Good afternoon, everyone, and thank you for joining BridgeBio Pharma's First Quarter 2026 Earnings Call. I'm Chinmay Shukla, Senior Vice President, Strategic Finance. With me are Neil Kumar, our CEO; Matt Outten, our Chief Commercial Officer; and Tom Trimarchi, our President and Chief Financial Officer. On today's call, Neil will walk through our commercial pipeline and business updates with Matt providing additional commercial detail and Tom covering financials.

Following our prepared remarks, we will open the call for questions. For the Q&A session, we will be joined by Ananth Sridhar, Anna Wade and Justin To, who will lead our programs with encaleret, BBP-418 and infigratinib respectively. With that, I'll turn it over to Neil.

Thanks, Chinmay, and thanks, everyone, for joining us today. As always, this is a forum in which we communicate salient aspects of our business that are of interest to investors, and we welcome your questions and feedback along the way. I want to spend the bulk of my time today talking about 3 things. The first is the Attruby franchise, and I want to talk about our continued commercial momentum there and how we think about clinical differentiation.

Importantly, these 2 things, plus the economics associated with the Part D orphan drug channel, underpin our confidence that Attruby will continue to grow even past 2032. The second thing I want to discuss is launch readiness against the 3 exciting first-in-class or best-in-class brands we have in ADH1, LGMD2I and achondroplasia. Although there are no major near-term clinical catalysts for any of these brands, there is a tremendous amount of activity going toward ensuring expeditious and high-quality approvals and launches.

In its history, BridgeBio has demonstrated across now 3 approved products with hopefully 3 more to come, the ability to take on post Phase III regulatory submission activities at very high quality, and we intend to build on this tradition with these new brands. I'll end my comments by addressing the current gap between our intrinsic value and where our shares trade today. I've heard from investors in the past that too much NPV talk is not what people tune into these calls to hear.

But at this point, it is my responsibility to discuss matters related to capturing the value that investors who have been in our stock for a long time have helped create. Our focus at BridgeBio has always been on long-term value creation and on reliably being able to take in money to do more work over time. And by the way, our activities across the BridgeBio ecosystem show that there are many more of these R&D opportunities out there.

But this model is reliant on capturing the value of the work for investors, which is why today, I'll be discussing a share buyback program that will commence immediately. Let me begin my comments by talking about Attruby. As many of you have read in the press release, we've had $186 -- we've had $180.6 million of Attruby sales in U.S. Attruby net product revenue this quarter, which represents a 24% growth from the last quarter and a 392% growth year-on-year and is consistent with the brand globally becoming a blockbuster in 2026.

Our focus continues to be on winning in the front line, where we believe a 95% stabilizer that preserves the native tetramer is not only the optimal solution, but even against combinations is the only solution one should start with as it provides the highest degree of management of TTR monomer deposition, provides impact more quickly and is consistent -- which is consistent with the pharmacokinetics of TTR stabilization and ultimately achieves all of this in a cost-efficient and easy-to-access manner. Parenthetically, our data suggests a tripling in combo use with Attruby with the various knockdowns, suggesting that the message that one should reach for a better stabilizer even in combination is resonating. As it relates to the front line, our major competition continues to be Pfizer, and our best understanding of our share is that it has grown from the NBRx share I quoted at the JPM talk of 25%, even furthermore, but still remains behind what Pfizer has been able to accomplish in the front line.

We believe that in this quarter, total new patient starts in the category were in excess of 6,100 new patients, and we believe that for the first time, we are convincingly the second brand by volume in the space. There's more work to be done, but all of these trends continue to be in the right direction for us. So how do we pour some gasoline on these growing sales? The obvious way to do that in our mind is through clinical differentiation.

We began to see reasonable inclines in the second derivative of our growth as the serum TTR story began to evolve in the marketplace with multiple papers suggesting that higher levels of serum TTR associated with lower levels of mortality at 30months. As a reminder, every mg per deciliter of incremental increase in serum TTR seems to lead to a 5% decrease in mortality risk at 30 months, meaning a more potent stabilizer and we do not hear from many physicians quibbling with the fact that Attruby is a more potent stabilizer, it is, should lead to better outcomes for the patients that we serve. Building on that, we are now beginning to explore and are confident in the outperformance of acoramidis versus tafamidis in the real-world setting.

There were only really 2 real-world evidence studies reported to date, survival studies done in Colombia and by Dr. Masri that showed outperformance of acoramidis both, but those were comparing our trial data and not at that point -- we didn't have enough time at that point to be in the market long enough to demonstrate anything in the classic real-world evidence setting. That is now changing. At SCAI, an independent real-world evidence study presented by the Valley Health System of Nevada revealed statistically significant outcome improvements associated with acoramidis as compared to tafamidis.

Building on this, we have a study in Med Archive that we will publish shortly in a major journal showing that Attruby reduces diuretic intensification by 43% as compared to tafamidis. We intend to continue studying and publishing on Attruby's differentiation in the real-world setting and are glad to see the cardiology community doing so independently. Interestingly, one of the benefits of acoramidis that was identified in the independent real-world evidence study was a lower incidence of acute kidney injury.

As I mentioned in my JPMorgan talk, we are driving toward what we believe will be a seminal publication with potential impact for patients, physicians and even on our label as it discusses an observed rapid hemodynamically mediated renal protective effect, which is unique to Attruby as opposed to the other stabilizers and knockdowns in the space. We continue to present and publish on acoramidis at major medical meetings as well. At ACC recently, we presented long-term efficacy and safety data from our Phase III open-label extension, showing sustained clinical benefit from acoramidis at month 54, including a remarkable statistically significant risk reduction of 45% in all-cause mortality with a p-value of less than 0.0001 and a 49% reduction in cardiovascular mortality, again, with a similar p-value versus placebo tafamidis or to acoramidis.

All right. I'd like to turn to the rest of the pipeline now. On LGMD2I as I alluded to in my earlier comments, our team was able to go from top line data to NDA submission in 155 days, consistent with our ethos at every minute counts and the fast pace that we have previously set with regard to our TTR regulatory submissions. We continue to work closely with the agency and foreign regulators to bring this medicine as expeditiously as possible to the patients who need it.

I had the opportunity to attend the top line result presentation recently in Orlando at the MDA meeting. It was a trip I won't soon forget. I was struck by the excitement that our data generated, not only within the LGMD2I community, but more broadly, given the striking results associated with BBP-418 suggests that functional improvement is possible when targeting well-described conditions at their source. Given the already 500 or so genetically confirmed patients in the United States to date, the highly engaged patient community and physician education being conducted by the team, all of this augurs well for a positive launch dynamic.

Moving to ADH1, I'll be leaving from here to a very similar gathering, a top line presentation of our CALIBRATE Phase III data at the European Congress of Endocrinology in just a matter of days. Here again, we'll be looking to drive excitement into the broader physician community and to educate the patient community and establish a base of data that, together with our publication of our Phase III data can ensure market building exercises can continue with high fidelity. Importantly, BridgeBio has been supporting via grant family genetic testing events in the United States that continue to identify new patients with relatively high yield.

Although we have been -- we are launching at a time when a vast majority of patients with ADH1 have not been identified yet, the combo of genetic testing, ICD-10 codes and broad disease awareness education helps buttress our belief that we will be able to find ever more patients in need of this compelling drug product. Furthermore, our Phase III in chronic hypoparathyroidism will be commencing this summer and is bolstered by recent published work that illuminates the central role that the calcium-sensing receptor in the kidney plays in regulating calcium metabolism. Finally, moving to achondroplasia.

The results from this trial came after LGMD2I and ADH1, but I suspect given the strength of the results, prominence of the condition and the remarkable KOLs we're privileged to partner with that the Phase III manuscript will be forthcoming in a major medical publication, and we anticipate presenting the full PROPEL 3 data set at a medical conference in the second half of 2026. Early commercial research here suggests unaided awareness in excess of 40% from this prescribing physician community, which for those of you who are commercial experts know is a very high starting point and certainly higher than we've seen before in our own portfolio. Finally, I want to touch on the share repurchase program that we announced today.

To do so, I'd like to go back to BridgeBio's founding principles. The company was built on 2 things: to help as many patients as possible and to establish a corporate and financial model that creates and captures value in predictable, responsible ways. That value capture has always been part of the mission, while we talk about NPV, while we anchor to intrinsic value, while we try to make the right economic decision at every forum.

The reason for that is because if we capture value, more capital flows into drug development over time and more patients get served by us and others employing our decentralized diversified model. Unfortunately, at this moment, we have not adequately captured value for the investors we serve given the large disconnect between our NPV per share and our firm's intrinsic value. Even with the revision of Vyndamax's entry from 2035 to mid-2031 or early 2032, our intrinsic value remains markedly higher than where we've been able to get the shares to trade to today for investors.

To that end, the Board has authorized a $500 million share repurchase program. These repurchases should allow our shareholders to concentrate their ownership in a portfolio whose risk profile has fundamentally improved. Of note, we have employed this technique in the past some 6x. In aggregate, even accounting for the pre-part A buyback, we have driven substantial returns for investors with our share repurchases. While we have this lever, we still believe in putting capital into our launches and advancing our clinical trials.

Repurchases are additive and opportunistic, not substitutive and are a direct result of our strong balance sheet. On the balance sheet point, we will always size deployment such that we preserve full flexibility to finance every credible program and activity in our portfolio. Plenty of liquidity and the ability to easily service our liabilities is a requirement before we deploy dollars into the buyback. Okay. With that, I'll turn the call over to Matt to talk more about our commercial efforts.

Thank you, Neil, and good afternoon, everyone. Q1 was another strong quarter for Attruby, delivering an impressive 24% increase in net sales from Q4 and a 392% year-over-year increase from Q1 2025. Growth was driven by our existing and expanded sales teams, accelerating new patient starts and first-line share gains. There are several factors which contributed to these results. Market momentum has remained strong. New-to-brand market share hit its fastest quarter-over-quarter growth since Q1 2025 and first-line patients have increased each and every month of the launch.

Fill rates, cap rates, gross to net, compliance and persistency all continue to remain in line with expectations. Insurance reauthorization dynamics has been a topic of industry discussion this quarter, and I want to address them directly. Attruby did not experience reauthorization disruptions for 2 reasons. Part D, D as in David is a continuous plan-based model, which avoids the annual renewal friction of Part B, B as in boy.

That structural advantage matters. In addition, in 2025, the average co-pay for Attruby patients was only $190 for the entire year, making many patients pay only $0 out of pocket as well. Our field teams executed with exceptional discipline to keep patients on therapy without interruption. We hire exceptional people and those people make sure that any patient who wants a near complete stabilizer can get Attruby and importantly, can stay on Attruby.

Turning to our pipeline. We are encouraged by early indicators across our 3 anticipated near-term launches in LGMD2I/R9, ADH1 and achondroplasia. In LGMD2I/R9, we are entering a disease area where no approved therapy exists. We've onboarded a commercial leadership team and have set up a specialized patient identification and field reimbursement infrastructure. Our goal is simple: find every patient who can benefit and be ready to serve them from day 1 of approval.

In ADH1, our claims analysis has already identified nearly 2,000 patients in the U.S., and that number continues to grow. We've built a dedicated sales leadership team and patient infrastructure tailored to this community. Encaleret would be the first medication to target the disease mechanism directly and it's orally administrated. Physician excitement is high, and we are ready to move immediately at approval. In achondroplasia, we are preparing for a global launch with a truly differentiated clinical profile.

Infigratinib is the first medication to demonstrate statistically significant improvement in body proportionality, not just improvements in average height velocity and the only oral option in the category. For families seeking an alternative to injectables or returning to treatment after a negative experience, the clinical profile and route of administration of infigratinib is very compelling. To summarize, Q1 continues to reflect a durable growth trajectory for Attruby and proof of the commercial capability we've built at BridgeBio, an organization that knows how to launch, scale and build franchises. We remain focused on execution for patients, for families, for prescribers and for long-term value creation. I'll now turn the call over to Tom.

Thank you, Matt, and good afternoon, everyone. I'll now walk through our financial results for the first quarter of 2026. Our commentary will focus on GAAP financials unless otherwise noted. Total revenues for the first quarter of 2026 were $194.5 million compared to $116.6 million for the same period of 2025. The $77.9 million increase was primarily driven by a $143.9 million increase in Attruby net product revenue.

Attruby net product revenue in the quarter was $180.6 million compared to $36.7 million in the same period last year. Royalty revenue increased by $9.3 million to $9.5 million, primarily earned from net product sales of BEYONTTRA in Europe and Japan. License and services revenue was $4.4 million compared to $79.7 million for the same period last year. The decline reflects the recognition of a onetime $75 million regulatory milestone from the prior year.

Total operating expenses for the first quarter of 2026 were $290.5 million compared to $218.4 million for the same period last year. The $72.1 million increase reflects deliberate and disciplined investment in Attruby and preparations for 3 upcoming launches. SG&A expenses were $163.9 million, an increase of $57.5 million compared to the same period last year, reflecting measured investment in our commercial activities.

R&D expenses were $126.6 million, an increase of $15.2 million driven by investments in medical affairs and CMC in support of our next launches. Turning to the operating line. In the first quarter, we recorded a $106 million operating loss. Over the last 5 quarters, our loss from operations has narrowed by more than 50% due to OpEx discipline paired with strong execution on Attruby. Looking at the quarterly trend, if we back out onetime milestone payments, we've seen an improvement in the operating line every quarter since the Attruby launch.

Looking ahead, we expect the trend in loss from operations to flatten over the next 2 quarters as we ramp up launch readiness activities for the next 3 products and continue narrowing towards the end of this year to 2027 as we transition toward P&L breakeven, followed by cash flow positivity, which we expect to be sustainable from that point on. Turning to the balance sheet. We ended the first quarter with $940.2 million in cash, cash equivalents and marketable securities compared to $587.5 million at the end of last year.

We believe our current cash position provides us with significant runway to fund our operating activities, advance our 3 late-stage programs towards approval and launch and continue to invest in Attruby's commercial growth, all while maintaining financial discipline we've demonstrated to date. With that, I'll turn the call back over to Chinmay.

Thank you, Neil, Matt and Tom. Operator, please open the line for questions now.

This is Matt. I'll take that one, and thanks for the question. We're definitely excited about the continued performance of Attruby. I think the acceleration you're referring to is being driven by a few things. The first is physicians' desire to use the only near-complete stabilizer on the market. Stabilization is the backbone of therapy in ATTR-CM and near complete stabilization along with Attruby speed and showing separation from placebo is attractive to patients and HCPs.

They want something that's going to work quickly and Attruby has shown that it can do that. And recently, as you heard from Neil in his original remarks, the real-world evidence has backed all of these points up for both the treatment-naive patients and switch patients, and that's helping to drive our share upwards.

Yes. Maybe the only thing I'd add there is the serum TTR story, I think you saw a bevy of papers, both from us, but then importantly, from others suggesting the numbers that I put forth the mg per deciliter increase associating with pretty remarkable decreases in mortality downstream. And obviously, as a reminder, when we put patients on acoramidis following administration of tafamidis coming out of our Phase III trial, you saw a 3.4 mg per deciliter increase and everyone increased their serum TTR level.

So it doesn't really matter how you measure it. You're just getting increases in serum TTR. The question outstanding was never, I don't know, Matt, if you'd agree with this, whether or not acoramidis is a better stabilizer. I think most people can understand that even if they can't understand a specific in vitro assay. And the bigger question was how much more is that buying me in terms of downstream results. And the serum TTR work was just the first part of that.

I think you're going to see a lot more of that in the coming 12 to 24 months, really just because we have enough patients now with enough duration that we can start to ask and answer those questions.

Mani, thanks for the question. So the clarity on Vyndamax IP is clearly a meaningful positive for Bridge and Attruby. We now have at least 6 years of runway before generics, which is more than enough time to reach peak share. And obviously, this all materially reduces any tail risk we would have to the NPV program. I don't think the resolution really changes our commercial strategy. We've always been focused on establishing Attruby as the treatment of choice in ATTR-CM given its differentiated profile, and we are executing against that.

I think you heard both Neil and Matt talk about the bevy of literature that we are producing as well as all the commercial activities which we are undertaking to really reinforce that differentiation and drive share. I guess what I'll say at the end is just -- we've shared our belief that Attruby will be a $4 billion drug last year in our Q1 '25 earnings call. I don't think we've ever been more confident in that estimate.

I actually think, if anything, there might be some room for potential upside. I think as Neil mentioned in his prepared remarks, Attruby is likely to keep growing even after 2032, given the ecosystem and channel dynamics that exist here with Part B. And so that's kind of what's driving our confidence. So yes, I think it's a good thing for us. We've reduced the error bars on our valuation.

Yes. Maybe I'll add to that. I mean, I personally did think, Mani, we talked about it that it would be 2035. So obviously, I was wrong on that. That is a little bit of a discount, but not material, as I mentioned in my comments. And the bigger thing is like all of these differentiating studies that we're running, it is really starting to resonate with clinicians in addition to the fact that the access programs are superior.

So, I guess, what your question is really alluding to is like will we run a double-blind head-to-head. We still might. We reserve the option to do that. Certainly, we've been excited to do that in the context of either TTR levels or NT-proBNP. But how we size like a hospitalization study is difficult if you look at the number of events. We're going to have a strong look at the placebo arm of the upcoming eplontersen trials to really understand what those event rates look like in the context of clinical trials to see if there are some double-blind head-to-head opportunities.

But there's nothing obvious right now. So we'll continue doing the real-world evidence studies, which I think are the best, honestly, characterization of sort of differential competitive dynamics.

I can kick that off. I mean I think right now, the focus is on focused execution against the pipeline that we have right now. I mean we've got in discussions with investors, ample growth that has not been valued in the context of this company to date. I mean, the LGMD2I launch that I referred to, the ADH1 launch, the achon launch even in its totality, I think we're projecting market share numbers well in excess of what typically a third mover gets in that space.

And then you think about the consequential additional indications, both in terms of hypocon and importantly, in terms of chronic hypoparathyroidism that we're kicking off. And then we've got the [indiscernible] program. So like that constellation of activities is more than enough to drive long-term growth for any company, and that's kind of what we're focused on. Do we -- can we fully finance all of that comfortably, and we feel like we can.

And therefore, beyond that, what we do with excess capital. And we think the best relative -- in terms of relative return way that we can deploy capital right now is into our own shares just given the disconnect between intrinsic value and where we're trading. So that's really what the discussion came down to. It's hard to -- I know the normal way that a biotech will grow and say, well, who cares, share price is low, let's go ahead and dilute everyone and just keep going after science that we believe in. But that is not a reliable, sustainable long-term model in my belief, and nor is it one that we intend to employ here at BridgeBio.

Yes, it's pretty different because recall that we had a significant less shift in our clinical trial, like those -- our placebo outperformed the on-drug arm of ATTR-ACT. So there's kind of no way for us to actually apples-to-apples go across like diuretic intensification. And by the way, like even the use of diuresis and resin control meds and SGLT2i use in this population, all of that stuff has changed pretty markedly.

So it almost made it impossible, accepting the in-trial comparisons we can make between tafamidis and acoramidis with all of the available caveats there, where, I mean, just as a reminder, acoramidis outperformed tafamidis in all aspects, which you did not see in HELIOS-B. But I think real-world evidence is the right way to do this within systems or across a constellation of systems that we know have a lot of integrity in terms of clinical studies. And here, you're seeing things like what we mentioned in terms of diuretic intensification.

We certainly didn't look at downstream kidney effects like the Nevada System did, but it's all resonant, I suppose, with the advantages that we think Attruby has versus tafamidis in terms of mortality and hospitalization. It's just nice to see it actually play out in the real world.

Yes. Thanks for the question. I think the feedback from the clinician and caregiver community has been overwhelmingly positive. HCPs are telling us that they're constantly being asked by families when the oral is coming, both from families who are on treatment today, but more importantly, those that stayed on the sidelines, which as a reminder, makes up about 70% to 80% of the U.S. market. The consistent best-in-class profile is continuing to resonate with clinicians.

They understand that AHV is best-in-class. The IT score is best-in-class. We have the most attractive safety profile and importantly, proportionality, right? The proportionality data point is the one that's resonating most with clinicians because this is the only product that has result of proportionality in the 3 to 8 age group population. And which is a demonstration of how directly targeting FGFR3 impacts more than just height here instead of health.

And on that note, we will be releasing more data on how infigratinib is benefiting more than just height in some medical congresses later this year, some of which have never been seen before in a 52-week placebo-controlled trial. So stay tuned there. Ultimately, all this is to show that it really reinforces our belief that we will have a peak market share, potentially more than 65% market share as validated by our market research here.

Ellie, this is Tom. So I'm going to pass the limb-girdle one to Anna Wade here and then CARDIO-TTRansform to Neil. But first, I want to say I'm really proud of our team for the quick turnaround on the NDA, and you can expect that level of efficiency from the next 2 as well. But over to Anna and then to Neil.

Thanks for the question, Ellie, and thanks for the kind words, Tom. So yes, we're really excited. We have our commercial and sales leadership on board. We're getting ready to have the sales reps hired later this year. We also now have our medical leadership in place as well as a seasoned MSL team with neuromuscular and rare disease experience. In Q1, our major catalyst was the MDA conference, as Neil mentioned, in March, where Dr.

Katherine Mathews, a leading KOL in the field presented our Phase III interim analysis data, and we had incredibly positive feedback at the meeting about the compelling data package. Since MDA, we've heard about significant patient outreach to neuromuscular centers. And internally, we have received many inbound inquiries from both patients and physicians. Our focus right now is driving awareness of the Phase III data as well as emphasizing the importance of genetic diagnosis, leveraging responsive testing programs that are currently available so that day 1 of launch, we can be ready to get patients on therapy.

I think let me address her second question, which I think was on the CARDIO-TTRansform. So yes, we agree with you. It's a super well-powered trial. I mean, obviously, against the primary, it looks good. And even in the subpopulations, like if you take the same point estimate from HELIOS-B on combo and you just take the Z-score and then you say how many more patients would you need? It's like 2.5x more to hit a p-value of 0.05 or less, and they're pretty well powered for that.

So I actually expect that they'll hit on almost everything that they're interrogating. And so then it comes back to how do I cross-trial compare, how do I understand this knockdown technology, part of that will be how much knockdown they get and are they able to improve on the PK profile because I think the reason that TAF performed similarly to AMVUTTRA or in the HELIOS-B trial has to do with the timing it takes for -- to get to mean max knockdown. So it takes a lot longer than I would have expected.

So we'll see if that's the case with their drug. I think overall, honestly, CARDIO-TTRansform has more to do with the commercial dynamics with Alnylam than it does with us, especially given the combo data that I just told you about. I mean I think people are going to reach for stabilizers first line anyway, number one. Number two, I think when they're failing stabilizers, they're going to want a better stabilizer on board in combination.

So if that combo arm does hit, I don't see it having a meaningful -- super meaningful effect for us. Again, I mean, I think from a biochemical standpoint, you always want to preserve the native tetramer. We're seeing more and more information about that. I'm surprised people haven't been looking at the publicly available FAERS database and what do things look like when you're knocking things down versus actually stabilizing and all consistent with the 2 25,000-plus patient studies that we've seen out there, suggesting that higher levels of serum TTR are better for you, but I understand that in a short trial, those signals aren't necessarily resolvable.

But I think over the longer period of time, stabilizers will continue to be front line. And then in combination, I think we'll have a pretty good say there, too. But that's kind of -- that's how we're thinking about it. We do think CARDIO-TTRansform will be positive just given the patient numbers. On your hazard ratio question, I mean, obviously, we think the bar is relative risk reduction of 42% and risk reduction of 50% on hospitalization, which I suspect if this study is consistent with the rest of the modern studies are going to be a vast majority of the events will be hospitalization, not mortality. So I think that bar 50% reduction in hospitalization is kind of what I'll be looking for.

Anup, good to hear from you. Yes, I would say that the foundation of everything that we're doing around patient identification is really awareness, awareness of the disease as an important distinct subset within hypopara. And then, of course, awareness of our drug and the wonderful effect it can have for these patients. I think a major catalyst for awareness is going to be the upcoming presentation at ECE next week, followed by U.S. presentations later in the year and then hopefully a very high-impact publication as well.

But in the background, I think there are some important tactics and strategies that we continue to employ. First, as you mentioned, the ICD-10 code is a huge advantage to us here. Many rare diseases don't have an ICD-10 code. We're lucky to have one that's been in place for a couple of years already. So there's a good amount of data in that. That lets us take our analytics capabilities, put them on top of this and really deploy our field-based medical and commercial leadership in a more surgical way to go into the offices, spread awareness and also make sure that the patients they think they have are appropriately diagnosed with our sponsored genetic tests or other commercially available genetic tests.

And then third, and I think this has been a bigger driver of identification than I would have thought is just family tracing. Makes sense when you consider this is a dominant condition. So there's a 50% chance of passing on. So when we tend to find one person with this condition, if they look and go to a family event, we find out that many of them running brothers, cousins, aunts and uncles also have the condition. So that's been a real valuable source of patient identification as well. So we'll continue all these efforts and accelerate them as we approach launch. Our next question comes from the line of Derek Archila with Wells Fargo.

Yes. Thanks, Derek. I think ultimately, physicians and families are excited about the total package of infigratinib, right, not just one thing. It starts with the 2.1 centimeter change from baseline AHV, the largest effect shown across any of the 3 Phase IIIs, which was remarkable consistent across the age groups. And of course, as I mentioned earlier, the only statistic improvement on proportionality, a demonstration of the importance of directly engaging FGFR3.

And then you have a differentiated safety profile, right, with no injection site reactions, no symptomatic hypertension, no hypertrichosis. And I think the safety differentiation is further playing out given the increasing and concerning signals of [indiscernible] and femur fractures, which are both looking like potential CMV class effects. The go on top of this for us is being the daily oral. Based on historical benchmarks, we know that when oral enters a market with only injectables, it expands the market on average by 3x to 4x at year 5 after launch. So ultimately, the families here will have a choice of either 365 injections a year, 52 injections a year or 0. I know which one in those families.

Yes. Thanks for the question, Paul. Definitely, I think there's a lot of excitement from sites and profound efficacy in the Phase III PROPEL 3 data, right? Just kind of what we know from the field shows that the earlier you intervene, the more likely to impact -- likely to impact clinical outcomes. I think we've seen definitely a burst of excitement there. So we'll provide an update on timing probably later on once we have some more clarity once this program progresses.

Yes. Thanks for the question. I think right now, as I think a lot of our comments and actions have been consistent with, we're very focused on executing the opportunity in front of us. It's not often that a biotech will launch 3 different products in 3 different indication settings alongside a pretty competitive market at the same time. And that's going to take certainly against our lean backbone, all of the focus that we have.

I also mentioned earlier that we have pretty significant additional opportunities associated with every single one of our drug products, including some that we haven't talked about vis-a-vis Attruby. So I actually think that there's some pretty interesting stuff to do. We have an internal pipeline, obviously, prosecuting programs in ADPKD, dilated cardiomyopathy and the depleter antibody program in ATTR cardiomyopathy.

So that's additionally programs that are very, very capitally efficient, but programs that we have an eye on to date. And then we've got backup programs against all of our current pipeline programs so that we can do what's right for the patient and physician community to continue to serve them as long as possible. So all of those things put together, I would say, represent the menu of activities that we're interested in, in the near term.

Obviously, we're students of the genetic disease space. BridgeBio has a significant stake in another company called GondolaBio, which is really kind of one of our sister companies, and that has 17 programs that I think we've gone through, ranging from Phase II all the way back to the preclinical setting and has a very, very exciting slate of small molecules, ASOs, antibodies, all targeting well-described genetic conditions at their source. And so I would say that -- we're happy for that to be sort of an off-balance sheet R&D exercise for now as is BridgeBio Oncology Therapeutics and really a focus on what we need to focus on here, which is continued prosecution of our pipeline programs, delivery of these important medicines to patients and ultimately, the capturing of the value that we have created for the investors that have backed us for many years.

Yes, sure. I mean I think this market continues to grow somewhere between like -- I think our internal numbers are somewhere between 5,000 and 6,000 in that range a quarter in terms of these new patient starts or new patients to brand. So actually, I don't think we have 4,500 for last quarter. I think it was above 5,000. But a little bit of this math has to do with like us guessing for our competitors what the inventory holdback was or what the inventory buys were and things of that nature.

So you can never get it fully right. We can get obviously, our own patient numbers fully right. But that does suggest continued growth. I mean, will it continue to grow? I think so. Obviously, there's 250,000 patients with ATTR cardiomyopathy at the low end in the U.S., and I think we're doing a better job of 3 things. One is making sure that the algorithms are in these EMRs so that people think a look for these patients.

There's all the TRACE AI stuff that we've been doing, other algorithms that individual health care systems have been putting forth to just get people to think, maybe this is a TTR patients. So that's one. Second is driving genetic testing into variant heavy populations. That's been helpful as well. And the third and probably best is just broad physician awareness and education through speaker bureaus, really getting out into the [indiscernible] practices and the community practices to educate them more.

So all of that's positive. I'd say on the negative side, we've heard quite a bit about this PYP shortage, the technetium scan, one of the ways that you can do the scans to get a definitive diagnosis alongside the ELISA assay. So that we have to keep an eye on. We've heard about that before, like in 2025, we heard about that, I think, in the second or third quarter, one of the big quarters and the market continues to grow.

But what to keep an eye on that. That's resolvable. There's 3 major suppliers of that. And I think I expect in years going forward, we shouldn't see much more of this sort of the supply chain iteration around PYP availability. Yes, I guess, long story short, I believe that you should see -- like I think Evercore put out a nice analysis of this 3 years ago or so is like you should see super linear growth in identification given the number of patients that we believe have ATTR cardiomyopathy, coupled with the number of sponsors in the playing field and the availability of reasonable testing. I would expect that trend -- that positive trend to continue with some error bars quarter-to-quarter.

Jason, it's great to hear from you, and thank you for the question. We look forward to seeing you next week at the conference. So in terms of encaleret in chronic hypoparathyroidism, when we did our market research, it's really 3 things which drove our excitement about the opportunity. The first is that this will be the first oral option available in this chronic setting. And so the ability to give patients freedom from injection-type reactions and all the pain that comes with it, it's something that resonates very well, I would say.

The second thing is, if you look at the current options available, you do see an effect in terms of blood calcium normalization, but you don't really see that effect on urine calcium normalization. And I think with encaleret, we have a very unique profile where we could normalize potentially both blood and urine calcium. And we saw that in our albeit small Phase II trial, where we had around 80% of the patients normalizing both blood and urine calcium.

And these were patients who are very sick and did not have the parathyroid gland or any amount of the hormone. And then really, the third thing is that there is a potential safety risk in terms of bone resorption from giving PTH at high levels for the whole day. And so I think we could completely avoid that. And I think actually the ADH1 readout significantly derisked the tox profile for encaleret. And so I think that those 3 things, oral, urine calcium normalization and potential benefit on safety is really why we think we can compete and get a reasonable share even in the chronic hypopara market, obviously, assuming that the trial works.

Thanks for the question. I think we've done a lot to really build strong commercial and medical leadership here, right, bringing on for both sides of the business, leadership had experience in both second and third market with superiority data, especially with experience kind of launching an oral. We've also have a lot of experience from groups with skeletal dysplasia experience as well. Ultimately, I think right now, we're trying to make sure that we get the word out, not just to the leading [ genetic and AMCs ] but also to the broader kind of community pediatric endocrinologists who are really excited about having an oral option, especially for families who have -- if they're not seeing kind of these super specialized standards of care, more interested in having something that's easier for families to administer as well. So a lot of exploration going on that front.

I think to remember we have a lot of the teams in place from the Attruby launch that can also help with the future launches for all of the indications. Think about market access with the payers, the pharmacies, these are all the same individuals, and we have relationships with all those people and are able to launch quickly, I think, as a result of that and get access and coverage.

Yes. Again, thanks for the question. I think that's been a core tenet of how we've been developing the drug since the very beginning. We've been working alongside advocacy groups, both in the United States and internationally on making sure that their input and voice is implemented in our development program and how we think endpoints. For us, being able to target FGFR3 directly addresses their concerns of being able to look at not just height outcomes, but health outcomes as well, which is something we expect to play out in the longer term in our open-label extension program. And I think they've been really wonderful partners with us, and we anticipate that persisting through commercialization and launch as well.

Thank you, everyone, for your questions today. We really appreciate your interest and look forward to updating you again next quarter.