Jazz Pharmaceuticals (JAZZ) - Conferencia de resultados del 3T de 2026: eleva la previsión de ingresos

Puntos clave

• Jazz Pharmaceuticals reportó un nivel récord de ingresos en el T3 de 2026 de 1.240 millones de dólares, un aumento del 10% interanual, impulsado por un crecimiento del 35% en oncología y un incremento del 12% en las ventas de Xywav.
• La empresa elevó y acotó su estimación de ingresos para todo el año 2026 a 4.770-4.850 millones de dólares. En el punto medio, la dirección afirmó que esto representa casi un crecimiento del 13% con respecto a 2025.
• Las ventas netas del producto Xywav alcanzaron los 483 millones de dólares, con aproximadamente 425 incorporaciones netas de pacientes durante el trimestre y 17.550 pacientes activos al cierre del trimestre.
• Ziihera generó 21 millones de dólares en ventas netas del producto. En septiembre se triplicaron las nuevas cuentas de pedidos con respecto a agosto, y más del 80% de esas cuentas procedían de clínicas comunitarias.
• Jazz mantuvo su potencial de ventas máximas de 3.000 a 5.000 millones de dólares para Ziihera, respaldado por datos de primera línea en GEA metastásico HER2 positivo que muestran una mediana de supervivencia global de 27 meses para el régimen de triplete.
• El flujo de efectivo operativo alcanzó los 1.300 millones de dólares durante los primeros nueve meses de 2026, mientras que el efectivo y las inversiones al cierre del trimestre se situaron en 2.900 millones de dólares.

Datos financieros principales

Rendimiento comercial y operativo

El lanzamiento de Ziihera gana tracción en la comunidad médica

La aprobación de la FDA y el lanzamiento de Ziihera en primera línea para el adenocarcinoma gastroesofágico metastásico HER2 positivo, o GEA, fue el principal hito comercial del trimestre. Jazz estima una población elegible anual en EE. UU. de aproximadamente 3.000-4.000 pacientes.

Septiembre fue el primer mes operativo completo tras la aprobación. Las nuevas cuentas de pedidos se triplicaron con respecto a agosto, y más del 80% de esas cuentas fueron clínicas comunitarias. La demanda promedio de viales por día hábil de venta aumentó aproximadamente un 40% intermensual.

La dirección afirmó que la adopción está impulsada por pacientes de nuevo diagnóstico en lugar del almacenamiento en el canal de distribución, conversiones de acceso expandido o cambios masivos desde tratamientos existentes. La empresa también informó de un reembolso sin contratiempos y una pronta inclusión en formularios, conjuntos de órdenes en registros médicos electrónicos y vías clínicas oncológicas.

En el congreso ESMO, el análisis final de HORIZON-GEA-01 mostró una mediana de supervivencia global de 27 meses para el triplete basado en Ziihera. Casi el 40% de los pacientes que recibieron el triplete estaban vivos a los tres años, en comparación con el 23% para trastuzumab más quimioterapia. El seguimiento más prolongado arrojó un cociente de riesgos de supervivencia global de 0,65. Jazz ha presentado los datos maduros para su evaluación de cara a una actualización de Categoría 1 de la NCCN.

Xywav sigue siendo el motor de crecimiento en trastornos raros del sueño

Xywav sumó aproximadamente 425 pacientes netos durante el tercer trimestre, lo que situó la base de pacientes activos en 17.550. La dirección atribuyó la durabilidad del producto a su perfil bajo en sodio, sus beneficios clínicos en la narcolepsia y la hipersomnia idiopática, la cobertura de los pagadores y el apoyo a pacientes a través de JazzCares.

La compañía señaló que los genéricos de oxibato con alto contenido de sodio han tenido un impacto menor al previsto inicialmente. Los agonistas del receptor de orexina-2 podrían alargar el tiempo antes de que algunos nuevos pacientes con narcolepsia de tipo 1 comiencen la terapia con oxibato, pero la dirección prevé que Xywav siga siendo un tratamiento fundamental para la narcolepsia de tipo 1, la narcolepsia de tipo 2 y la hipersomnia idiopática.

Epidiolex y expansión del pipeline

Epidiolex registró 295 millones de dólares en ventas netas trimestrales de productos. La FDA aceptó la solicitud de Jazz para una formulación de cápsulas orales de cannabidiol, con una fecha PDUFA fijada para el 16 de abril de 2027. La compañía también está estudiando Epidiolex en encefalopatías del desarrollo y epilépticas y en crisis de inicio focal.

Jazz completó su adquisición de Actio Biosciences por 820 millones de dólares, incorporando ABS-1230, una terapia de precisión dirigida al canal iónico KCNT1. Se esperan los datos iniciales de eficacia en pacientes en un congreso médico durante el cuarto trimestre de 2026.

Otros hitos señalados incluyen los resultados de la fase III del ensayo ACTION en el primer semestre de 2027 y los datos principales de EMPOWER-Breast Cancer-303 a finales de 2027 o principios de 2028.

Zepzelca y Modeyso

Las ventas de Zepzelca aumentaron un 32% hasta 104 millones de dólares, impulsadas por su adopción en combinación con atezolizumab como mantenimiento de primera línea para el cáncer de pulmón de células pequeñas en estadio extendido. La indicación de segunda línea se retiró de la etiqueta a finales del tercer trimestre de acuerdo con la FDA.

La dirección prevé que los datos competitivos presentados recientemente en mantenimiento de primera línea supongan un obstáculo tras el posible lanzamiento de un competidor en 2027. No obstante, Jazz considera que Zepzelca es una opción consolidada gracias a su perfil de administración y su beneficio en la supervivencia global.

Modeyso ha generado aproximadamente 200 millones de dólares en ventas netas de productos desde su lanzamiento en el tercer trimestre de 2025, con aproximadamente 725 pacientes tratados hasta el tercer trimestre de 2026. Los ingresos trimestrales incluyeron una acumulación de inventario de los socios de 14 millones de dólares tras la aprobación en Japón. La dirección prevé un ritmo de ingresos a corto plazo más moderado a medida que la actividad comercial se expanda desde los centros académicos hacia las redes de oncología comunitaria.

Previsiones de la dirección

La directiva señaló que algo más de la mitad del incremento en las previsiones de ingresos provino de la franquicia de trastornos raros del sueño. Un desempeño más sólido de Epidiolex y de los productos de oncología en EE. UU. y Europa también respaldó la revisión.

Riesgos y aspectos a vigilar

• Los agonistas del receptor de orexina-2 podrían retrasar la iniciación del tratamiento con oxibato entre algunos nuevos pacientes con narcolepsia de tipo 1, aunque la directiva no prevé un cambio generalizado entre los pacientes estables que reciben Xywav.
• Zepzelca se enfrenta a un posible obstáculo competitivo en 2027, mientras que su indicación de segunda línea se retiró de la ficha técnica a finales del tercer trimestre de 2026.
• El crecimiento a corto plazo de Modeyso podría moderarse a medida que Jazz se expanda más allá de los centros académicos y trabaje para aumentar las pruebas de biomarcadores en centros comunitarios.
• El despliegue de Ziihera en primera línea para GEA depende en gran medida de los nuevos pacientes diagnosticados que inician tratamiento, más que de una acumulación inicial de pacientes de ensayos o de acceso expandido.
• Los resultados trimestrales no GAAP se vieron afectados significativamente por el cargo de 754 millones de dólares por IPR&D adquirida asociado a la transacción de Actio Biosciences.

Puntos destacados de las preguntas y respuestas de los analistas

• Previsiones de ingresos: La directiva atribuyó algo más de la mitad del incremento a la franquicia de trastornos raros del sueño, impulsada por una mejor ejecución con Xywav y una erosión limitada frente a los genéricos de alto contenido en sodio. El desempeño de Epidiolex y de oncología también redujo los escenarios desfavorables.
• Adopción de Ziihera: Jazz destacó que las clínicas comunitarias representaron más del 80% de las nuevas cuentas con pedidos en septiembre. La directiva prevé que el crecimiento siga el ritmo con el que los pacientes recién diagnosticados acuden a recibir tratamiento.
• Expansión del mercado de GEA: La compañía señaló que la realización de pruebas de HER2 ya es relativamente alta, pero solo alrededor del 65% de los pacientes diagnosticados con HER2 positivo pueden recibir actualmente un tratamiento dirigido a HER2. Jazz planea centrarse en aumentar su uso adecuado en primera línea.
• Durabilidad de Xywav: Los comentarios de los prescriptores citados por la directiva sugieren que es poco probable que los pacientes estables cambien de tratamiento. La compañía también destacó la relevancia cardiovascular del perfil bajo en sodio de Xywav y su infraestructura de apoyo al paciente.
• ABS-1230: La directiva calificó la epilepsia relacionada con KCNT1 de muy refractaria y señaló que la información clínica preliminar revisada antes de la adquisición era prometedora. Se esperan los primeros datos de pacientes durante el cuarto trimestre de 2026.
• Asignación de capital: Tras la adquisición de Actio, la emisión de bonos convertibles y la refinanciación del préstamo a plazo, Jazz afirmó que su generación de caja y su posición de liquidez de 2.900 millones de dólares respaldan la inversión continuada en productos comercializados, I+D y desarrollo corporativo.

Transcripción completa de la llamada de resultados

Transcripción completa de la conferencia de resultados

Comentarios de la dirección

Operator

Ladies and gentlemen, thank you for standing by. Welcome to Jazz Pharmaceuticals 2026 Third Quarter Earnings Call. [Operator Instructions] Please be advised that today's conference is being recorded. I would like now to turn the conference over to John Bluth, Head of Investor Relations. Please go ahead.

John Bluth

Thank you, and good afternoon, everyone. Today, Jazz Pharmaceuticals reported its third quarter 2026 financial results. The slide presentation accompanying this webcast is available on the Investors section of our website, along with the press release and quarterly report on Form 10-Q for the quarter ended September 30, 2026. On the call today are Renee Gala, President and Chief Executive Officer; Sam Pearce, Chief Commercial Officer; Rob Iannone, Global Head of R&D and Chief Medical Officer; and Phil Johnson, Chief Financial Officer. On Slide 2, I'd like to remind you that today's webcast includes forward-looking statements, such as those related to our future financial and operating results, growth potential and anticipated development, regulatory and commercial milestones which involve risks and uncertainties that could cause actual events, performance and results to differ materially from those contained in these forward-looking statements. .

We encourage you to review these risks and uncertainties described in today's press release and under the caption Risk Factors in our annual report on Form 10-K for the fiscal year ended December 31, 2025, and quarterly report on Form 10-Q for the quarter ended September 30, 2026. We undertake no duty or obligation to update our forward-looking statements. Furthermore, we will discuss non-GAAP financial measures on this webcast, descriptions of these non-GAAP financial measures and reconciliations of GAAP to non-GAAP financial measures are included in today's press release and the slide presentation available on the Investors section of our website. I'll now turn the call over to Renee.

Renée Galá

Thank you, John. Good afternoon, everyone, and thank you for joining us today. Our third quarter results demonstrate the progress we are making as we build a more innovative and diversified Jazz. We delivered record revenues of $1.24 billion, an increase of 10% year-over-year, while advancing several important drivers of our future growth. Most notably, the FDA approval and launch of XYHARA in first-line HER2-positive metastatic GEA with a defining milestone for Jazz, establishing an important new source of growth and marking the beginning of what we believe could be a much broader opportunity across HER2 expressing cancers.

And as you'll hear from Sam, the launch is off to a fantastic start. Longer-term data presented at ESMO further strengthened our conviction in Zihera, and we continue to see peak sales potential of $3 billion to $5 billion. Our commercial portfolio is performing well. with multiple products contributing to our growth. Oncology revenues grew 35% year-over-year, driven by the launches of Madeco and Zepzelca in the first-line maintenance setting, while sustained demand for Xywav continued to underscore its durability and differentiation. Given our third quarter performance, we have increased our 2026 revenue guidance, as Phil will outline later in the call. Our sustained performance and disciplined approach to capital allocation places us in an excellent position to continue investing in our business today while further building new sources of growth for the future.

One important example of how we are investing for the future is our acquisition of Actio Biosciences, which we completed during the quarter. This acquisition brings ABS 1230 into the Jazz pipeline and builds on our leadership in rare epilepsy. ABS-1230 is a clinical-stage novel small molecule precision therapy designed to selectively inhibit the KCNT1-ion channel. In early proof-of-concept trials, ABS-1230 demonstrated meaningful seizure reductions that provide a high degree of confidence in the mechanism and molecule. We look forward to presenting initial patient data at a medical meeting this quarter, which we believe will generate shared excitement for the program.

As outlined on Slide 5, the Apio acquisition illustrates the type of rare disease opportunities we are seeking, highly differentiated assets in areas of significant unmet medical need where we believe Jazz can create meaningful value. And the cash flow generated by our commercial portfolio gives us the flexibility to pursue additional opportunities with the same disciplined approach. Before turning the call over to Sam, I want to take a moment to recognize the tremendous contributions she has made to Jazz. Under her leadership, our commercial teams have achieved major milestones, including propelling Epidiolex to blockbuster status, executing key oncology launches and further establishing our leadership in sleep medicine.

Equally important, Sam has built a highly capable commercial leadership team that is driving our performance today and is well positioned to carry it forward. She will remain with Jazz through the appointment of her successor to support a seamless transition. Sam, we are deeply grateful for your leadership and contributions, and we wish you a wonderful well-deserved retirement. With that, I'll turn the call over to Sam to review our commercial performance.

Samantha Pearce

Thank you for those kind words, Renee. It has been an absolute privilege to lead this exceptional commercial team during a transformative period of growth for Jazz. I came into this role looking to accomplish 3 key things: to drive strong growth in the commercial portfolio, to build out the team's capabilities to ensure long-term success and to build a high-performing cohesive leadership team. I can say with certainty that we've achieved all of those things. While I will miss my time at Jazz, and I'm certainly looking forward to my retirement, I will be here to ensure a smooth transition over the coming months.

With that, I'll now jump into the quarter. The commercial team delivered another quarter of record revenues. These results reflect our sharp operational focus which continues to yield commercial momentum across our expanding portfolio headlined by the outstanding early launch of Xihera in GEA. To kick off our third quarter commercial performance update, I'll begin with our rare sleep portfolio on Slide 7. Xywav's net product sales increased 12% to $483 million. We added approximately 425 net patients in the quarter across narcolepsy and idiopathic hypersomnia, demonstrating the sustained clinical value, physicians and patients place on this medicine. We believe that truly addressing rare sleep disorders requires a restorative approach that connects night and day.

Recently updated findings from our DUET trial demonstrates Xyway's profound impact on consolidating disruptive nighttime sleep, which directly translates to a meaningful reduction in debilitating daytime symptoms for both narcolepsy and idiopathic hypersomnia patients. These data reinforce Xywav's critical dual role, optimizing sleep architecture overnight to maximize patient functioning during the day. Furthermore, our Xylo study showed that patients switching to this low-sodium formulation achieved a clinically meaningful reduction in blood pressure, reinforcing Xyway's crucial cardiovascular safety profile. Our dedication to patient well-being also extends to our best-in-class JazOlin care patient services, including our field-based nurse educators.

These programs drive patient persistence and ensure appropriate use and long-term adherence to treatment. As the NT1 landscape evolves with the introduction of orexin 2 receptor agonist, we expect there could be near-term extension and the time it takes for some new patients to initiate therapy. However, we expect the clinical value of treating disruptive nighttime sleep to remain a priority for HCPs and patients. and we expect Xyway to remain a foundational therapy across NT1, NT2 and idiopathic hypersomnia. Our payer discussions for 2027 are well underway, positioning us favorably as we head into next year. We've consistently seen throughout 2026 that the low sodium profile of Xywav is highly valued by physicians, patients and payers.

We entered 2027 focused on maintaining this momentum. And we believe the strong clinical differentiation of ZieWave will continue to support its durability. Turning to Epidiolex on Slide 8. net product sales reached $295 million for the quarter, driven by solid underlying demand. Year-over-year growth was negatively affected by lower gross to net deductions in the third quarter of 2025 and lower levels of inventory build this quarter compared to the same quarter last year. A key driver of exceptional patient persistence for Epidiolex is our nurse navigator program within [indiscernible]. We see a direct correlation between program enrollment and improved treatment adherence. To further support long-term adherence, we are actively generating evidence to underscore Epidiolex's broad benefits beyond seizure control alone. Real-world insights from studies like Epicom and our become caregiver survey, highlight meaningful improvements in daily cognitive functioning and reduced caregiver burden.

Looking ahead, we have several key levers to drive long-term expansion. The FDA has accepted our NDA for a new cannabidiol oral capsule formulation with a PDUFA date of April 16, 2027, which will improve accessibility and compliance for patients. including certain segments of the adult patient population. We are also advancing a clinical trial exploring Epidiolex in developmental and eclectic encephalopathies, as well as our ongoing focal onset seizure trial. Supported by robust patient durability into the very late 2030s, we remain highly confident in Epidiolex' ability to serve a broader patient population. Turning to our oncology portfolio on Slide 9. The early launch of Xyhera in GEA is delivering a truly transformative therapy for patients. while establishing an expansion opportunity for our oncology business. In the third quarter, Zahira generated $21 million in net product sales.

Feedback from key opinion leaders and treating physicians has been exceptional, confirming our belief that Zahira represents a new HER2-positive backbone therapy in this setting. Our early post-launch market research shows more than 3/4 of HCPs reports a high likelihood to prescribe Viera for GEA, which signals a positive reaction to our data. Our launch Blueprint draws directly on Zahira's core strengths, identifying highly defined specialist patient populations and mobilizing a dedicated commercial infrastructure to serve them efficiently. To help frame the trajectory of the launch and model the uptake curve going forward, I want to highlight 2 core dynamics. First, our commercial strategy is focused on precisely identifying the specific population of 3,000 to 4,000 annual patients in the U.S. who are eligible to receive Zahira in this indication. Because these patients are distributed across different clinical settings, we are deploying a comprehensive outreach strategy, broadening our reach beyond academic centers to mobilize community accounts where the majority of GEA patients are cared for.

Within the first 2 weeks post approval, our field teams conducted more than 1,500 clinical interactions with oncologists and patient advocacy partners. This approach has resulted in strong brand awareness. We saw a threefold increase in new account ordering of Zahira in September compared to August, with the vast majority coming from community accounts. This contributed to an approximately 40% month-over-month increase in average vial demand per selling day. Second, given there is no bolus of expanded access program or clinical trial patients waiting to transition to commercial drug, the demand we are seeing reflects new patient starts as community centers integrate this practice-changing regimen into their treatment protocols. As a result, we expect Zahira Fiera's uptake to build as new patients present for treatment. Market access has been smooth, facilitated by Xihira's existing permanent J code and preferred NCCN guideline status and we are seeing clinical pathways preferentially adopt the Horizon regimen based on superior results that reach the longest median overall survival ever reported in this setting.

Moving to Slide 10. The clinical data zanidatamab has generated to date has strengthened our conviction and its potential across HER2-driven cancers. Consequently, we recently updated our peak sales potential for Vera to a range of $3 billion to $5 billion. Turning to Slide 11. Medeso has generated approximately $200 million in net product sales since its launch in the third quarter of 2025, with approximately 725 patients treated as of the third quarter '26. The strong performance of Medezo reflects the significant unmet need these patients face. We have observed strong patient persistence and continue to collect data to fully characterize average duration of treatment.

Academic center adoption remains strong, and we are expanding our field efforts into the community setting through peer-to-peer programs and initiatives to increase biomarker testing. As we establish these community-focused strategies and ahead of overall survival data from our Phase III ACTION trial, we anticipate a more measured revenue pace in the near term. Of note, our third quarter revenue includes a $14 million partner inventory build following the Daiso's recent approval in Japan. We look forward to sharing top line results from the ACTION trial in the first half of 2027. On Slide 12, Zepzelca net product sales increased 32% to $104 million driven by strong adoption of the Zepzelca and atezolizumab combination in first-line maintenance for cell lung cancer.

In alignment with the FDA, the second line indication was removed from the label at the end of the third quarter. Small cell lung cancer has been an area of high unmet need for many years. 2 years ago, data from the EMFORTE trial showed the Zepzelca and atezolizumab combination delivered improved overall survival benefit and a favorable safety profile. The note regimen brought a new maintenance option to patients for the first time in decades. Recently, at the ESMO Congress in October, we saw a strong new competitor data in first-line maintenance extensive stage small cell lung cancer. This is positive news for patients as innovative science continues to evolve the treatment landscape.

Our focus remains on maintaining Zepzelca's role as an established and practical option for patients with extensive stage small cell lung cancer. We are focused on driving adoption in the first-line maintenance setting for patients who need an effective treatment option today ahead of the anticipated competitor launch in 2027 which is likely to pose a future headwind to Zepzelca sales. Our commercial execution this quarter has been exceptional, giving us strong momentum with which to finish the year. We are fully confident in our trajectory with the continued strength of Xyway and successful early launch of Vihera. I'll now turn the call over to Rob to discuss our upcoming pipeline milestones. Rob?

Robert Iannone

Thanks, Sam. The FDA approval of Zahiara is a pivotal moment for Jazz and represents a paradigm shift for the treatment of first-line HER2-positive metastatic GEA. Slide 14 illustrates how we expect the Horizon regimen to transform legacy standards of care and reshape the management of this aggressive cancer. Unlike prior regimens that restricted immunotherapy to PD-L1 positive cases, Xihira-based regimens provide a consistent survival benefit across both PD-L1 positive and PD-L1 negative populations. At the ESMO Congress in October, we presented the final formal analysis for the Horizon GA 01 trial.

At this analysis, -- the results showed Zyheraplus chemotherapy delivered a statistically significant and clinically meaningful OS benefit, reducing the risk of death by 24% versus trastuzumab plus chemotherapy. Nearly 40% of patients treated with the triplet regimen compared to 23% who were treated with tras and chemo were alive at 3 years, and this was irrespective of PD-L1 status. achieving a median OS of 27 months, representing the longest survival outcomes ever reported in this setting. In addition, the longer follow-up of the triplet regimen showed an improved OS hazard ratio of 0.65 further supporting Xihera plustizolizumab and chemotherapy as the new standard of care. Slide 15 highlights the expansion of our pipeline, leveraging both internal discovery and strategic business development to deliver our next horizon of innovation.

We continue to progress our development program for zanidatamab. One of the most exciting areas is breast cancer, where we have the ongoing EMPOWER 303 trial in metastatic breast cancer patients who have progressed on or are intolerant to TDXD. We expect top line data from this trial late next year or in early 2028. At the same time, we are actively expanding into earlier stage breast cancer through the EMPOWER BC 208 trial and the ICP and MD Anderson Cancer Center collaborations. Beyond breast cancer, we are continuing to enroll patients with colorectal cancer and non-small cell lung cancer in the pAN-TUMOR-206 trial. FDA granted breakthrough therapy designation for zanidatamab in adults with previously treated locally advanced unresectable or metastatic HER2-positive colorectal cancer.

Moving to our early-stage pipeline. We recently initiated a Phase I first-in-human trial of JZP-269, our differentiated corexin-2 receptor agonist to evaluate the safety, tolerability and weight promoting effects in sleep-deprived healthy participants. Expanding the breadth of our research in epilepsy treatment, the acquisition of Akio adds a highly differentiated asset with promising early data to our pipeline. Regulatory agencies have recognized the potential of ABS 1230 and by granting Fast Track, rare pediatric disease and orphan drug designations. ABS-1230 is advancing in the Phase Ib/IIa CIRN trial, which is structured as a registrational trial in could support future NDA submission. We look forward to sharing initial patient efficacy data at a medical meeting this quarter.

We are making steady progress across our pipeline and R&D organization, positioning us to share additional developments and milestones in the months ahead. Now I will turn the call over to Phil for a financial update. Phil?

Philip Johnson

Thanks, Rob. Turning to our financial results for the quarter. I'll start with high-level comments on our non-GAAP adjusted P&L as shown on Slide 17. Please note that full financial results are available in today's press release and 10-Q. The outstanding execution of our field-based teams was reflected in record quarterly revenue of $1.24 billion, an increase of 10% over the third quarter of 2025. And driven by 35% growth in our oncology portfolio and 12% growth in Xywav. As a reminder, in the third quarter of 2025, we had 14 shipping weeks for our U.S. oncology products, while this year we had a normal 13 weeks.

This provided a 9 percentage point headwind to our U.S. oncology revenue growth. Moving down the P&L. Our non-GAAP adjusted gross margin declined by 110 basis points year-on-year, primarily due to royalties on higher sales of Medellin and Zepzelca as well as tech transfers for manufacturing of several products.

Non-GAAP adjusted SG&A decreased by $132 million, driven by the inclusion in last year's quarter of $151.5 million in charges for Avadel and Xyrem antitrust litigation settlements. Excluding these charges, non-GAAP SG&A expenses increased $19 million or 6%, driven by higher expenses for Zahira first-line GEA and investments in key commercial capabilities. Non-GAAP adjusted R&D expenses grew 11%, primarily due to higher expenses for evidence generation studies and advancing our early-stage portfolio. Our nonpit tax rate of negative 40% and loss per share of $3.88 reflect the Apio acquired IPR&D charge of $754 million or $11.03 per share. Excluding this charge, our non-GAAP ETR would have been approximately 13% and non-GAAP EPS would have been positive at $7.15 per share. Beyond the income statement, I'd highlight that we generated operating cash flow of $1.3 billion in the first 9 months of the year.

During the third quarter, we issued $1.25 billion in convertible notes reduced the interest rate and extended the maturity of our term loan and invested $820 million to acquire Apio. We finished the quarter with $2.9 billion of cash and investments and are well positioned to continue to invest in our currently marketed products, our existing pipeline and corporate development to drive even greater value for shareholders and patients. Turning to Slide 18 and our 2026 financial guidance. I'm pleased to report that we're raising and narrowing our total revenue guidance to a range of $4.77 billion to $4.85 billion.

At the midpoint, this represents nearly 13% growth over 2025. This is the second quarter in a row that outstanding execution by our field teams across multiple products in the U.S. and Europe is driving an increase in our revenue guidance that sets the low end of our revised revenue outlook above the high end of our prior outlook. The special call out and thanks to our Jazz colleagues across the globe for their unwavering commitment to bring our highly differentiated products to those patients who can benefit from them. In addition we now expect rare sleep revenue of $2.125 billion to $2.175 billion led by Xywav growth of low double digits to the low teens. XiwaY's unique benefits as the only low sodium oxybate continue to resonate with patients, physicians and payers. And uptake of high sodium generics to date continues to be limited. Our increased revenue outlook is also driving a 50 basis point increase in our non-GAAP gross margin guidance to a range of 90.5% to 91.5%.

Our guidance for non-GAAP SG&A and R&D expenses is unchanged and as we continue to exercise disciplined capital allocation while achieving our commercial and R&D objectives. We have updated our non-GAAP effective tax rate to a range of 19.5% to 21.5% and to reflect the effect of a nontax deductible acquired IPR&D charge from the Apptio acquisition. Finally, our share count guidance is unchanged at 69 million to 70 million shares. I'll now turn the call back to Renee for closing remarks.

Renée Galá

Thank you, Phil. I'll conclude our prepared remarks on Slide 20. Jazz's outstanding results this quarter demonstrate our continued focus on high performance and the disciplined execution of our strategy. We raised our revenue guidance, launched Xyhara in first-line GEA and advanced our key pipeline programs and strengthened our rare epilepsy portfolio through the acquisition of Apio. Looking ahead, the next important inflection points are already in view. .

Initial patient data from ABS 1230 this quarter, the action readout in the first half of 2027 and and top line data from the EMPOWER Breast Cancer 303 study in late 2027 or early 2028. As we enter 2027, we have clear priorities the financial strength to invest behind them and a strong track record of execution. Together, -- these give us confidence in the Jazz we are building for the future and the meaningful value we can create for patients, employees and shareholders. With that, I'll ask the operator to please open the line for questions.

Operator

[Operator Instructions] The first question is going to come from Jessica Fye with JPMorgan.

Preguntas y respuestas

Jessica Fye

I was wondering if you could elaborate a little bit more on the factors behind the guidance update, including that increase to the rare sleep guidance, but it seems like that was not the only thing driving the upside?

Bruce Cozadd

Yes, Jeff, happy to. This is Phil. So you're right, a little over half of that increase was coming from the rare sleep franchise, where we've seen outstanding execution across the first 9 months of the year for Xywav. And in the high sodium oxybate portion of our business, we really have seen very little impact from the high sodium generics. -- something that we didn't originally anticipate might occur as we got later into the year, which just is not taking place at the pace that we had originally expected. And then we are seeing strong performance not only in the U.S. but also in Europe on a host of other products. in the Epidiolex and oncology parts of our business that sort of took away potential downside scenarios and allowed us to capitalize on the strong performance to date and raise that portion of our guidance as well.

So I really feel extremely proud and thankful for the commercial execution, Sam and her team have provided is allowing us to raise guidance now for a second quarter in a row, and we did not increase the operating expense guidance. As I mentioned on the call, we continue to execute well, hitting on all our major milestones, both commercially and R&D while still maintaining the guidance from our prior quarter. So really strong financial execution here in the third quarter, setting us up for a strong finish to the year.

Operator

And our next question is going to come from Joseph Thome with TD Cowen.

Joseph Thome

Progresso did mention the community setting a couple of times. Maybe specifically for zanidatamab. Can you talk about the experience of physicians in the community setting using HER2-targeted agents, maybe in general and kind of the overall diagnosis strategy there? Is this lagging behind the academic centers? And maybe how can Jazz make an impact here?

Renée Galá

Yes. Thanks for the question, Joseph. Yes, I mean, I think we've highlighted previously the importance of the community setting when it comes to the launch of Zahira. And we had a very specific focus on ensuring that we would see adoption not only in the academic centers of excellence, where you would expect high brand awareness already, but also in the community setting, which will account for the majority of the use of Zahira where patients will get treated there. And as you've seen from some of the KPIs that we've described we're seeing already really strong uptake community in September, which was our first full operational months post launch. We achieved a threefold increase in new accounts ordering Xahira compared to August. And crucially, 80% of these new ordering accounts came directly from the community setting, demonstrating rapid penetration there, which obviously is very important for the ongoing momentum of the launch.

And then when you couple that with some of the other KPIs such as the brand awareness, 43% unneeded spontaneous physician awareness and 79% of surveyed oncologists reporting a high intent to prescribe Xahira for first-line GEA. These are really good indicators of what we expect to see the momentum growing into the fourth quarter and beyond. And I think in just 1 month, seeing our expanding customer base translated directly into a 40% month-over-month increase in average file demand per selling day is really extremely encouraging, yes, good start in the community. Obviously, we continue to be highly focused there.

Operator

And the next question will come from Andrea Newkirk Goldman Sachs.

Andrea Tan

Contrats on the quarter. Sam, best for your retirement. Maybe another 1 for you on Zahara and GEA. I guess, maybe across the threefold increase in ordering accounts that you mentioned, what proportion represents single patient orders versus clinics that have maybe already placed repeat orders. And then recognizing it's early, but what feedback are you seeing regarding treatment adherence and dose modifications.

Renée Galá

Thanks for the question. Yes, the threefold increase in new ordering accounts that we saw, they were accounts ordering for the first time. And I mentioned that more than 80% of those accounts that were ordering first time were coming directly from the community setting. So that reflects, I think, the strong uptake in adoption that we're starting to see already in that space. In terms of -- it's obviously too early for us to talk about persistence. But what we're very, very pleased to see is the frictionless reimbursement and pathway adoption. And we've invested in ensuring that patients have a seamless experience coming on to the product, so our investment in the field force, clinical nurse educators, the starter kits are all actively supporting clinics to establish Xihira as the default frontline choice. So some of those investments that we've made, I think, are really paying off. And we haven't encountered any issues in patients being kind of adopted onto the treatment?

Operator

And the next question is going to come from Ash Verma with UBS.

Ashwani Verma

Congrats on your progress. Can you talk about the Xyra addressable patient distribution for GEA. I think you mentioned that A lot of these patients are spread across different settings and some more community heavy. How would the ramp here for GA compared to how fast Xyra adopted in the BTC segment? .

Renée Galá

Yes. Thanks for the question, Ash. Yes, the distribution here the GA indication is going to be predominantly from the community setting, and that is different to BTC. And we don't report revenue broken down by individual tumor indication because we don't get via level indication tagging from distribution channels. However, the vast majority of the month-over-month sequential growth was driven by new patient starts in first-line GEA the approval in late August. I think 1 thing just to mention in terms of the ramp dynamics that you mentioned, there is no channel stocking or expanded access program bolus that was waiting to get transitioned over to commercial Zahira, and as you know, Zahira was already commercially stocked in institutional channels for second-line BTC. So the demand that we are now seeing represents newly presenting patient starts as community oncology clinics integrate the regimen into their practice protocols. And we can expect that continued momentum into 4Q and beyond, as I hear is adopted as a new standard of care in this setting.

Operator

And the next question is going to come from Mohit Bansal with Wells Fargo.

Unknown Analyst

This is Will Zhang on for Mohit. I guess like within gears over to Xia. Just want to understand going into '27, how are you guys thinking about the pace of net patient adds on the narcolepsy side given we could see greater build of the generics -- oxybate on top of orexin impact on the narcolepsy side -- and then also on the IA side, I just want to understand the amount of runway for net patient adds you guys see for Xywav in that setting. .

Renée Galá

Yes, thanks for the question. Yes, obviously, we're delighted with wage this year and this quarter, specifically an additional 12% growth 425 net patient adds in the quarter. So we now have 17,550 patients active on treatment at the end of the third quarter. Through 2026 we've obviously performed extremely well. I think the differentiation that Xywav offers has been very robust and durable, and we're not expecting the multisource generics to have any additional impact in the foreseeable future. When it comes the orexin, the orexins obviously do offer an additional daytime wait for this option for type 1 narcolepsy. And that may lengthen the period it takes before patients start on oxybate therapy. But we orexins do not treat disruptive nighttime sleep, and that is the foundational pathophysiology of narcolepsy -- as we've demonstrated in our DUET trial, Xywav consolidates fragmented nighttime sleep architecture, and that directly resolves some of the debilitating daytime symptoms that patients experience.

So feedback that we've had from prescribers indicate that they don't intend to switch that stable controlled Xywav patient base. And we believe that Xywav remains the foundational standard across not just NT1, but NT2 and idiopathic hypersomnia. So I believe we're entering 2027 in a commercially very strong position. with good coverage from the payers, and we're extremely optimistic about the robust durable nature of our Xyway business.

Operator

And the next question will come from Marc Goodman with Leerink.

Marc Goodman

Rob, what's the strategy to play catch up with respect to your Orexin -- and are you thinking about fast forwarding into non-narcolepsy indications? Or are you going to be doing narcolepsy you doing both? What's the strategy? .

Robert Iannone

Mark. So just as a reminder, the approval currently is for NT1 only. And certainly, I think there's somewhat of a consensus that maybe the best-in-class hasn't appeared yet in terms of things like optimal half-life, et cetera. So I do think there's an opportunity for a best-in-class and I do think that can be differentiated in the setting of a broader narcolepsy population, inclusive of NT2 and for idiopathic hypersomnia, where you're likely to need more exposure, more dose than you would, and as we mentioned, we've entered the clinic now in healthy volunteers for this particular mechanism.

You can learn quite a bit in healthy volunteers, utilizing sleep deprivation models, for example, so I think there is an opportunity to go quickly in development. So we're hopeful that 269 will turn into something that's competitive.

Operator

And the next question will come from Jason Gerberry with Bank of America Securities.

Unknown Analyst

This is Chi on for Jason. As a multipart question on SIA. I did not hear Sahara being called out as part of the guidance update. Is that performing in line with your expectation? And in your prepared remarks, you said you are seeing clinical pathways potentially adopt the horizon regimen -- can you expand a little bit more on that comment? Is that both academic and community. Is that over Toga or [indiscernible] and lastly, can you talk about opportunity to upgrade the NCCN guideline to category 1 now that you have updated OS data.

Renée Galá

Bill, do you want to jump in on the guidance question, and then Sam can cover the question afterwards on community versus institution? .

Philip Johnson

Absolutely. So yes, we're very much pleased with the initial uptake of Zahir in first-line GEA very much in line with our expectations and ambition for the molecule, given the late in the year launch, effectively, it's not having a significant impact on our overall revenue guidance for 2026. And certainly look forward to continuing to expand the use of Zahira in both second-line BTC and first-line GEA as we head into 2027, where we'd expect it to be an even more meaningful contributor to our revenue and revenue growth. Sam?

Samantha Pearce

Yes. And in relation to the question around formulary and pathway inclusion. As I mentioned, we've seen really frictionless reimburseware and pathway at adoption, positive early formulary and EHR order set inclusion with preferred status on the leading oncology pathway. Still some work to be done with some of the other oncology pathways, but that's all happening as expected currently, and it's not introducing any kind of administrative lag there. In relation to your question around NCCN. Yes, the NCCN preferred status today already provides broad frictionless reimbursement and pathway access. That was based on the initial category. The category to designation was based on the early interim data. And as you're probably aware, at ESMO just a couple of weeks ago, we presented the final Phase III Horizon GA 01 analysis, which showed an improvement in the median OS triple arm to '27 months, which is the longest ever reported in the Phase III trial in this setting with a 35% reduction in the risk of death for the triple.

We've submitted these mature data now to NCCA for consideration of a category 1 update. But meanwhile, as I've mentioned previously, 80% of our new ordering accounts in September were from community clinics, just showing the Category 2A status that we have today is not impeding clinical uptake.

Operator

And the next question will come from Gregory Renza with Truist Securities.

Gregory Renza

Great. as the progress -- maybe for this one, I just wanted to ask on Modesto. I know that, Sam, you identified perhaps maybe a more measured pace when it comes to looking at how that should play out, especially ahead of the action data next year. Just curious if you could talk about your confidence in how that is -- [indiscernible] with respect to your expectations -- and maybe more importantly, how it sort of fares with your interest in external assets that pertain to the rare disease and even the rare oncology spaces.

Renée Galá

Yes. Thanks for the question. So Medezo has achieved a really rapid uptake through the launch. We've had $200 million in sales and more than 725 patients treated since its August 2025 approval. Some of that was driven by patients transitioning from the expanded access program as well as very rapid adoption by academic centers. We're now really in the next phase of the launch. We did see new patient additions experience a transient dip over the summer months. but initiation rates have since rebounded close to previous levels.

The measured pace that I spoke about really reflects our commercial expansion as we move from concentrated academic centers of excellence into broader community oncology networks. And our focus there really is on reaching those community prescribers, and it's being facilitated by a suite of peer-to-peer programs and our focus on supporting increasing testing rates in the community as well as timely referral to academic centers of excellence as well.

So that measured pace, I really just think reflects this next phase of the launch that we're in. And of course, we're looking forward to the ACTION study readout in the first half of next year, which will support that further growth rate.

Samantha Pearce

And Greg, just to answer the last part of your question in terms of how that impacts our interest and other external assets. mean the Chimerix transaction, which brought us Madsowas exactly the type of transaction that we are interested in today and also quite similar to what we were looking for when we acquired Apio Biosciences. This is an area where there's a significant unmet need where we think we can make a real meaningful impact for patients where we can leverage our expertise, our commercial footprint, our global footprint, and create another durable revenue stream, putting capital to work in a way that is consistent with our strategy and consistent with generating value for patients and for shareholders.

So we're very pleased with the overall performance of Madasa. And as Sam mentioned, with an upcoming inflection point with the action study reading out in the first half of next year, we think we're well positioned to continue that expansion and certainly have continued confidence behind our $500 million peak expectation in the U.S.

Operator

The next question is going to come from Sean Laaman with Morgan Stanley.

Jason Gerberry

This is Mike, on for Sean. Any commentary on why the high sodium generics aren't causing that erosion? Maybe like what are you learning about the market's willingness to accept high sodium regimens? And has anything maybe change your thinking of how you think Lumeris would perform in IH once it gets on market. I think what's being appreciated in the market is the benefits of the low sodium oxybate profile. We know that the vast majority of patients with narcolepsy and idiopathic hypersomnia have cardiovascular or cardio metabolic comorbidities. And so it makes sense for these patients who be offered a low sodium oxybate as opposed to a high sodium oxybate, which could exacerbate those complications. I also think that what is appreciated by health care providers and patients is the wraparound services that we provide to patients that really helps smooth the onboarding of patients onto treatment. Our Jazz Care program is highly regarded in the market. .

And of course, there's also the REMS associated with this treatment as well that it requires some significant investment and support to operationalize. But I think all of those things have contributed to the fact that Xywave has really been uninterrupted by the availability of high sodium oxybate generics, and we expect that to continue.

Operator

And the next question will come from [indiscernible] with Barclays.

Unknown Analyst

Just 1 on ABS 12:30. Just wondering ahead of this initial patient data that you expect this quarter? If maybe you could frame what you need to see on sees reduction, durability, maybe consistency across patients to give you confidence that the Caron can support registration.

Robert Iannone

Yes. So some context in this disorder. It's highly refractory to most antiseizure medications, and it's a severe form of epilepsy coming from mutations, all in the KCMT1G. What we find really promising about ABS cell therapy 30 is that it's targeted to essentially all of the known mutations in that particular gene, which caused a gain of function mutation. So targeting that with an inhibitor can normalize the function of that ion channel. And so that's well established preclinically in preclinical models. It reverses the epilepsy phenotype.

And at the time of the deal, we had some insight into clinical data that were quite promising. So the bar is fairly low. However, we think this approach could actually be quite transformational, and we're excited to be able to share the data, as we said later this year.

Operator

And the next question will come from Leon Timashev with RBC. SP45271794 Maybe 1 for Rene. I think you recently sat down at a panel that included some FDA officials on rare disease. So maybe I wanted to ask, what were your key takeaways with respect to how the FDA is thinking about rare diseases. And I mean, what would you take away back to Jazz on how you think about the development programs, especially in rare epilepsies such as for ABS or for Epidiolex? .

Renée Galá

Yes. Thanks for the question. Well, first of all, we were quite pleased to see the FDA's guidance come out in terms of their fit for purpose rare disease. Framework I think there's a strong acknowledgment that when you're working in rare disease, you need to think about the studies differently. You need to think about patient finding differently. And there seems to be a lot of momentum coming out of that discussion as well as the public forum to receive comment on those topics. For us having a strategy that is focused on rare disease and knowing that there are 30 million patients in the U.S. with rare disease, we have 10,000 rare diseases, 95% of which have no approved therapy, the need is just immense.

And so to both acknowledge the fact that we need both fit-for-purpose, regulatory pathways and pathways that can be predictable is incredibly helpful. It's important for patients. And when it comes to rare disease patients, they deserve the same level of confidence in the efficacy and the safety of the drugs that are being developed for them but the pathway just often look different. So a number of topics that were covered importantly, a lot of momentum serious intent is what I took away from the discussion, and I'm incredibly optimistic about the opportunity going forward.

Philip Johnson

Lena, this is Phil. Maybe 1 thing I'd add, just broadly on policy, we continue to see support MDC for ensuring that incentives are in place for companies to pursue novel solutions for rare diseases, including the recent rules issued in October on the globe Medicare Part B pilot program that exempted sole orphan disease indication drugs from that particular globe program. So again, we feel very good about the company's strategy where we've got [indiscernible] capabilities to also feel very good about the continued support, patient advocacy groups, FDA politicians, broadly, I'd say, in D.C. and recognizing this is an important area for us to continue to innovate to bring new solutions to patients.

Operator

And the next question is going to come from David Hoang with Deutsche Bank.

David Hoang

I wanted to drill down a little bit on the commentary about the threefold increase, I believe, in ordering accounts in September for Sierra that you're seeing. How should we think about that step-up in accounts translating over to revenues? And what would be the time frame that, that would occur in? And then with the mix of patients that you're seeing on ZARA, I wondering if you could comment on are these newly diagnosed patients? And what -- maybe what percentage are coming from patients on KEYNOTE-11 regimen of KEYTRUDA and Herceptin switching over to Zero regimens.

Renée Galá

Thank you. Thank you for the question. Yes. So I think it's very encouraging that in September, our first full operational months post launch. We did see such a significant increase in new ordering accounts. And these are accounts just to be clear, that our ordering for the first time. So what we what we take from that is that they have patients, newly diagnosed patients that they're ordering for to put on treatment. And of course, we're then seeing that kind of directly correlate with a significant increase in the month-over-month increase in average bile demand per selling day, which also increased by 40%. And -- we don't have the detail to share with you as to what the origin of those patients are.

We don't get that level of detail from the distribution channels. However, we're not expecting this to be a market where we see a significant switching of patients -- it's much more likely that these are newly diagnosed patients. And I think that's what we can expect to see in the future. Obviously, this is a rare disease, and we would expect the pace of growth really to reflect the pace at which newly diagnosed patients are presenting at clinics. And of course, our job will be to ensure that when those patients -- newly diagnosed patients present that the physicians are equipped with all of the information that they need to consider Xiera -- and given the kind of very significant strength of the data we would expect Siirto be the standard of care and the choice for those patients.

Operator

And our next question will come from Annabel Samimy with Stifel.

Annabel Samimy

Just going back to Zahira and GEA. For the 3 to 4,000 target population, you've mentioned in the past that it takes into account unresectable disease, first-line treatment rate in testing. And it seems like there are 2 factors there, at least that you could potentially improve on. So utilization first line and testing. So given the pretty dramatic increase in efficacy over trials, is there any indication that you could drive higher HER2 testing and utilization upfront than historically, and if not, what can you do to move that need a little bit .

Renée Galá

Yes. Thank you for the question. Yes, that's right. We've spoken about the 3,000 to 4,000 range being the true treatable frontline patient population aligned with our label. Those are the patients with unresectable, locally advanced or metastatic disease who are eligible for systemic first-line treatment and have received HER2 testing. Now you're quite right. Actually, there are a number of things there that we will be very much focused on. I mean, first of all, is to ensure that patients get a HER2 test, that level is quite high. But what's surprisingly low is even those patients who are tested and are HER2 positive, many of those patients -- not all of those patients actually do today get a HER2 treatment. So that's an area, and it can be as low as actually 65%.

So that's an area that with, obviously, the -- as you mentioned, the very strong efficacy data by Zier and the fact that we have teams actively out there in the market. That's 1 area that we will very much be focused on. We do believe that all eligible patients should have the opportunity to use Zier.

Operator

And the next question is going to come from David Amsellem with Sandler. .

David Amsellem

I have a Zepzelca question. Just wanted to get your thoughts on the trajectory of the product longer term given the presentation of Amgen's in Delta survival data in first-line extensive stage small cell lung. How are you thinking about the trajectory of the product, just given the data that was recently presented .

Annabel Samimy

Yes. Thank you for the question. Yes, there are a few different dynamics in relation to see Obviously, we had the removal of the second-line monotherapy indication at the end of September that aligned with the FDA. That does not affect our full approval in first-line maintenance segment, and that segment accounts for about 30% to 40% of our total revenue. We did see a strong competitive data in first-line maintenance presented at ESMO, as you mentioned. In Delta, as we know it was very strong data. It's not yet approved or reimbursed in that maintenance setting. But once it is approved, we would anticipate that and Delta will represent a competitive headwind in 2027.

But there is not anticipated to be any impact on our raise 2026 revenue guidance that was mentioned on this call. And we do believe Zepzelca remains an established practical and familiar standard for community oncologists, particularly who value the convenient administration and proven OS benefit. Without requiring some of the specials in patient monitoring. So I think it's good news that there are more options a couple of years ago when the In-Force data came out. That was the first new data in this space for decades. So it's good news for patients that there are more options and I believe both treatments have a place for patients.

Operator

And the next question will come from Ami Fadia with Needham & Company. .

Ami Fadia

Congratulations on the nice quarter. Maybe just on Epidiolex for the [indiscernible] trial. Can you tell us a little bit about the representation of the different subtypes that you are enrolling in the trial? And what would success look like in the context of data from some competitors that's expected in the coming months as well. .

Robert Iannone

Yes. So the trial Amis based on prior data we have where we see broad activity of Epidiolex really regardless of the underlying syndrome across a number of different seizure types and a number of different seizure types. And so the goal of this study is to ensure that we will enroll a broad enough group of DEs that ultimately, the FDA is convinced that a broader label is appropriate beyond the specific indications that we currently have. As you know, it's a randomized Phase III trial. It's one-to-one randomization between Epidiolex and placebo.

Operator

Thank you. So at this time, I will now turn the call back over to Renee for closing remarks. .

Renée Galá

Great. Thank you, operator. I'd like to close today's call by thanking all our employees as well as our partners and stakeholders for their continued confidence and support. Thank you for joining us today.

Operator

This concludes today's conference call. Thank you for participating, and you may now disconnect.