BridgeBio Pharma, Inc. Common Stock 12th Annual Cantor Fitzgerald Global Healthcare Conference

Yeah, happy to do that. First, Josh, thank you for hosting us, and thank you to all the investors for joining us here, and as well as on our one-on-ones. BridgeBio today is at an inflection point. We have $8 billion in post Phase III peak year sales assets. The first of that is Attruby, which is launched, which we think is a $4 billion drug. Globally, it was already annualizing to over $1 billion in 2Q, so we are building on our strength there. Right after that, we have three launches upcoming very shortly now. I think the first one, limb-girdle, is going to be in November, and then we expect a launch in achondroplasia as well as ADH1 early next year. So that is where we are at. All those four indications put together are $8 billion in peak year sales.

What is very exciting is that right behind that, we have an expansion indication in hypoparathyroidism, which is probably worth another couple billion dollars, especially when you put it with the depleter antibody, which is in early stage in ATTR-CM. That is not it. I know, Josh, you have always liked for us to think more holistically and think more broadly about genetic diseases and helping patients who are suffering with these diseases. We have a sister company, GondolaBio, where they have a late-stage EPP program, as well as some 16 or 17 very early-stage assets, which are all very exciting. So there is a lot happening. We are trying to do a lot for patients, and my hope is that over time, that value is going to accrue to shareholders also.

Yeah. Happy to do that. I think CARDIO-TTRansform was, I would say, the last big data event, which has now really clarified a lot of the picture for us in ATTR-CM. Where are we today? I think the first thing to realize is that stabilizer therapies, there are two main types of therapies, stabilizers and knockdowns. Stabilizer therapy, which is the type of therapy that Attruby is, they are going to be the treatment of choice for frontline ATTR-CM patients. If a new patient comes in, which is a vast majority of patients today, they are going to be put on a stabilizer therapy. The knockdown therapies take about a year and a half to work, whereas Attruby takes about a month to work.

And then you also have to take into account that combination therapy, which some people had hopes for, was proven decisively to be inefficacious in CARDIO-TTRansform. I think the second thing which we learned is that the two knockdown agents are more similar to each other than different. If you look at the placebo-adjusted knockdowns in the Gilmore et al paper, you saw that the two knockdown percentages adjusted for placebo were very similar. And then that translated to monotherapy hazard ratios for the two knockdown agents to also be about 0.67 and 0.7 respectively, so very similar. And then the third thing which I would say is we were very encouraged to see that clearly there is room to do more beyond VYNDAMAX, which is the first generation old stabilizer, which is where Attruby, which is our second generation new stabilizer, has a unique differentiated edge.

And so we do think that having that near-complete stabilizer in Attruby, it confers a very unique kidney protective effect. We also see the fact that it has much stronger effects on hospitalization as well as time to separation, hard outcome separating as early as one month. So we think that that is where Attruby is positioned. Today we have more than 25% share in frontline patients. We have said that our goal is to be at 30%-40% at peak. We are doing market research to refine that, and my expectation is that 30% number will probably move up on the bottom end of the range at least. And then the last thing which I would say is, in our experience, it takes a little bit of time for all this data to really get out there in the field.

We have noticed that it takes physicians multiple visits explaining the data carefully, that these are nuanced data sets. As we do all of that, I think it takes about a year or so for these amazing data sets for Attruby to translate into script growth and then ultimately revenue growth. So near term, we expect about a $25 million to $30 million quarter-over-quarter sales increase for the next three or four quarters, which should then start to accelerate as you get into calendar late 2027 or early 2028.

Yeah. That's a great question. We think that Attruby is the best drug for ATTR-CM patients, and we do think that everyone should be on Attruby. Actually, in Europe, more than 50% of new patients are on Attruby, especially in Germany, which is where the drug was first launched in Europe by our partner, Bayer. Why is it that I'm saying that our goal in America is 30%-40%? Well, I think there are a few reasons for that. The first reason is I don't think most investors believe 30%-40%, so let's start there so we can sort of walk them through it over time. Second of all, I think that there are some unique differences in our healthcare system, such as the buy-and-bill economics and things like that, which do impact prescribing on the edges.

In an ideal world, it wouldn't, and I know the government's thinking about that, but it does right now, and so we have to be realistic about that. But what I would say is we have built a very strong foundation of evidence now that Attruby is a differentiated stabilizer. It's not just another VYNDAMAX, it's a much better stabilizer. That started with the label. As you remember very well, Josh, we're the only agent in the field which has the verbiage near complete on our label. Beyond that, what I would say is we've then built upon that to say that that near complete stabilization is correlated with a decrease in all-cause mortality. Then we've built upon that with subgroup analysis, whether it's the AFib patients or the variant patients.

Yes, now we are expanding upon that with a unique kidney protective effect, which Attruby has, as well as the claims data which you're saying, although the claims data is maturing. So my expectation is we'll see more independent studies come out at HFSA. We are always excited when an independent person looks at Attruby versus VYNDAMAX because we feel so good about our profile.

Thus far, we've done analysis from our own phase III trials, whether that's looking at Attruby versus VYNDAMAX in the trial, and we've also looked at subgroup analysis. I think some people have also done some comparisons of Attruby versus VYNDAMAX on serum TTR in real-world settings. I think what the field is looking for is clinical worsening outcomes. What do I mean by that? Things like diuretic intensification, hospitalizations. Those are hard outcomes. It takes a little bit of time for this data to mature, but I think we're almost 2 years into our launch. I know that there are some systems which have been looking into this, and my expectation is that people publish what they've found on Attruby versus VYNDAMAX.