43Hello, good afternoon, everyone. This is Thomas, here asking a group of questions for Ed. Thank you so much for taking our questions. So first, for the Volixibat this study in PFIC, good to hear that it's on target to complete enrollment in the second half this year. Just wonder how many months or when should we expect to see top-line data after complete enrollment is announced? If you can outline some details on the process. Chris PeetzCEO at Mirum Pharmaceuticals00:27:15Yeah. Thanks for the question, Thomas. I mean, the simple way to think of it is it's approximately six-month endpoint and time to close and clean the database. So you can kind of project some amount of time like that after enrollment completion. We do plan to announce enrollment completion when we get there. Thomas HoffmannManaging Director at H.C. Wainwright00:27:34Got it. And then perhaps one question on Phase III on the EXPAND study with LIVMARLI as well. Just wonder if you can share some patient experience that you have received to date and which type of rare cholestatic conditions are most common so far. Chris PeetzCEO at Mirum Pharmaceuticals00:27:56Yeah. Thanks for the question. I'll maybe ask Joanne to speak to some of the data at AASLD last year on that point. Joanne QuanCMO at Mirum Pharmaceuticals00:28:03Yeah. We do actually have a number of patients that were treated through compassionate use for biliary atresia. And those results are quite strikingly positive for treatment of their pruritus. And of note, this is a different patient group than was studied in the earlier EMBARK study. So these are biliary atresia patients that have likely had a Kasai when they were quite young. And then they continue on. We do know that over time, patients will progress in terms of their disease and often require liver transplant. And as part of that progression of disease, they will develop pruritus. And so we do have an abstract with a handful of cases where there's been quite good treatment outcomes using IBAT inhibition. Joanne QuanCMO at Mirum Pharmaceuticals00:28:43So that's partly what gives us confidence in conducting a study like the EXPAND study that ultimately there is a need and also that we do have a product that can really address that. Thomas HoffmannManaging Director at H.C. Wainwright00:28:56Understood. Perhaps one follow-up on that. Should we expect to see some kind of interim data from this study, perhaps in medical conferences, posters? Joanne QuanCMO at Mirum Pharmaceuticals00:29:11Actually, we do not plan to do an interim analysis for the study. Our plan is to complete enrollment in 2026, next year. So if we did an interim, it would actually slow things down. So we do think we're on track to complete enrollment in 2026 and look forward to sharing the results when they're available for the full study. Thomas HoffmannManaging Director at H.C. Wainwright00:29:33Understood. Thank you again for the kind questions. Chris PeetzCEO at Mirum Pharmaceuticals00:29:37Thank you, Thomas. Operator00:29:41This concludes our Q&A. I'll now hand back to Chris Peetz, CEO, for any final remarks. Chris PeetzCEO at Mirum Pharmaceuticals00:29:48Great. Thank you all for joining us today. Have a great afternoon. Thanks. Operator00:29:54Ladies and gentlemen, today's call is now concluded. We'd like to thank you for your participation. You may now disconnect your lines.Read moreParticipantsExecutivesEric BjerkholtCFOJoanne QuanCMOAndrew McKibbenSVP of Strategic Finance and Investor RelationsChris PeetzCEOAnalystsRyan DeschnerVP at Raymond JamesThomas HoffmannManaging Director at H.C. WainwrightJonathan WollebenManaging Director at Citizens JMPAnalyst at Leerink PartnersAnalyst at BairdAnalyst at Morgan StanleyDavid LebowitzSenior Research Analyst at CitiGavin Clark-GartnerManaging Director at Evercore ISIJessica FyeManaging Director at JPMorganDavid LebowitzAnalyst at CitiPowered by