ACADIA Pharmaceuticals Q3 2026 Earnings Call Transcript

ACADIA Pharmaceuticals (NASDAQ:ACAD) reported third-quarter financial results on Wednesday. The transcript from the company’s third-quarter earnings call has been provided below.

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Summary

ACADIA Pharmaceuticals reported Q3 2026 total revenues of $342 million, a 22% year-over-year increase. DAYBUE net sales reached a record $140 million, up 39% year over year, while NUPLAZID sales were $202 million, showing a 12% increase.

The company is optimistic about DAYBUE’s future, raising its 2026 sales guidance and projecting $700 million in sales by 2028. The new patent for DAYBUE’s dosing regimen extends protection until 2041.

Pipeline updates include a Phase 2 trial for remlafanserin, which showed promising efficacy in Alzheimer’s disease psychosis and is advancing to Phase 3. The company plans further development of ACP211 for major depressive disorder, with Phase 2 results expected in late 2027.

ACADIA continues to expand DAYBUE’s market presence, receiving European approval and launching in Germany. Efforts to increase NUPLAZID’s reach include a larger sales force and direct-to-consumer campaigns.

The financial outlook for 2026 is revised, with expected total revenues of $1.265 to $1.295 billion. The company maintains a strong cash position of $976 million, supporting strategic investments in pipeline and commercial efforts.

Full Transcript

OPERATOR

Hello and welcome to ACADIA Pharmaceuticals third quarter earnings call. All lines have been placed on mute to prevent any background noise. After the speakers’ remarks, there will be a question-and-answer session. If you would like to ask a question during this time, please press star-1 on your telephone keypad. I would now like to turn the conference over to Al Kildani, Senior Vice President, Investor Relations and Corporate Communications. You may begin.

Al Kildani (Senior Vice President, Investor Relations and Corporate Communications)

Good afternoon and thank you for joining us on today’s call to discuss ACADIA’s third quarter 2026 financial results. Joining me on the call today from ACADIA are Catherine Owen Adams, our Chief Executive Officer, who will provide some opening remarks, followed by Tom Garner, our Chief Commercial Officer, who will discuss our commercial brands DAYBUE and NUPLAZID. Also joining us today is Dr. Sanjeev Pathak, SVP and Head of Clinical Development, who will provide an update on our pipeline programs, and Mark Schneyer, our Chief Financial Officer, who will review the financial highlights.

Catherine will then provide some closing remarks before we open up the call for your questions. We are using supplemental slides which are available on our website in the Events and Presentations section. On today’s call, both GAAP and non-GAAP financial measures will be discussed, including non-GAAP NUPLAZID net sales and non-GAAP total revenues. The non-GAAP financial measures, which are also referred to as adjusted financial measures, pertain only to NUPLAZID sales in 2025 and their impact on total revenues. All references to non-GAAP are reconciled with the most directly comparable GAAP financial measures in our earnings press release and slide presentation, which have been posted on the Investors page of the company’s website.

Before proceeding, I would like to remind you that during our call today we will be making several forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. These forward-looking statements, including goals, expectations, plans, prospects, growth potential, timing of events, future results, and financial guidance, are based on current information, assumptions, and expectations that are inherently subject to change and involve several risks and uncertainties that may cause results to differ materially.

These factors and other risks associated with our business can be found in our filings made with the SEC. You are cautioned not to place undue reliance on these forward-looking statements, which are made only as of today’s date, and we assume no obligation to update or revise these forward-looking statements as circumstances change, except as required by law. I’ll now turn the call over to Catherine for opening remarks.

Catherine Owen Adams (Chief Executive Officer)

Thank you, Al, and good afternoon, everyone. Quarter three was another strong quarter for ACADIA, one that demonstrates the strength of our commercial foundation and the progress we are making to translate that strength into our next chapter of growth. In the third quarter we delivered total revenues of $342 million, representing 22% year-over-year growth. On an adjusted basis, DAYBUE delivered record net sales of $140 million, up 39% year over year.

DAYBUE STIX is expanding our opportunity in several different ways: current patients who want to switch to STIX, new patients who are trying DAYBUE for the first time, and patients who previously stopped treatment and are coming back to try again with STIX. Given this momentum, we are raising our 2026 DAYBUE guidance and we remain confident that we can reach $700 million in DAYBUE sales by the end of 2028. We also achieved an important IP milestone during the quarter, receiving a USPTO Notice of Allowance for an important new patent covering the weight-banded dosing regimen used in both DAYBUE Oral Solution and DAYBUE STIX. Following issuance, with pediatric exclusivity, the patent is expected to provide U.S. protection for both formulations of DAYBUE through March 2041, extending patent protections by nearly five years.

Following the successful completion of our Phase 3 trial for DAYBUE in Japan, we are focused on identifying the right distribution partner while preparing for an expected 2027 regulatory submission to support market entry and remain committed to bringing DAYBUE to patients there. NUPLAZID delivered $202 million in net sales, up 12% year over year on an adjusted basis, with virtually all of that growth driven by patient demand through volume. As we approach the end of the year, we are narrowing our NUPLAZID guidance and remain confident that we are on track toward our ambition to reach approximately $1 billion in NUPLAZID net sales by the end of 2028. Tom will provide additional color on the commercial drivers behind our performance on both brands.

Turning to our pipeline, the Phase 2 portion of our Radiant program of remlafanserin in Alzheimer’s disease psychosis narrowly missed statistical significance on the primary endpoint, but achieved our goals with the study to clarify the dose to advance into Phase 3 and generate insights needed to optimize the Phase 3 portion of the program. At the 60 milligram dose, efficacy was observed across all four psychosis scales assessed in the full study population, with increasing separation from placebo through the six-week treatment period on both the primary and key secondary endpoint, along with a favorable safety and tolerability profile similar to placebo. Based on these findings, we are focusing our Phase 3 program on the 60 milligram dose and taking additional steps designed to optimize for potential positive Phase 3 outcomes.

The more we have learned from these data, the more confident we have become in the path forward for the program. The findings from our Radiant Phase 2 in ADP also reinforce our confidence in the opportunity in Lewy Body Dementia psychosis. We remain excited about the potential for remlafanserin in this population and are pleased to announce that we expect Phase 2 results from the Illumira study in the fourth quarter of 2027. Taken together, remlafanserin represents an important potential growth franchise across both ADP and LBDP, both areas of huge unmet medical need with an approximately $4 billion combined peak sales opportunity.

Our priority now is to generate the clinical evidence needed to validate that opportunity. Beyond remlafanserin, we are advancing our broader pipeline of promising programs that we believe have the potential to address significant unmet needs and create long-term value. An additional data readout for our Norlite Phase 2 study of ACP211, our once-a-day oral deuterated form of arnor ketamine for the treatment of major depressive disorder, is now expected in the second half of 2027. We believe ACP211 has the potential to address significant unmet need in major depressive disorder, specifically around the patient and clinician experience, and we look forward to sharing more on this program as we move into 2027.

When you step back and look at the full picture—remlafanserin in ADP and LBDP, ACP211 in MDD, and some of our earlier-stage programs—we see multiple independent paths to add potential value across large, high unmet-need markets representing combined peak sales potential of approximately $11 billion. The opportunity is significant, but our conviction and investment will continue to be guided by the evidence each program generates. Before I hand over, a brief update on our R&D leadership. Today’s pipeline update will be delivered by Dr. Sanjeev Pathak, our Senior Vice President and Head of Clinical Development. Many of you will know Sanjeev from our R&D Day or from prior investor conferences, and I think you’ll find his perspective as a double board-certified psychiatrist on the remlafanserin data particularly valuable. As we indicated in April, Dr. Liz Thompson has now retired from her role as Head of R&D. Liz has made an extraordinary contribution during her tenure at ACADIA and we are deeply grateful for her leadership. She remains engaged with us as a valued consultant and we wish her very well in her retirement. We do expect to announce our new Head of R&D in the near term. In the meantime, R&D leadership responsibilities are being shared by Sanjeev along with other members of our R&D leadership team.

With that, I’ll hand the call over to Tom to walk through our commercial performance in detail.

Tom Garner (Executive Vice President & Chief Commercial Officer)

Thank you, Catherine, and good afternoon, everyone. I’m pleased to walk you through what was another strong quarter for the commercial business, starting with DAYBUE. Q3 marked yet another record quarter for the brand, with $140 million in net sales, representing 39% growth year over year, with almost all of that being driven by volume. That’s a result that we’re particularly proud of, as it not only reflects the continued execution of our commercial team, but also the deepening position DAYBUE holds as the foundational standard of care for Rett syndrome.

DAYBUE STIX continued to be an important contributor to growth in Q3. Now, with approximately six months of commercial experience, we’re seeing increasing utilization across the patient base and continued adoption in both centers of excellence and community practices. Over 50% of all U.S. DAYBUE patients were receiving STIX by the end of Q3, with these patients generally utilizing doses Consistent with or somewhat higher than what we have seen historically with DAYBUE liquid. We’re also encouraged by the early experience with patient restarts, which expands the growth opportunity for DAYBUE beyond naive patients alone. Patients who previously discontinued therapy represent an opportunity for re-engagement, and STIX provides caregivers with a compelling reason to reconsider treatment with a different formulation. While the initial pace of STIX conversion will naturally moderate as the launch matures, we believe continued new patient uptake and restarts provide two distinct opportunities to drive sustained growth going forwards.

Turning to DAYBUE outside the US, Q3 was a landmark quarter. We received European Commission approval for DAYBUE, making it the first and only approved treatment for the neurobehavioral symptoms of Rett syndrome in the EU. This is an important milestone for patients, families, and treating physicians who previously had no approved treatment options available. We launched commercially in Germany in early October, and the early response from Rett-treating physicians has been encouraging.

We’re already seeing that initial interest translate into new patients receiving commercial product in addition to those patients converting from our Compassionate Use program. As a reminder, Germany allows us to launch at a freely set price while reimbursement negotiations are completed, so we were able to move quickly to make DAYBUE available to these patients. Looking across the rest of the EU, we plan to submit reimbursement dossiers for our key planned launch countries before year-end to drive additional commercial access to DAYBUE.

In addition, our named patient supply programs have been important in markets where we do not yet have regulatory approval, and the continued momentum across those programs reinforces the breadth of interest in this therapy globally. As we look to the remainder of the year, we feel good about where we stand. The momentum with DAYBUE STIX is real and building, and the EU launch adds a new dimension to the growth story that we’re just beginning to realize. As Catherine noted, we are raising our full-year guidance for DAYBUE and reiterating our confidence in our previously stated $700 million sales ambition for 2028. We see 2028 as a milestone on a much longer growth path because the recently announced patent allowance extends our US exclusivity runway into 2041.

That confidence is supported by multiple growth drivers beyond the US. Our expansion into Europe and other international markets adds another meaningful source of future growth. Together, these drivers and our long-term exclusivity support sustained growth of DAYBUE as the standard of care for patients living with Rett syndrome. Turning now to NUPLAZID. Net sales in the third quarter were $202 million, representing 12% growth year over year on an adjusted basis, with 11% of that growth coming from volume. New-to-brand prescription trends remain healthy, with NBRx growth continuing to outpace the prior-year period, reflecting the underlying demand we’re building in the Parkinson’s disease psychosis market. Earlier this year, we made a significant investment in our NUPLAZID field force to increase the reach and frequency of our engagement with neurologists, psychiatrists, movement disorder specialists, and PCPs.

That investment has more than doubled our reach. We now engage a customer universe of over 10,000 physicians, including more than 5,000 that we are calling on for the first time. The results thus far are encouraging. Call volume and rep productivity have increased as expected, and when our highest-value customers are called on, their intent to prescribe NUPLAZID increases; it is now at its highest level in years. Our focus now is on converting this positive momentum into new-to-brand prescriptions through focused execution.

As expected with a new group of physicians, building those relationships takes a few more calls, and our reps are moving up the productivity curve. We are confident in the trajectory, and we expect to realize the full benefit of the expansion through the back end of this year and into 2027. With one quarter remaining, we have narrowed our NUPLAZID guidance within our prior range to reflect that timing. At the same time, our direct-to-consumer investment is expanding awareness of PDP and encouraging patients and caregivers to talk about symptoms and treatment. Aided awareness of NUPLAZID is at an all-time high, and awareness of hallucinations and delusions associated with Parkinson’s disease has also increased significantly. That awareness is turning into action. Through September, our branded and unbranded campaigns reached more than 1.3 million qualified Parkinson’s patients.

Approximately one in 10 subsequently visited a neurologist, with more than 1,500 having since initiated NUPLAZID. As a result, these campaigns complement our expanded field organization. They build awareness and intent among patients and caregivers, while our teams increase engagement with the healthcare professionals who diagnose and treat them. Together, they are building momentum towards sustained NUPLAZID growth. Looking ahead, our confidence in reaching approximately $1 billion in net sales by the end of 2028 remains unchanged. Thank you. The path to that ambition is clear. Expand awareness and diagnosis of PDP among treating HCPs and people living with Parkinson’s disease. Increase the number of appropriate patients who initiate treatment, and support patients in remaining on therapy. With a larger and more productive field force now in place, we are well positioned to deliver on each of these priorities and drive sustained growth for NUPLAZID.

With that, I’ll hand the call over to Dr. Sanjeev Pathak to walk through our pipeline programs.

Sanjeev Pathak (Senior Vice President and Head of Clinical Development)

Thank you, Tom. Good afternoon everyone. I’m Sanjeev Pathak, and I’m very pleased to be speaking with you today in my role as Senior Vice President and Head of Clinical Development here at ACADIA Pharmaceuticals. By way of background, I’m board certified in both psychiatry and pediatric psychiatry and maintain an active medical license. In my clinical practice, I have treated children with Rett syndrome and related disorders as well as patients with Alzheimer’s disease and other dementias.

That experience continues to shape my work and reinforces the importance of getting the science right. I’ve led development programs across pharma and biotech and joined ACADIA five years ago. Remlifanserin sits at the intersection of my clinical background and the diseases I have focused on throughout my career. I’m honored to share leadership responsibilities for our R&D organization during this transition and look forward to engaging with many of you.

As you can see on this slide, it’s a great privilege to lead clinical development at a time when ACADIA has such a broad and promising pipeline across neurological and rare diseases. Let me now turn to remlifanserin and the Phase 2 RADIANT study results in ADP. The Phase 2 portion of the seamless Phase 2/Phase 3 RADIANT study had two important goals: first, to establish the appropriate dose to advance into Phase 3, and second, to generate the data and insights needed to optimize the design and execution of our ongoing registration studies. The study achieved both of these goals. While it narrowly missed statistical significance on the primary endpoint SAPS-HND with a p-value of 0.0603, the 60 milligram dose demonstrated a clear and consistent signal of activity.

Efficacy was observed across all four psychosis efficacy scales that were assessed for the full study population evaluated, including SAPS-HND, CGI-S ADP, CGI-I ADP, and NPI, with the key secondary endpoint CGI-S ADP achieving nominal statistical significance with a p-value of 0.0077. Effect sizes were 0.26 on the primary endpoint and 0.37 on CGI-S ADP, and both measures showed increasing separation from placebo through the six-week treatment period.

Taken together, we believe these findings support further evaluation of the 60 milligram dose in Phase 3. There was evidence of a dose-response relationship with minimal efficacy observed with 30 mg. Therefore, we plan to discontinue the 30 mg dose in Phase 3 for ADP. Importantly, the study also provided insights into the relationship between patient characteristics and efficacy. When we examined outcomes by baseline disease severity, we observed greater treatment effects among patients with higher baseline severity. This, along with other learnings from RADIANT, directly informs the second goal of the study—optimizing the Phase 3 program. That objective was particularly important because this was our first global, parallel-group, randomized, placebo-controlled study in ADP using biomarkers to identify patients with Alzheimer’s disease.

As you may recall, previous pimavanserin ADP studies either used a randomized withdrawal design or were conducted exclusively in UK nursing homes using older clinical diagnostic criteria. RADIANT therefore provided valuable clinical and operational insights specific to remlifanserin as a new 5-HT2A inverse agonist that we can now apply directly to Phase 3. Safety and tolerability are another important part of what we learned, particularly given the vulnerability of this patient population. Adverse event rates were similar to placebo. We observed no negative impact on cognition, no motor adverse effects compared with placebo, no signal of QTc prolongation compared with placebo, and no deaths in the remlifanserin treatment arms. For a therapy intended to treat patients with ADP who are typically older, cognitively impaired, and often medically fragile, this safety and tolerability profile is particularly important.

Together with the extensive clinical experience with pimavanserin, we believe these findings reduce an important source of safety-related uncertainty as we move into Phase 3. So while we continue to evaluate the full data set, the key takeaway is that RADIANT has meaningfully reduced several important areas of uncertainty, given us greater clarity on how to optimize the Phase 3 program, and strengthened our confidence in the path forward towards potential registration. We look forward to sharing additional RADIANT Phase 2 results at CTAD in Boston later this month.

Moving to next steps, we are continuing enrollment in our Phase 3 program and updating the study protocols based on what we learned in Phase 2. The most important change is the dose: we are removing the 30 milligram arm and focusing on 60 milligrams, where we observed the efficacy signal. We are also taking steps to potentially optimize the study for effect size and regulatory success. Some of these modifications we will share at a later date, while certain design elements will remain confidential to protect the integrity of the study.

First, we are refining site selection based on site performance in Phase 2. Second, we are expanding the use of central raters, particularly at sites where we identified rating challenges or limited availability of qualified local raters. Finally, we will be making modifications to the statistical plan with the most promising potential to optimize the effect size. We are not disclosing those specific details at this time, but we are confirming there are no plans to make any changes to the current inclusion criteria.

Together, these steps allow us to focus our efforts on the dose with the greatest potential to benefit patients while actively trying to optimize the Phase 3 program to generate robust, registrational-quality evidence. I’d now like to connect what we learned in ADP to our LBDP program because we believe this is another important part of the remlifanserin opportunity. We are pleased to share today that we expect Phase 2 results from the Elimira study in Lewy body dementia psychosis in the fourth quarter of 2027. We also recently received FDA Fast Track designation for remlifanserin in Lewy body dementia psychosis, recognizing the significant unmet need for new treatment options.

The ADP results provide additional support for our confidence in the LBDP program. Importantly, a reminder that with pimavanserin, our approved 5-HT2A inverse agonist, we have observed greater efficacy in LBDP than in ADP, both within individual studies and across studies, although the LBDP sample size was small. Remlifanserin is, of course, a new and distinct molecule with different attributes and its own clinical profile, but it targets the same validated mechanism as a novel, highly selective 5-HT2A inverse agonist.

We therefore believe the pimavanserin experience, together with the activity observed with remlifanserin in ADP, provides additional support for the potential of remlifanserin in LBDP. In addition to the mechanistic and clinical rationale, the potential utility of remlifanserin in LBDP is supported by the favorable tolerability profile observed with remlifanserin in RADIANT. Patients with Lewy body dementia can be particularly sensitive to adverse effects, including motor symptoms and cognitive burden. The absence of motor adverse effects, a negative impact on cognition, and similar rates of adverse events to placebo in RADIANT is therefore an encouraging finding as we evaluate remlifanserin’s potential in LBDP.

Beyond remlifanserin in later stages of development, we have ACP-211, our investigational oral nutritive or nor-ketamine compound in major depressive disorder, or MDD, in Phase 1. Thus far with ACP-211, we have observed no sedation, limited dissociation, and no blood pressure liability in healthy volunteers, supporting the potential for a differentiated profile and patient experience relative to existing treatments. We expect to share these Phase 1 data at medical conferences in 2027, followed by the Phase 2 readout in the second half of 2027.

MDD remains one of the largest and most underserved markets in psychiatry, so we very much look forward to sharing more data as we try to optimize the treatment experience for patients. In Japan, we successfully completed our Phase 3 trial for DAYBUE, generating results consistent with the previous LAVENDER Phase 3 results that support filing for approval with Japan’s Pharmaceuticals and Medical Devices Agency, and we remain committed to bringing DAYBUE to patients there with a targeted launch in 2028. Taken together, these programs reflect the pipeline focused on areas of significant unmet need where we believe we can make a meaningful difference for patients.

We are encouraged by the opportunities ahead and remain committed to advancing the programs where the data are strongest. With that, I’ll hand the call over to Mark to walk through our financial results.

Mark Schneyer (Chief Financial Officer)

Thank you, Sanjeev. Good afternoon everyone. I’ll now walk you through our financial results for the third quarter of 2026 and provide an update on our full-year outlook. Total revenues for the third quarter came in at $342 million, representing 22% year-over-year growth. On an adjusted basis, DAYBUE net sales were $140 million in the quarter, up 39% year over year, driven almost entirely by volume. The gross-to-net adjustment for DAYBUE in the quarter was 23.2%.

As Tom described, the continued uptake of DAYBUE in the U.S. was the predominant contributor to our growth this quarter. NUPLAZID net sales were $202 million in the quarter, up 12% year over year on an adjusted basis, with 11% of that growth attributable to volume. This volume-driven growth reflects continued expansion in underlying demand. The gross-to-net adjustment for NUPLAZID in the quarter was 22.7%. Turning to operating expenses, research and development expenses for the quarter were $76 million compared to $88 million a year ago. The decrease was primarily related to reduced expenditures for ending studies that took place in 2025, partially offset by increased expenditures for remlifanserin and ACP-211. SG&A expenses were $159 million for the quarter compared to $133 million a year ago. This increase reflects our investments to expand both the NUPLAZID and DAYBUE field forces and increased Marketing investments supporting both brands. We continue to manage our cost base with discipline while ensuring we are making the right investments to support both near-term commercial execution and the longer-term pipeline programs.

Our cash position at the end of the quarter was $976 million. We believe our balance sheet is a genuine strategic asset. It provides the flexibility to invest behind the strongest evidence in our pipeline, pursue business development where strategic fit and expected returns are compelling, and to continue to execute against our commercial ambitions from a position of strength. Turning to our full-year outlook now that we are three-quarters into the year, we are narrowing our guidance ranges and providing several updates. We now expect total revenues of $1.265 to $1.295 billion. For Daybue, we are raising and narrowing our full-year global net sales guidance to $505 to $520 million. This reflects the strong performance we’ve seen from Daybue STIKS in the U.S. and the momentum Tom described earlier. For NUPLAZID, we are narrowing our full-year net sales guidance to $760 to $775 million, reflecting the timing of the field force impact Tom described.

For gross-to-net, we now expect Daybue to be approximately 23% to 24% and NUPLAZID to be approximately 22% to 23% for the full year. Turning to operating expenses, we now expect full-year R&D expenses of $325 to $340 million. This updated outlook reflects the timing of development spend, portfolio prioritization decisions, and reduced personnel costs. For SG&A, we now expect full-year expenses of $665 to $685 million. Overall, these updates reflect our latest expectations as we enter the final quarter of the year. We remain focused on executing against the continued growth opportunities for both commercial brands while maintaining disciplined investment across our pipeline. With that, I’ll hand the call back to Catherine for her closing remarks.

Catherine Owen Adams (Chief Executive Officer)

Thank you, Mark. Before we open the call for questions, let me briefly step back and highlight what this quarter says about ACADIA Pharmaceuticals’ trajectory. We had an excellent quarter commercially and expect to finish the year with continued momentum across both Daybue and NUPLAZID. At the same time, we are making important progress across our pipeline, creating multiple opportunities to drive our next phase of growth. Ramnathantharan is central to that opportunity. The Phase 2 Radiant results show a clear efficacy signal at 60 milligrams and a favorable safety and tolerability profile while providing important insights into how to optimize Phase 3. We are moving forward with conviction in ADP and will present more data at CTAD later this month. Results have also reinforced our confidence in the LBDP opportunity where Phase 2 results from Lumera are expected in the fourth quarter of 2027.

Beyond Remlaf Answerin, we are advancing additional programs that can broaden our portfolio and create new growth opportunities led by ACP211 with Phase 2 results in MDD expected in the second half of 2027. Together, these programs give us multiple potential paths to value creation in large, high unmet-need markets. With a strong commercial foundation and the financial flexibility to invest behind the opportunities where the evidence and our conviction is strongest, we are well positioned to advance this pipeline and build momentum across several important clinical programs. Thank you all for your continued support of ACADIA, and with that we’re happy to take your questions.

OPERATOR

Thank you. If you would like to ask a question, please press star-one on your telephone keypad. If you would like to withdraw your question, simply press star-one again. Your first question comes from Ritu Baral with TD Cowen. Your line is open.

Ritu Baral (Analyst at TD Cowen)

Good afternoon, everyone. Thanks for taking the question. Two quick questions. One is on the optimization of the Phase 3 design for Retml Sansaren in ADP. Previously, you had mentioned potentially tweaking the inclusion criteria for more severe patients, as I think some of the additional analyses suggested a greater effect size in more severe patients. Will that also be part of forward optimization to improve probabilities of success? And then on the continued strength of Daybue, specifically Daybue STIKS—congratulations—have you guys found in your post-marketing experience any evidence of improved tolerability with the STIKS formulation? This was a very hot topic of patient groups and the moms at the IRSF conference a few months ago.

Catherine Owen Adams (Chief Executive Officer)

Thanks, Ritu. I’m going to take those questions in order. So, in terms of optimizing in the ADP trial and referring to the inclusion criteria versus statistical modifications, I’m going to ask Sanjeev to take you through the thinking and help sort of illustrate what we’re thinking right now. Sanjeev.

Sanjeev Pathak (Senior Vice President and Head of Clinical Development)

Thank you, Ritu. You’re asking a very relevant question. Our goal of optimization is to potentially increase the effect size, and what we are going to do is statistical modifications. I wanted to clarify that we are not changing the inclusion or exclusion criteria. The analysis of the data has informed us about various patient characteristics that are linked to most robust efficacy, and we will utilize them in the statistical modifications. The severity criterion is an important one, which we will be including as part of the statistical modification.

I also want to take the opportunity to guide through what other optimization approaches we would be taking. We also plan to modify the protocol where we will be dropping the 30 milligram arm, and once again, no change in inclusion/exclusion criteria. We are also going to optimize the study conduct. Key among them would be increased use of central raters. You may recall with the pimavanserin PDP pivotal program, when we went from Phase 2 to Phase 3, we had increased use of central raters.

It led to a better effect size and successful registration. So we will be doing that. We’ll also have enhanced training of the sites. We are also refining the site selections based on the performance in the Phase 2. Taken together, we are feeling much more confident about the effect size and the robustness of the results that we hope to deliver in our Phase 3 program.

Catherine Owen Adams (Chief Executive Officer)

Thanks for clarifying that, Sanjeev. Tom, why don’t you address the question around STIKS and post-marketing and tolerability?

Tom Garner (Executive Vice President & Chief Commercial Officer)

Absolutely. Hi, Ritu. Hope you’re doing well. As we shared on the call, we continue to be very pleased with the performance of STIKS and the role it’s playing in really fueling this next stage of growth that we’re seeing for Daybue. Clearly, the reception from both the clinical community and the patient community remains very encouraging. And it’s establishing, obviously, multiple fronts that we can now continue to grow from, both in terms of naïve patients but also patients who may have discontinued previously.

In terms of your questions around tolerability, this is something that we are continuing to monitor very closely. What I would say is, if we look at ongoing persistency across the two formulations, at the moment they look fairly similar. What we do hear from families is that the ability to use a lower volume is actually seen as very meaningful. It means that they’re spending less time administering the medicine in comparison to the liquid formulation.

But on the whole, we’re not hearing or seeing any major differences between the two formulations, because obviously they do both have trofinetide as the active ingredient. So, continuing to monitor closely, but we continue to be pleased with the progress that we’re making.

Ritu Baral (Analyst at TD Cowen)

Thank you.

OPERATOR

Your next question comes from Tessa Romero with J.P. Morgan. Your line is open.

Caroline Poacher (Analyst at J.P. Morgan)

Hi, team, this is Caroline Poacher on for Tessa Romero with J.P. Morgan. Thanks so much for taking our questions. So just first, how does the new U.S. patent that extends the patent protection for Daybue and Daybue STIKS change how you think about the long-term trajectory for the brand out to 2041? And then I just have a follow-up.

Tom Garner (Executive Vice President & Chief Commercial Officer)

Yeah, I think for us it really gives us confidence now that we can continue to invest and grow the brand out to Q1 of 2041. The weight-banded dosing was something we felt very strongly about. We are very pleased to be issued the patent. We’re also prosecuting that same patent in Europe and hope to see a similar result there. So overall, the patent allows us to really have a strong commercial outlook through 2041 and make the appropriate investments to drive that.

In terms of the potential upside to any forecast for Daybue moving forward, we do look forward to updating our conviction around that. We’re not going to do that on this call, but I would probably say that we’re likely to do that in Q1 of next year in terms of restressing what we think the peak sales opportunity will be for Daybue. Thanks for the question.

Caroline Poacher (Analyst at J.P. Morgan)

And yeah, if I can just squeeze one more in, kind of along those lines, can we expect you to guide in February as per usual, or will you consider perhaps guiding at a small conference that may be taking place in San Francisco in January?

Mark Schneyer (Chief Financial Officer)

We will likely provide guidance during our usual time, but thanks for the opportunity.

Caroline Poacher (Analyst at J.P. Morgan)

Thank you.

OPERATOR

Your next question comes from Brian Abrahams of RBC Capital Markets. Your line is open.

Brian Abrahams (Analyst at RBC Capital Markets)

Hi, good afternoon. Thanks for taking our question and congrats on the quarter. Just on remle, I’m curious if you can give us a sense of what the effect size would have been with the use of the optimized sites, the central raters and the most more optimal population, which it sounds like is going to be what’s statistically analyzed in the Phase 3 portion. And then secondarily, just on the Daybue restarts, just wonder if you could speak to how sustainable that is, how many more patients are out there on the sidelines that could potentially come back over time.

Catherine Owen Adams (Chief Executive Officer)

Thanks, Brian. I’m going to ask Sanjeev to have a go at the sense of effect size, although, as you can probably imagine, we’re not going to give you specifics around that. But, Sanjeev, why don’t you give Brian some thoughts on that?

Sanjeev Pathak (Senior Vice President and Head of Clinical Development)

Thank you, Brian, for your question. As you can imagine, we want to keep some elements of our statistical methodology and our analysis confidential to ensure the integrity of the trial. We are unable to share those specific effect sizes of the analysis that we have done. At a future date, when we have agreed upon the plan with the FDA in the first quarter of 2027, we would be in a better position to discuss some of it. Of course, some aspects of this will remain confidential, as you can understand.

Catherine Owen Adams (Chief Executive Officer)

Thank you, Sanjeev. And, Tom, Daybue restarts?

Tom Garner (Executive Vice President & Chief Commercial Officer)

Absolutely. Thank you for the question. Just as a reminder, we think about the market in two distinct buckets. There’s the naïve patient population, which we’ve been pursuing ever since we launched Daybue, and now we have Daybue STIKS. It’s opened up an additional front in terms of patients who may have discontinued the therapy previously, who we are now re-engaging with STIKS. If we think about that second bucket of patients and you think about how well penetrated we are, there’s still significant headroom there. Over 80% of those patients are yet to retry Daybue STIKS. Obviously, that’s an area that we continue to work closely with the patient community and the HCP community to educate on—not only the benefit that Daybue can bring, but now we have the new formulation, why it remains a viable option as the only approved treatment for patients living with Rett.

So we remain excited. Q3 was another standout quarter for the brand. We continue to reach new highs, especially on the restarts front, and we still have significant headroom to grow. So, look forward to sharing more information in due course.

OPERATOR

Your next question comes from Yigal Nochomovitz with Citi. Your line is open.

Yigal Nochomovitz (Analyst at Citi)

Hi. Thank you. Just one additional question on Radian. You mentioned a few of the ways you’re going to optimize the effect size. What about the primary endpoint in the downstream analysis of the top line? The CGI-S ADP looked very good. Just wondering if that’s something that you would change in the protocol to be the primary endpoint or if that’s something that you’re going to leave as it is currently. Thanks.

Catherine Owen Adams (Chief Executive Officer)

That’s a good question, Yigal. I’ll let Sanjeev share our thoughts on the endpoint analysis that we’re looking at.

Sanjeev Pathak (Senior Vice President and Head of Clinical Development)

Good question, Yigal. Our primary endpoint remains SAPS-H+D as our preferred endpoint. And you’re right to point out that if we look at the totality of the evidence, including CGI-S ADP, you can see that 60 milligrams performed well. And when we look at the totality of the data, some additional information that we’ll share at CTAD, we are seeing good activity with 60 milligrams. We are also seeing a dose response and, as has been pointed out by Dr. Liz Thompson at the top-line results call, that there was greater efficacy in patient population with higher severity.

We typically see these with active medications, and so it is giving us more confidence in our approach forward. But to go back to your primary question, SAPS-H+D remains our primary endpoint. We will be developing a dossier and submitting to the FDA and meeting with the FDA in the second quarter of 2027. And we will also be developing additional information to support the additional endpoints that we have.

Catherine Owen Adams (Chief Executive Officer)

Yeah, I think the key to that is our discussion with the FDA in the first quarter, and we’ll update you on the output of those meetings. But as Sanjeev says, our preference is still around SAPS-H+D. And with that, we’ll take the next question. Operator. Oh, sorry, I’ve got something else—

Yigal Nochomovitz (Analyst at Citi)

I just was going to ask—thanks, thanks—I’m just going to ask quickly on 711 in essential tremor. You know, you have three—I believe you have three metrics there. They’re slightly different. The TETRAS Performance Scale at week four, there’s an ADL score at week four, and then there’s a change in CGI. Are those all going to be bundled together in looking at the efficacy picture, or is there one that’s kind of the standout that you’re going to focus on more?

Catherine Owen Adams (Chief Executive Officer)

Good question. So we have 711 still in phase one right now. So, Sanjeev, is there anything you want to add to Yigal’s question around the endpoints we’re looking at potentially to move into phase two, or—

Sanjeev Pathak (Senior Vice President and Head of Clinical Development)

Yes, Catherine. Yigal, we are currently in phase one. Our phase two study design is in development. The endpoints that you mentioned are, in general, reasonable endpoints. But our protocol is not final yet, so we will share that with you next year and confirm that phase two program.

Yigal Nochomovitz (Analyst at Citi)

Got it. Thank you.

OPERATOR

Your next question comes from Amy Fadia with Needham. Your line is open.

Amy Fadia (Analyst at Needham)

Hi, good evening. Thanks for taking my question. I wanted to sort of go back to the comment that you made that as you analyze the data for the REMEDY study, you found some patient characteristics that you’re going to reflect in the new statistical modifications. Can you elaborate a little bit about that? Is that, you know, kind of the baseline patient severity based on which you might modify the statistical analysis? And then also, you know, given the modifications that you’re making to your approach here for this indication, are there any implications for the Lewy body dementia trial analysis?

Thank you.

Catherine Owen Adams (Chief Executive Officer)

Thanks, Amy. I’ll let Sanjeev answer further on those characteristics that we’re looking at.

Sanjeev Pathak (Senior Vice President and Head of Clinical Development)

Great question. Yes, we have looked at several patient characteristics. Of course, disease severity remains one of the key ones. And this is a finding not only in our trial, but also studies with other active medications. So we would likely incorporate that into our statistical modifications. There are other characteristics that we have identified which we are not sharing. We are keeping these confidential, as I said, to maintain the integrity of the trial.

In regards to the Lewy body dementia psychosis program, it has increased our confidence in that program. As I shared in the prepared remarks, when we looked at the pimavanserin program, despite small sample size, we had seen greater efficacy in subpopulations of LBDP. Now, remlufanserin is a distinct molecule. It does give us greater confidence. And we will be looking at the LBDP study design, and if there’s an opportunity to optimize, we will do so.

So far we are progressing as planned.

Catherine Owen Adams (Chief Executive Officer)

I think this might be a good place to hit the 30 milligram, but that will continue in the LBD.

Sanjeev Pathak (Senior Vice President and Head of Clinical Development)

Yes, yes. So we are studying 30 milligrams and 60 milligram doses in the LBDP program. And as you know, LBDP is a distinct disease state and also has distinct efficacy and safety outcomes with off-label treatment. These patients are very sensitive to adverse effects. So therefore we are studying both these doses. And also, given that the pimavanserin data is with 34 milligrams, which is deemed equivalent to 30 milligrams of remlufanserin, it makes sense to continue the experiment with both the doses in the LBDP study.

Catherine Owen Adams (Chief Executive Officer)

Thanks, Sanjeev. Thanks for the question, Amy.

OPERATOR

Your next question comes from David Huang with Deutsche Bank. Your line is open.

David Huang (Analyst at Deutsche Bank)

Hi there. Thanks for taking the questions and congrats on the strong quarter. I had two—so maybe first with DAYBUE. I know in the past you had talked about how the uptake and penetration was going in academic versus community practices, and so was just wondering what the latest is there in terms of how penetration is looking in those segments and where there might be more room to grow. And then secondly, with ACP211 in MDD, could you just kind of frame out what you’re looking to see from the Phase 2 NORLITE trial?

You know, what signal of efficacy there would be compelling and where could 211 fit into the treatment paradigm? Thank you.

Catherine Owen Adams (Chief Executive Officer)

Thanks, David. I’ll let Tom start on DAYBUE penetration, and then we’ll go to NORLITE.

Tom Garner (Executive Vice President & Chief Commercial Officer)

Thanks for the question, David. I hope you’re doing well. Let me just give you a snapshot as to what we saw in the third quarter in terms of referrals and where they were coming from. I think that’s always a useful point to start. So in Q3, nearly 80% of our referrals came from the community. About 20% of those came from COEs. And I think that that’s a reflection of the fact that we’re now through the immediacy of the STIX launch and obviously the team is now focused on educating the broader community on the benefits that STIX can offer, both for naive patients and for patients who’ve discontinued.

So that’s been a full court press from the team through Q3 and will continue into the end of this year. In terms of overall penetration, we still have significant headroom within the community setting. Remember that about two-thirds of our overall volume falls outside of COEs. At the moment, we’re about 30% penetrated there. So again, significant headroom. And now we have STIX in hand, we believe that that could be a true enabler to help us unlock future growth through the back end of this year and into 2027, which we’re really excited by. So look forward to sharing more as we progress.

Catherine Owen Adams (Chief Executive Officer)

So the question around ACP211 in major depressive disorder—I think you are wanting to understand what signals we would view as compelling as we move into the phase two study. So, Sanjeev, why don’t you share a little bit more about what we’re looking for with that trial?

Sanjeev Pathak (Senior Vice President and Head of Clinical Development)

Yes, sure, Catherine. So ACP211 is our oral R-nor-ketamine, which is deuterated, and what we are hoping to see in this phase two trial is an evidence of a dose response to enable dose selection for phase three. We also want to learn about the efficacy, operational characteristics of the study design per se and execution and conduct to inform the phase three design. Our TPP is about a better patient experience, so we are assessing the safety thoroughly.

And also we do want to see an evidence of efficacy. So, taken together, our study design is well suited to answer these questions. I do want to underscore that what we currently know from phase one is that there have been no cases of sedation and limited dissociation, as well as no psychotomimetic effects, no blood pressure signal. So, so far we are feeling good about our phase two program as well and the totality of the evidence that we have.

Catherine Owen Adams (Chief Executive Officer)

Yeah. And I just think from an overall perspective, we are looking for a patient experience that is a little bit different to the current patient experience—taking, for example, something like Spravato where they’re monitored for a long period of time. We’re hoping that the sedation and dissociation indicators that we’re currently seeing in phase one are something that would carry through to phase two and phase three and therefore allow the patient to have a different experience when they’re dosed with our oral product.

Sanjeev Pathak (Senior Vice President and Head of Clinical Development)

Yes, and allow limited or better monitoring for the patients, as well as in the clinic setting that they could go home after administration early relative to what is being done with other treatments.

Catherine Owen Adams (Chief Executive Officer)

Yep. So great. A lot of excitement around this trial to see what we can see within both the efficacy and the safety parameters of ACP211. Thanks for the question. Your next question comes from Rudy Lee with Wolfe Research. Your line is open.

Rudy Lee (Analyst at Wolfe Research)

Thanks for taking my question. Just a quick follow-up for the LBDP phase 2 readout. Can you talk about the powering assumptions of this study versus the phase 2 ADP trial? And should we think that the Parkinson’s cohort will drive stronger efficacy? And any color on the data stratification for Parkinson’s versus Lewy body, and your strategy for different subtypes? Thanks.

Catherine Owen Adams (Chief Executive Officer)

Yeah, thanks, Rudy. I think just at a high level, we haven’t shared the powering assumptions around the LBDP study yet, but I will ask Sanjeev to talk about the stratification of the two groups of patients that we’re looking at within that study.

Sanjeev Pathak (Senior Vice President and Head of Clinical Development)

Yeah. First I would like to point out that the LBDP population has Parkinson’s disease dementia psychosis population as well as the dementia with Lewy body psychosis population. Both have the same underlying pathology of the alpha-synuclein pathology, and that is why we are studying them together. And we will be evaluating the efficacy in totality as well as in these two subgroups as well. And as you may be aware, this is again a phase two study with two doses with a sample size of around 180, but it should give us good information to inform phase three.

Catherine Owen Adams (Chief Executive Officer)

Thanks, Sanjeev. Thanks for the question, Rudy.

OPERATOR

Your next question comes from Ash Verma with UBS. Your line is open.

Hoyonan (Analyst at UBS)

Hi, this is Hoyonan for Ash. Thanks for taking our question. Wanted to ask about the NUPLAZID patent appeal by Aurobindo at the Circuit Court. There’s an oral argument coming up on November 9th next Monday related to the ‘721 patent. Based on the briefing, Aurobindo appears to be challenging the district court’s claim construction and its interpretation of the patent claims. Can you talk about your level of confidence in the IP position here and how you’re thinking about the risk that the Circuit Court could reverse the district court’s decision?

Thank you.

Catherine Owen Adams (Chief Executive Officer)

Yeah, I’m going to ask Mark to take that question.

Mark Schneyer (Chief Financial Officer)

Yeah, I think at this point, I mean, as you note, oral arguments are right in front of us, you know, at the beginning of next week. Appreciate the question, but we’re not going to get into the details of the case other than to say that we continue to remain confident in our position related to the appeal, which is supported by the win that we earned at the district court level last year.

Catherine Owen Adams (Chief Executive Officer)

Thanks for the question.

OPERATOR

Your next question comes from Jack Allen with Baird. Your line is open.

Catherine Owen Adams (Chief Executive Officer)

I thought somebody might ask about exposure. So, Sanji, why don’t you share a little bit more?

Sanjeev Pathak (Senior Vice President and Head of Clinical Development)

Yeah, we are working on the exposure-response analysis, but it will not be ready for CTAD. This is to inform our future thinking for the entire program, and perhaps it will be available in 2027.

Catherine Owen Adams (Chief Executive Officer)

Yeah, CTAD will really be sharing a little bit more around the overall effect size that we’ve seen across the four psychosis scales. We were showing you a little bit more data around the efficacy over time and some other sub-cuts of data. But the exposure-response, to Sanjeev’s point, is just going to take us a little bit more time to work through. So we look forward to sharing that data when we have a good summary of that that we can share with you, with a focus on the meaningfulness behind it.

Sanjeev Pathak (Senior Vice President and Head of Clinical Development)

What I will underscore is that we have seen a dose response, which gives us confidence in the activity of the molecule.

Catherine Owen Adams (Chief Executive Officer)

Thanks, Sanjeev. Okay.

OPERATOR

That is all the time we have for questions. Sorry, I’ll turn it back to you, Catherine.

Catherine Owen Adams (Chief Executive Officer)

No, that’s fine. Thank you so much, operator. So thank you all for your time and attention. We appreciate the questions and look forward to following up with many of you in the next 48 hours and then, no doubt, following up after our CTAD presentation. Thank you again for supporting ACADIA Pharmaceuticals.

OPERATOR

This concludes today’s conference call. Thank you for joining. You may now disconnect.

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