ニューロクライン・バイオサイエンシズ（NBIX）2026年第3四半期決算説明会：INGREZZAのガイダンスを引き上げ

要点

• ニューロクライン・バイオサイエンシズは、2026年第3四半期の製品売上高（純額）が11億ドルを超えて過去最高を記録し、前年同期比で40%超増加するとともに、過去最高の営業利益率を達成したと発表しました。
• INGREZZAの売上高は前年同期比17%増の8億100万ドルに達し、新規および総処方件数が過去最高となったことが寄与しました。通期の売上高見通しは29億〜29億2,500万ドルに引き上げられました。
• CRENESSITYの四半期売上高は2億1,100万ドルに達しました。米国の古典的先天性副腎過形成と診断された推定患者数の15%以上に、現在この治療薬が処方されています。
• VYKAT XRの売上高は1億700万ドルに達し、純新規患者数の増加が牽引しました。経営陣は、最近の外部事象により予想されていた成長軌道が遅れる可能性があると警戒感を示しました。
• Non-GAAPの1株当たり利益は3ドルを超えました。ニューロクラインの当四半期末時点の現金残高は約8億ドルとなりました。これは4億ドルの営業キャッシュフローを創出し、自社株買いに約1億ドルを充当した後の数値です。
• 経営陣は、精神疾患プログラムの第III相試験データや、フリードライヒ運動失調症遺伝子治療プログラム「NBI-223」の患者レベルでの初期データを含め、2027年は株価変動要因（カタリスト）が豊富な年になると予想しています。

主要財務データ

事業および営業業績

INGREZZA

INGREZZAは引き続きニューロクラインの最大の成長ドライバーとなりました。四半期売上高は初めて8億ドルを超え、新規および総処方件数は過去最高を記録しました。経営陣は、通期の処方件数成長率が10%台後半になると予想しています。

同社は、精神科、神経科、長期療養施設分野においてさらなる拡大余地があるとみています。経営陣によると、遅発性ジスキネジア患者の約半数が診断されているものの、患有人口全体の約10%しか2つのVMAT2阻害薬のいずれも投与されていないとのことです。

ニューロクラインはまた、拡大された営業部門からの生産性向上がさらに進むと見込んでいます。経営陣は、そのフル効果が表れるには通常数四半期を要し、2026年第4四半期から2027年にかけてより顕著になるはずだと述べています。

CRENESSITY

CRENESSITYの四半期売上高は初めて2億ドルを超えました。着実な患者数の増加、有利な保険償還、強固な治療継続率（経営陣によると第3四半期も安定を維持）が成長を裏付けました。

小児内分泌科が引き続き新規治療開始の大部分を占めていますが、成人の内分泌科医における採用も増加しています。現在、治療を受けている患者の約半数が成人です。ニューロクラインは、適応拡大の可能性をサポートすることを目的として、4歳未満の患者を対象とした試験も開始しています。

VYKAT XR

VYKAT XRの四半期売上高は初めて1億ドルを超えました。経営陣はこの業績の要因を価格設定ではなく純新規患者数の増加によるものとし、平均投与量は患者1人当たり約250ミリグラムで、年間で約55万ドルの卸売購入価格（WAC）に相当すると述べました。

ニューロクラインは、米国のプラダー・ウィリー症候群患者数を概ね1万〜1万2,000人と推定しており、その大半が過食症を伴っています。同社は引き続き、患者選択、用量調整、有害事象のモニタリング、ならびに臨床医や介護者への教育を重視しています。

経営陣は、複雑な健康状態を伴うプラダー・ウィリー症候群患者を対象にVYKAT XRを評価する試験を2027年に開始する計画です。この試験は、主要な意見指導者（KOL）と協力してニューロクラインによって提案されました。

パイプライン

ニューロクラインは、NBI-567（M1受容体優先の選択的ムスカリン作動薬）のアルツハイマー病における認知機能改善の補助療法としての第II相試験を開始しました。同試験では、軽度から中等度の50〜85歳の成人約135人を組み入れ、12週間後の結果を評価する予定です。

同社はまた、肥満症治療薬候補であるNBI-1968の第I相試験を開始したほか、NBI-2118（CRF2受容体作動薬）の開発も継続しています。経営陣は単独療法および併用療法のアプローチを検討しており、初期開発では体重減少、体組成、安全性、耐容性に重点を置いた評価を行っています。

フリードライヒ運動失調症治療のためのNBI-223遺伝子治療プログラムは、今後数ヶ月以内に第I相試験を開始する見込みであり、2027年には初期の患者レベルデータが得られると予想されています。

経営陣の見通し

• ニューロクラインは、2026年通期のINGREZZA売上高見通しを、当初予想の27億ドルから29億〜29億2,500万ドルに引き上げました。
• 第3四半期のINGREZZA売上高には、顧客の注文タイミングによる2,000万ドルのプラス効果が含まれています。経営陣はこの効果が第4四半期に反転すると予想しており、この影響は通期見通しに織り込まれています。
• 第4四半期について、経営陣は季節的な売上総額から控除後額（gross-to-net）への売上値引き圧力を指摘しつつも、INGREZZAの実質的な総処方件数の成長率は10%台半ばになると予想しています。
• 2027年について、経営陣はINGREZZAの2桁の数量成長が1桁台半ばから後半の純価格引き下げ圧力を十分に相殺し、継続的な収益成長を支えると見込んでいます。
• 同社は、2027年のINGREZZAの適用リスト（フォーミュラリー）におけるカバー範囲およびアクセス環境は、少なくとも2026年と同等以上に好調に維持されるはずだと述べました。正式な2027年売上高見通しは2月に発表される予定です。

リスクと注目領域

電話会議ではVYKAT XRの安全性と採用が中心的なテーマとなりました。経営陣は本治療薬のベネフィット・リスク・プロファイルおよび現在の適応症ラベルに自信を示したものの、最近の外部事象により成長が遅れる可能性があることを認めました。ニューロクラインは市販後モニタリングを継続しており、複雑な併存疾患を持つ患者を対象とした追加の検証を計画しています。

経営陣によると、VYKAT XRの治療中断件数は数値的には前四半期と同水準ですが、同社は発売直後の動向を把握している段階であると述べています。初期の患者集中によりその後の治療中断が増加したものの、より最近の新規投与開始は安定しています。

INGREZZAは2027年に1桁台半ばから後半の純価格圧力を受ける見込みです。経営陣は2桁の数量成長がこの逆風を相殺すると確信していますが、最終的な見通しは年末の実績と支払者（保険会社等）との契約状況に依存します。

ニューロクラインはまた、同社のパイプラインが引き続き治験の実施およびデータリスクに晒されていることを指摘しました。同社は、第I相の薬物動態、薬力学、および耐容性データの全体像が第II相へ進めるための社内基準を満たさなかったため、M4受容体拮抗薬「NBI-986」の開発を中止しました。経営陣は、特定の安全性上の問題がこの決定を主導したわけではないと述べています。

アナリストQ&Aの要点

• INGREZZAの第4四半期見通し：経営陣によると、予想される売上高の前四半期比の動きは、2,000万ドルの注文タイミングによるプラス効果の反転や季節的な控除前後の価格調整（gross-to-net）動向を反映したものであり、基調的な処方傾向の弱まりを示すものではないとのことです。
• 2027年のアクセスと価格設定：ニューロクラインによると、支払者との協議はほぼ完了しており、フォーミュラリーへのアクセスは引き続き強固に維持される見込みです。予想される価格引き下げは、数量増によって上回ると予測されています。
• VYKAT XRの成長：経営陣は長期的可能性を引き続き認識しているものの、最近の外部要因を受けて足元の進捗軌道はより穏やかになると予想しています。毎四半期の目標は、四半期末時点の治療患者数を開始時より増やすことです。
• CRENESSITYの治療継続率：治療の中断および継続の傾向は前四半期と一致していました。経営陣は、本薬剤の継続率は希少疾患用薬の平均よりも強力であると説明しました。
• 統合失調症プログラム：経営陣は、用量調整不要の1日1回投与と、現在の第III相プログラムにおける3%以下という低い治療中断率を強調しました。安全性モニタリングの審査によりプログラム変更が求められたことはありません。
• 事業開発（BD）：ニューロクラインは、神経学、精神医学、内分泌学、および将来の免疫学分野における差別化された科学と強力な知的財産に焦点を当てています。経営陣は財務的柔軟性を備えているものの、案件の成立を急ぐ必要はないと述べました。

決算説明会トランスクリプト全文

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決算説明会の完全なトランスクリプト

経営陣による説明

Operator

Hello, and welcome, everyone joining today's Neurocrine Biosciences Third Quarter 2026 Earnings Call. [Operator Instructions] Please note this call is being recorded, and we are standing by if you should need any assistance. It is now my pleasure to turn the meeting over to Todd Tushla, Vice President of Investor Relations. Please go ahead.

Todd Tushla

Thank you. And happy Monday, wherever it is that you may be. Welcome to Neurocrine Biosciences Third Quarter 2026 Earnings Call. Joining me on today's call are Kyle Gano, Chief Executive Officer; Matt Abernethy, Chief Financial Officer; Eric Benevich, Chief Commercial Officer; Eiry Roberts, Chief Medical Officer; and Samir Siddhanti, Chief Business Officer. During today's call, we will be making forward-looking statements. These statements are subject to certain risks and uncertainties, and our actual results may differ materially.

I encourage you to review the risk factors discussed in our latest SEC filings. In addition, some of the information discussed today includes non-GAAP financial measures that have not been calculated in accordance with U.S. GAAP. Reconciliations of these non-GAAP financial measures to the most directly comparable GAAP financial measures are presented in the tables at the end of our earnings release issued earlier today which has been posted on the Investor Relations page of the company's website. Following prepared remarks, we'll be happy to take your questions. With that, I'll hand the call off to Kyle.

Kyle Gano

Good afternoon, everyone. Nearly 2 years ago, my first earnings call as CEO, I shared my optimism about Neurocrine's future and the significant opportunities ahead. Today, that confidence has only grown stronger as I remain deeply confident in our ability to drive sustained growth and create long-term value for our shareholders. Our strategy to build a leading biopharmaceutical company is grounded in execution and delivering meaningful results.

In the third quarter, we generated record net product sales of more than $1.1 billion and record profitability. These results underscore the strength of our diversified portfolio of 3 first-in-class medicines and our growing ability to reach and serve more patients than ever before. This momentum positions us well to drive continued growth across INGREZZA Konety and Vicat XR in 2027 and beyond. The strength of our growing commercial business and financial position also enables us to continue investing in our industry-leading pipeline. With several important clinical milestones anticipated in 2027, including Phase III data readouts for OSAvapator in major depressive disorder and directing and schizophrenia, we believe Neurocrine is approaching a potentially transformative period 1 that could further expand our pipeline, strengthen our long-term growth prospects and extend our impact on patients.

Overall, Neurocrine's third quarter performance exemplifies the strength of our strategy, the discipline of our execution and the significant opportunity ahead to create long-term value. As we close out the year, we look forward to hosting our 2026 R&D Day in New York City on December 15. The event will feature a Vicat XR panel discussion with Dr. Jennifer Miller, Professor of Pediatric Endocrinology and Director of the Potter Willy syndrome program at the University of Florida College of Medicine as well as an update on our pipeline. I look forward to sharing our progress, engaging with the investment community and discussing the opportunities ahead as we enter what promises to be a catalyst-rich 2027. With that, I'll turn the call over to Matt.

Matthew Abernethy

Thank you, Kyle, and good afternoon, everyone. The third quarter reflects Neurocrine's continued evolution into a diversified, highly profitable biopharmaceutical company. As Kyle mentioned, we delivered record net product sales exceeding $1.1 billion, up more than 40% year-over-year, alongside record operating profitability. Our 3 commercial products provide a growing foundation to invest in innovation and prepare for a data-rich 2027.

Starting with INGREZZA. Third quarter sales were $801 million, up 17% year-over-year, driven by continued volume growth with record new and total prescriptions. Underlying INGREZZA performance continues to exceed our own internal expectations, leading to another full year INGREZZA guidance increase to $2.9 billion to $2.925 billion. Third quarter sales included a $20 million benefit from customer order timing, which we expect to reverse in the fourth quarter and is reflected in our full year guidance.

Overall, 2026 is turning out to be a remarkable year for INGREZZA with the prescription growth expected to be in the high teens, underscoring the strength and durability of the INGREZZA franchise in the tardive dyskinesia market. Looking ahead to 2027, we expect continued double-digit INGREZZA volume growth to more than offset anticipated mid- to high single-digit net pricing headwinds, supporting another year of revenue growth. As customary, we will provide formal 2027 sales guidance in February. Ternessity delivered $211 million in third quarter sales, supported by steady patient additions strong persistency and favorable reimbursement.

Over 15% of the estimated diagnosed classic CAH population has now been prescribed chronicity highlighting the opportunity that we still have ahead. For Vicat XR, we delivered $107 million in third quarter sales, reflecting sequential growth driven by new patient demand. We remain focused on our efforts to support appropriate patient identification, physician and caregiver education and patient support. We believe Vicat XR offers a meaningful opportunity for long-term growth to help many patients with this devastating condition.

Turning to the financials. Record revenue drove non-GAAP earnings above $3 per share. This reflects significant operating leverage while continuing to invest in commercial growth and our R&D pipeline. We ended the quarter with approximately $800 million in cash, generating $400 million in operating cash flow and deploying approximately $100 million to repurchase shares and offset dilution from our share-based compensation. Our capital allocation priorities remain driving commercial growth advancing high-value pipeline programs and pursuing disciplined business development.

Overall, with 3 growing commercial products, expanding profitability and a broad pipeline, Neurocrine is well positioned for durable growth in important clinical catalysts in 2027. With that, I'll turn the call over to Eric Benevich, our Chief Commercial Officer. Eric?

Eric Benevich

Thanks, Matt. Our record third quarter performance reflects strong performance across all 3 of our first-in-class medicines, INGREZZA, Cronecity and VicodXR while each is at a different stage of commercialization, all 3 continue to address significant unmet medical needs and contribute to Neurocrine's commercial diversification and revenue growth. Starting with INGREZZA, quarterly sales surpassed $800 million for the first time, driven by strong demand with record new and total prescriptions, remarkably, 9 years into launch, INGREZZA continues to deliver double-digit prescription growth with full year sales guidance raised once again, 2026 is shaping up to be another outstanding year for the brand. .

Cronescity also reached a new milestone, exceeding $200 million in quarterly sales for the first time. The rate of new patient starts have remained steady throughout the year, and we estimate more than 15% of U.S. patients with classic congenital adrenal hyperplasia have now been prescribed Cronescity. Just 7 quarters into the launch, we're making meaningful progress towards establishing Conecta together with low-dose GCs as the standard of care treatment for classic CAH.

Now turning to Vicat XR. Quarterly sales exceeded $100 million for the first time. Since the acquisition, our commercial and medical teams have focused on HCP education, including appropriate PWS patient selection, dose titration, careful monitoring and management of potential adverse events while setting expectations for both the timing and nature of treatment response. These efforts reflect our commitment to maximizing patient safety and treatment results. As newcomers to the PWS community we're listening to all stakeholders and gaining insights from clinicians, PWS scientific thought leaders and the Prader-Willi syndrome patient and family community.

We're confident in Vicat XR's benefit and its longer-term potential in our rare endocrine franchise. 2026 will no doubt end up being the strongest commercial year in Neurocrine's history, and we look forward to carrying this momentum into 2027. We I want to thank our entire commercial and medical organizations, including our newest Vicat XR colleagues for their unwavering dedication to patients and outstanding execution. And with that, it's my pleasure to turn the call over to our Chief Medical Officer, Dr. Eiry Roberts.

Eiry Roberts

Thanks, Eric, and good afternoon, everyone. First, I want to thank Kyle and the Board of Directors for the opportunity to return as Chief Medical Officer. During my previous tenure, I had the privilege of helping advance cronecity through clinical development and approval as well as generating positive Phase II data and initiating the Phase III programs for both osavampator and directed I'm excited to build upon the team's recent progress as we advance the deepest and most diversified pipeline in Neurocrine's history.

I'd like to begin today with Vicat XR, the first and only FDA-approved treatment for hyperphagia in patients age 4 and older with Prader-Willi syndrome. Since Neurocrine's acquisition of this medicine in May, our clinical and medical teams have worked closely with expert clinicians, regulators and the PWS community to support the safe and appropriate use of this important new medicine.

As real-world experience grows, we remain committed to ongoing safety monitoring collaboration with the FDA and timely communication of important new information. To further advance our understanding, we plan to initiate a study in 2027, evaluating Vicat XR in people with PWS and complex health issues. Continued engagement with advocacy organizations, including FPWR and PWS USA remains central to our efforts also.

Turning to the pipeline we recently initiated a Phase II study of NBI 567, our M1 preferring select muscarinic agonist as an adjunctive treatment for cognition in Alzheimer's disease. In obesity, we initiated a Phase I study of NBIP-1968, our investigational GGG agonist, this program has the potential to complement our CRS-2 agonist, NBIP-2118. Also in Phase I as we explore differentiated combinations to treat obesity.

Finally, NBI 223 our Friedreich's ataxia gene therapy program in collaboration with Voyager Therapeutics is expected to enter Phase I in the coming months with initial patient-level data anticipated in 2027. As Kyle mentioned, we will close out the year with our 2026 R&D Day in New York City on December 15. The I look forward to sharing our progress and reengaging with the investment community as we prepare for a data-rich year in 2027. With that, I'll turn it back to Todd. Todd?

Todd Tushla

Thanks, Eiry , and welcome back to the role. We're happy to have you here. Apologies for the slight delay in the distribution of today's earnings release. We appreciate your patience and look forward to your questions. So Nicki, let's take the questions.

Operator

[Operator Instructions]

We'll take our first question from Philip Nadeau with TD Cowen.

質疑応答

Philip Nadeau

Congrats on a really strong quarter. Question on INGREZZA trends and guidance. So if we back out the $20 million that you mentioned of orders this quarter, even taking that out, it does look like the top end of guidance assumes a sequentially down Q4 and so I guess we're curious why that would be, was there something else that was lumpy in Q3 beyond just the $20 million? Or are there other headwinds you expect in the fourth quarter for INGREZZA?

Matthew Abernethy

It was a really strong third quarter across the board, and we anticipate in the fourth quarter to have similar underlying TRx growth somewhere in the mid-teens. So the other -- the only other item is seasonally, there's always a gross-to-net dynamic in the fourth quarter. But overall, you take a step back, and you see we started the year at $2.7 billion in guidance going all the way up to $2.9 billion in guidance, feel quite good with how we're positioned, and we're in a place to have strong momentum headed into 2027. .

Operator

We will move next with Paul Matteis with Stifel.

Paul Matteis

Congrats on the quarter. I wanted to ask a question about Vicat. Obviously, it's been discussed in the media and the press related to its safety profile. I was curious from your perspective, are you comfortable that going forward in the next set of quarters that Vicat will continue to be sort of a resilient grower?

And maybe just as a sub question to that, is there any thought that at some point there could be engagement with regulators around some of the post-marketing safety reports? And maybe you could just give a little color there.

Eric Benevich

Yes. Paul, it's Eric. So certainly, we know that in orphan diseases, launches aren't always linear. And I think we're about, what, 2.5 quarters now post acquisition. So we're still getting our arms around the Vicat business. And we're still in the thick of the integration. However, given the recent external events, we do anticipate a return to growth, but it might be a little bit more delayed Ultimately, we still have very strong conviction in the benefit of Vicat and we're working through making sure that everyone understands both the benefits and how to safely use it. Anything to add?

Eiry Roberts

Yes. Thanks, Paul. I mean patients stay at Neurocrine. And so we take every adverse event and every outcome very seriously, and we continuously monitor safety as we -- in the post-marketing environment. That said, we are very confident in the benefit risk profile that we have for VICATXR. And we believe that the current label describes very effectively use the medicine safely and effectively in the relevant patient population.

Obviously, we continue to collect ongoing information. And in particular note, I'd draw your attention to what we mentioned in the at the end this year in our R&D Day, we will have a focus on understanding PWS and particularly hyperphagia more for the community by engaging with Dr. Jennifer Miller and several patients from the community. And I think that will be helpful in that regard. In addition, we are planning to initiate study starting next year in patients with Pradawilli who also have significant other comorbidities and other conditions that make them obviously at higher risk generally in terms of their disease to understand how to safely and effectively use Vicat XR in that population.

Operator

Thank you. We will move next with Tazeen Ahmad with Bank of America.

Tazeen Ahmad

Just wanted to get any color on 2027 INGREZZA contracting particularly weather access and net price intact or tracking with what you would have expected? Any color would be great.

Kyle Gano

Thanks, Tazeen. This is Kyle. It's hard to not talk about 2027 pricing without starting with access because they are linked. For this year, as you know, we have about 70% of Medicare lives covered under the contracting that we executed on in 2025, and that gave us great momentum here throughout the course of this year, and we think that will continue to be the case as we close out Q4 into 2027.

So when we think about 2027, we do expect that underlying momentum to lead to, again, double-digit volume growth for 2027, and that reinforces really the durability of INGREZZA as a product in TD as well as continued revenue growth. When it comes to contracting now for 2027, we're nearly the end -- at the end of our discussions with payers. We do have pretty good visibility in terms of our formulary status for 2027. And what we see is a really strong year in terms of coverage and access a live at least as good as this year.

So we're looking forward to a really strong access year for 2027. In terms of the net price, we'll get into the details of that as we move into the new year. But roughly speaking, we're looking at mid- to high single-digit price concession for 2027. And but that will be more than offset by our double-digit revenue growth for next year. So this will be playing out in our assessment of performance as we move through Q4 into the new year when we talk about guidance at our February meeting. But overall, really strong year ahead for 2027.

Operator

Thank you. We will move next with Brian Abrahams with RBC Capital Markets.

Unknown Analyst

This is Kevin on for Brian. Maybe just back on Vicat considering some of the on-the-ground dynamics that you're seeing this quarter being the first full quarter with Vicat, just maybe can you share your latest thoughts on how the potential opportunity, the peak opportunity in PWS may be, whether your thoughts now are a bit more refined and what the opportunity could look like and the time lines around that.

Eric Benevich

Sure. This is Eric. So kind of taking a step back, thinking about the Prader-Willi population, we estimate that there's roughly 10,000 to 12,000 patients in the U.S. The majority of them have hyperphagia, not everyone though. Obviously, patients that are very young typically don't experience hyperphagia until they get to be 4 or 5 or 6 years old. And certainly, there are some patients that would not be considered appropriate for treatment based on, as I resaid, significant comorbidities.

Ultimately, though, we feel that the majority of patients with hyperphagia secondary to BWS are candidates for treatment -- and this is a in that's still relatively early in its launch. It's only been out there a little over 1.5 years. And there's a lot of providers in the community that we're still reaching and educating and also within the patient and family community. I don't know that we've really altered our thinking around the opportunity. We still have really strong conviction in the potential for this medication.

As you know, it's the first and only approved treatment for hyperphagia and PWS but we do recognize that we do have a lot of work ahead of us in terms of educating and continuing to generate data to understand how to best use this medication.

Operator

We will move next with Brian Skorney with Baird.

Brian Skorney

Congrats on a great quarter. Maybe on Vicat, you mentioned growth coming from new patient starts, but wanted to hear anything you could say about discontinuations. I know there's sort of this bolus effect to new patient starts at the launch running into maybe a headwind in terms of discontinuations from that initial bolus once they reach therapy. Do you think we're through that at this point? And are you expecting more of a normal number of patients discontinuing per quarter because that roll-off is no longer coming from the neutral bolus? Just want to get an idea of how to think about the balance between starts and discontinuations at this point.

Eric Benevich

Yes. I would say -- I'd start by saying we're still learning about the dynamics here. As I mentioned, this product has only been on the market for a little over 1.5 years. And certainly, there was a bolus of starts in the first quarter when Vicat was launched last year. And then we did see sort of an increase in discontinuations from that bolus of early starting patients, since then, we've seen pretty consistent and steady starts.

And it's hard to say whether Q3 was any different from a discontinuation standpoint because numerically, it was similar to prior quarters. So I would say stay tuned.

Operator

We will move next with Anupam Rama with JPMorgan.

Anupam Rama

Look, it was a nice beat on INGREZZA and even if you back out the $20 million onetimer was still going deep consensus. So if you see any outsized growth in the various segments, psychiatry, neurology, long-term care that you'd want to highlight?

Eric Benevich

Yes. Thanks for the question. I think you see growth potential across all the prescriber segments. And as we've said before, the majority of patients out there with tardive dyskinesia yet to be -- well, now we're actually approaching a point where about half of the patients out there have been diagnosed and the other half have yet to be diagnosed, but there's still substantial opportunity to drive diagnosis, recognition and treatment. .

In addition, only about 10-ish percent of the total TD prevalent population is currently on either of the 2B VMAT2 inhibitors. So lots of headroom from a growth potential perspective. Obviously, we see the psychiatry segment as the main growth driver. And within psychiatry, in particular, advanced practice providers are really important in terms of recognizing and treating TD with INGREZZA.

So I think that reflects sort of the deployment of our sales team. The biggest team is focused on psychiatry. We've also seen really strong and consistent growth in long-term care. So we're excited about the opportunity. As Kyle said earlier, we're going to carry the momentum into 2027. But we expect to see continued strong volume growth across all the segments, psychiatry, neurology and long-term care.

Operator

Thank you. We will move next with Cory Kasimov with Evercore ISI.

Unknown Analyst

This is Josh on for Cory. On Konecity, growth has been really steady here. Wondering if you can comment on where growth is coming from? Is it new prescribers? Is it returning prescribers? Any color you can give?

Eric Benevich

Yes. Cronecity has been remarkably consistent. Ever since the early days of the launch, we've seen a real steady pace of patient adds. We've also seen favorable reimbursement. And lastly, and critically important, really strong persistence. And I think all of those elements combined have led to what's been a really strong launch in the first we're 1 year in 3 quarters now into the cronesciti launch.

So it's still early in its commercial ramp. But ultimately, at the very beginning of the launch, most of the growth was driven by new prescribers. And to this day, there are still the majority of prescribers have only 1 or 2 patients that are on treatment. However, we are seeing increased depth of prescribing -- and so as we go forward, those practices that have more than a handful of patients we're continuing to drive adoption of the majority of their patients within those practices.

So we've done a really great job, I think, in the pediatric endocrinology segment. and that does represent the majority of patient starts. However, as of late, we've continued to see growth and adoption of -- within the adult endo practices. And now we're at a point where roughly half the patients out there on cronecity are adult patients. So we're going to continue to do our work. We're going to drive education and we've got a lot of remaining opportunities. As we said in the prepared remarks, over 15% of the population with Classic CH has now been offered treatment and are on medicine.

Operator

Thank you. We will move next with Jay Olson with Oppenheimer. .

Jay Olson

Congrats on the quarter, and welcome back, Eriy. Looking forward to seeing you all in December. We had a question about 567. Can you just talk about now that you have the Phase II study initiated, what would be a clinically meaningful result on the 12-week neuropsychological test battery.

Eiry Roberts

Okay. And it's great to be back. On 567, that's our M1 preferring muscarinic agonist. And as you mentioned, that study will be a study of Phase II just started in around 135 adults age 50 to 85 with moderate -- mild to moderate Alzheimer's disease. Who are receiving stable treatment with acetylcholinesterase inhibitors, but still have evidence of cognitive decline. We're actually looking at a range of different endpoints in the context of study and looking at a change from baseline for that adjunctive treatment at week 12.

The primary endpoint we're looking at is a neuropsychological test battery composite score and any -- and the goal will be to compare the 2 treatments within the study to placebo and look for any clinically significant trend or statistical significance in different on that endpoint to placebo. In addition, however, though, we're going to be looking at the totality of the data that we generate in that study, including ADAS COG measurements and clinical dementia rating coupled with obviously tolerability, given that in this patient population for acetochlnester use, tolerability is 1 of the most significant issues that impact use of that medication currently.

We haven't talked specifically about bars or barriers to -- in terms of the endpoints, but obviously, we'll be looking holistically at the data that we generate.

Operator

Thank you. We will move next with Akash Tewari with Jefferies.

Phoebe Tan

This is Phoebe on for Akash. We had a question on the announcement of ex higher dose of eracladine in the Phase II cytopenia study? I guess, number one, what is your take on this given there is kind of an unclear dose response in emrocladine and NBI-568 data. And then also, can you provide kind of thoughts on where you think the comparable M4 inhibition levels of eracladine at this dose compared to your 20-milligram dose?

And then finally, your overall confidence going into the schizophrenia readout next year.

Samir Siddhanti

This is Samir. Thanks so much for the question. So we have our M4 selective orthosteric agonist direcedine, which we anticipate top line data from the first short-term study next year time lines are on track there. Really excited about that data in relation to what's out there with the competitive landscape, we believe that this could offer potential benefit for patients without some of the side effects that those are experiencing with the existing commercial product with regards to your questions on other competitors like AbbVie with emracuity and certainly watching landscape there and wish them the best. But for right now, we're focused on our program. Thank you.

Operator

Thank you. We will move next with Mohit Bansal with Wells Fargo Securities.

Susan Chor

This is Susan on for Mohit. On Vicat this quarter, you guys had commented that trends were similar, but you definitely did better than expectations. Can you just talk a little bit about maybe where some of the upside came from? Is it pricing, inventory, net adds?

Eric Benevich

Yes. I mean, the way I would characterize it is we exited the quarter with more patients on treatment than we started. So it's net adds, not pricing.

Susan Chor

I'm sorry, since I sure if I may. What is the rationale for this additional study in Porterville with comorbidities, is it more for medical education and just answering some of the questions there? Or is there an opportunity for label expansion?

Eiry Roberts

We think the current label really accurately reflects the benefit and risk of VICAT Xi and the population that were studied. And we do believe that there is room for education, particularly when it comes to selection of the appropriate patients to treat with Vicat XR with hypophagia in Pradelli syndrome also guidance on safe and effective titration dose titration and also understanding how to monitor more closely for adverse events that may occur during the course of treatment and manage those effectively from the outset.

It's also really important to note that not very much is known about hyperphagia in Pradelli syndrome. And so there's a lot of education that we need to do around understanding hypothesia, understanding the impact that hyperphagia has on both the patient and their family. It's very much a behavioral disorder. And as such, I think we have to set expectations around what sort of behavioral changes can we expect to be seeing in patients when this medicine is improving the hypothesis symptoms for them.

So for all of those reasons, I think we're interested in continuing to expand the knowledge base of patients treated with Vicat, including those who have other complex conditions, such as obesity respiratory disorders, et cetera. Thank you.

Operator

We will move next with David Amsellem with Piper Sandler.

David Amsellem

How would you articulate your top business development/M&A priorities as we move through 2027. I think Kyle, early this year, you talked about being over-indexed in psychiatry post Selina, do you still think as an what therapeutic areas within your core focus areas are you prioritizing?

Kyle Gano

Thanks, David. Appreciate the question. Maybe I'll have Samir share his thoughts here.

Samir Siddhanti

This is Samir. What I'd say on the BD focus is that we really want to remain focused and disciplined on future opportunities. What we're looking for are opportunities with differentiated innovative science and strong IP within our areas of expertise. So we term that right now in neurology, psychiatry, endocrinology and soon-to-be immunology here. Transactions that we're looking at must create value for our shareholders. So we remain engaged and prepared to act if something opportunistic comes up. We've got a lot of financial flexibility. We don't feel like we have to do a deal right now.

Operator

Thank you. We will move next with Bitman with Leerink.

Unknown Analyst

Hi, everyone. This is Alyssa on for Mark. On Cronecity, could you talk about the discontinuation rates in the third quarter relative to prior quarters? And how are you thinking about persistency trends looking forward? And on Vicat, could you comment on the current dose distribution in which maintenance doses are most commonly used?

Eric Benevich

So I'll comment on the persistency trends. What I had mentioned earlier was that Cronecity has been a remarkably consistent medication. In terms of persistency and certainly above average when you look at other rare disease drugs. In fact, that's 1 of the important drivers of growth. We've had consistent patient adds we've had favorable reimbursement, and we had really strong persistency, and it was no different in Q3 versus prior quarters. Obviously, we hope to see that continue into the future. though we're still early in the commercial ramp for Cronesciti, but I have no reason to believe that it's going to be any different going forward.

Matthew Abernethy

Yes. On Vicat, I would just guide you to around 250 milligrams is what we're seeing on average per patient at this point. So I think that that's a good proxy that gets you to a WACC of around $550,000 per year. .

Operator

Thank you. We will move next with Ash Verma with UBS.

So Youn Shim

This is So Youn on for Ash. For Vicat, what's the best way to identify the frequency of side effects reported for the drug in the real world. And the fares database, we see that the total AEs and serious AEs are both up for 2026 compared to 2025 and can you share if this is because of the drug use is increasing?

Or is the absolute frequency of AEs higher in 2026 versus how much it was in 2025? And also, if we can also get your latest thoughts on VAT -- how confident are you on the IP runway here? It seems like the 895 patent post-grant review for a generic challenging this patent was instituted recently and it is not likely to go into a PTAB trial? What do you expect as the outcome here?

Eiry Roberts

Thanks for the questions. Lots of questions in there. So I'll try and I think I may share the stage of my colleagues on the IP front. But let me start with some of the questions you asked around adverse events. Going back to the safety is our primary focus with respect to patient safety medicines. And in the post-marketing setting, I think in terms of Vicat XR, we have the benefit of having a single specialized pharmacy that is engaged in supplying this medicine and provides a lot of support mechanism around that, including the support provided by our own commercial and medical team.

In fact, we have very close contact with patients and their prescribers as they are this medicine. So we're able to provide the education that helps and is necessary ensure appropriate patient selection that the dose titration is done in a safe and effective way. And the label itself provides the guidance that is needed around side effects such as hypoglycemia and fluid unknown to be associated with diazoxide use. And so I think we have a a well-controlled environment to enable patient support and the support of their families and clinicians as well as we go through that process.

Kyle Gano

And on the IP front, this is -- I think it's probably too early to talk about any of the challenges on existing patents. But in terms of our overall view on exclusivity, we've commented that we feel good about that going out to the mid-20 40s on patents to be published and issued and I think we're confident with what we have there. .

Operator

Thank you. We will move next with Myles Minter with William Blair.

Myles Minter

Just curious about the terminology about a collaboration with the FDA when you're talking about Vicat XR was the study in PWS and complex health issues, a result of those collaborative talks, and they wanted you to do it? Or is this something that literally you're proposing that will definitely help use of Cadex in this high unmet need patient population.

Eiry Roberts

This was our proposal in collaboration with the several key opinion leaders in the field. And I think it reflects the fact that given that this is the first and only approved medicine to treat hyperphagia and pretail syndrome, there was a desire to understand the breadth of the population that could be served effectively by this medicine beyond those individuals who are included in the clinical trial program that led to registration.

So we are finalizing the design of that study in collaboration with these KOLs, including Dr. Jennifer Miller, and we're also very pleased that Dr. Moss already taken the step in terms of publishing an article that gives guidance around the use of Vicat XR in a broader patient population in the real-world setting already. And that's already something that we're using in support of the community as we educate out there in the field.

Operator

We go next with Sean Laaman with Morgan Stanley.

Let's go to the next question we'll move next with Sumant Kulkarni with Canaccord.

Sumant Kulkarni

I think Samir alluded to some aspects of this, but given the somewhat muted launch for Kabenfiin schizophrenia, does this change your market outlook for directly lean and schizophrenia at all? And what would you most like to see in Phase II that could make you excited about the product's competitive profile in the schizophrenia market. .

Samir Siddhanti

Thanks, Sumant. This is Samir. Let me start with the for the Phase III study here, really, what we're looking for is a positive study. What we've seen in psychiatry that medicines that make it across the finish line tend to have strong and high uptake, particularly if they have a novel mechanism of action, which we believe are M4 selective orthosteric agonist does really, what we're going to win here is on safety and tolerability.

We've got a drug that administered once-daily no titration. And if you look at the Phase II data, we saw limited GI side effects relative to placebo we think that this is going to be a best-in-class, very convenient, easy-to-use medicine for patients with schizophrenia that will offer a novel mechanism in a patient population that hasn't had many treatments for several years here. So very excited about the first study data to come next year. Eiry, anything you want to add there?

Eiry Roberts

No. The only thing I'll add is that we continue to be doing very well in terms of the progress of the Phase III program. And with reference to what Samir said about the importance of safety and tolerability here. I will comment that in the context that program. We've had several DMC meetings to look at safety and tolerability of the program.

And we've had not had to make any changes to the program as a result of those. And also, if you look at discontinuation, which we know is an issue for Cabemfiin the context of some of the tolerability issues that are seen there. We have a low discontinuation rate of 3% or less in our current program. And so we're very confident about the profile that we're seeing there.

Operator

Thank you. We will move next with Eagle Nochomovitz with Citigroup.

Unknown Analyst

I just wanted to return to a topic that was first introduced back at your R&D Day in San Diego last year, and that's your early obesity program. I'm just wondering if you could comment on the 2 programs, the RFG and the GGG. How are you thinking about those in terms of development? Is it sort of a bake-off between the 2? Are they going to serve different patient populations? And what would you want to see in the early Phase I data to determine how to make 1 or both of those programs forward?

Kyle Gano

No, I appreciate the question. This is Kyle. So our leading CRF 2 agonist is MBIP2118. This is a subcutaneous at least a once-weekly injectable peptide that we're developing for obesity. It has a lot of redeeming qualities that we see from preclinical studies. Obviously, we need to replicate that in the human condition, which is really our focus in the near term is getting the study in healthy volunteers at our best and see if we can replicate a similar profile from the preclinical studies.

But what we're trying to look at here is comparable weight loss to the incretin but with quality weight loss with the loss of weight coming from fat, not muscle, so muscle mass preserving -- we've seen also preclinically additional benefits in the cardiac and renal area as well that could offer some differentiating properties. But certainly not going through the GLP pathway. We're also looking for a more favorable safety and tolerability profile.

So there's a lot to like about the mechanism. And obviously, we know a lot about CRF 1 and do as a company, we able to leverage that moving forward. GGG or our GGG program, which is NBIP-1968 comes into play is a mix and match type of strategy. We know that mechanisms are used in combination in the real world, and that's probably where the space will go over time. So having our own BCG is something that's important for our program. We have that as a stand-alone medicine that can be paired with 2118 and we've also combined it to an unavalent molecule that could be a single medicine that could be taken forward as well.

So we're excited with what we have. But right now, it's all about getting into the obese population, seeing if we can replicate that earlier profile. We're really excited at what we have in being at this particular stage of the program is exciting.

Operator

We will move next with Sean Laaman with Morgan Stanley.

Todd Tushla

All right. Sean, this is Todd. You can give me a call later. Let's go to the next question, please.

Operator

We will move next with Daniel Brill with Truist.

Unknown Analyst

This is Tyler in for Daniel. With the sales expansion now a couple of quarters in the deployment, how much of the recent growth reflects this investment? And is there still meaningful productivity upside ahead.

Eric Benevich

I assume that you're referring to INGREZZA. I would say that, obviously, we've seen strong growth in Q2 and Q3, subsequent to the deployment of the expanded sales team However, historically, our experience is that it takes a few quarters to have the full impact or see the full impact of the expansion. So I would expect that Q4 would be more impact from the sales force and really carrying that into 2027.

And as we said earlier in the call, we do expect to see double-digit growth next year in part due to the sales force expansion.

Operator

We will move next to Rudy Lee with Wolfe Research.

Unknown Analyst

So for PWS, can you provide additional color on the growth trajectory, provide cut into fourth quarter 2027 in patient starts and discontinuation rates should we expect meaningful sequential growth from fourth quarter into 2027? Or is it most likely into the second half of the year?

Eric Benevich

Yes. The way that I would characterize it is, first of all, that we do see that there's a lot of potential with this medicine. And there are a lot of untreated patients yet with hyperphagia and given the recent external events, we do think that it's going to delay somewhat the growth trajectory that we're expecting.

But ultimately, I think we're doing the right things from an educational standpoint from a promotional standpoint to continue to drive growth with this medicine. So just feeling good about the potential of Vicat in hyperphagia and we had a growth quarter this quarter. And like I said earlier, every quarter, we want to see more patients on than the prior quarter.

Operator

Thank you. We will move next with Delma Maari with Guggenheim.

Unknown Analyst

Congrats on the quarter. So maybe 1 on 569 in Alzheimer's psychosis, what do you need to see in Phase I on word efficacy and safety to move to Phase II and since the replacements tend to be more sensitive to muscarinic side effect. How are you thinking about the dosing and titration in this population?

Eiry Roberts

So it's a little bit early days really to understand what we're going to see in terms of dosing, in particular, whether we even need to do dose titration. I mean, that hasn't been the case for other muscarinic agonist to date. So just answering that last piece first. We're still in Phase I. A lot of Phase I work, as you know, is focused on understanding safety and tolerability and helping us choose the appropriate dose for a Phase II study.

And so right now, we're working through that. I would say that 569 has been well tolerated in the patient population to date, and we're accomplishing the dosing regimen that we need to do in terms of going into the next stage of development. But obviously, we won't know for certain until we complete that work.

Operator

Thank you. We will move next with Laura Chico with Wedbush Securities. .

Laura Chico

One back on the obesity franchise with 1968 in 2118. I apologize if I missed this, but what is the scientific rationale for pairing a CRF agonist with the GGG agonist? And then I guess kind of related to that, what is, I guess, the R&D spend that you're willing to commit to for obesity, just given the other events you've got going on in psychiatry. Just curious if you can kind of elaborate there.

Kyle Gano

I think on R2 in 2118 and 1968, I think we appreciate at the stage of development that we are and we still have a lot of unanswered questions in terms of how R2 can work as a stand-alone treatment or potentially better in a combination with a incident of BCG type of approach at lower doses. So these are things that we're going to learn early I think that's a good segue into your second question, when it comes to obesity studies and spend, the way that we look at it is that it's a nice balance of the types of programs that we invest in particular, on the neurology and psychiatry side of the business.

There, we have to invest all the way through Phase III before we know our winners and how they look completely with obesity programs that we get in early development are things like biomarkers, objective endpoints and the ability to see the opportunity for efficacy as early as in Phase I if you have patients that are healthy volunteers. So we think there's a good opportunity here for us to identify which programs we can take into later stage Phase II and Phase III development and knowing what those profiles look in comparison or in contrast to our psychiatry program.

So it's a nice way to strategically diversify Neurocrine. I use that word strategically here deliberately because we're moving into a broader foundation that we've already set with cronecity and endocrinology, and we're leading into the biology that we already know in CRF.

Operator

Thank you. We will move next with Ami Fadia with Needham & Company.

Unknown Analyst

This is Bonn for Ami.

For tenacity, what is the headroom for growth in the main adult population? And how are you targeting these patients? And also, what additional proportion of the market can capture with the ages under 4 study?

Eric Benevich

I'm sorry, can you clarify which population were you asking about? .

Unknown Analyst

So ages on the 4. The male the yes.

Eric Benevich

Yes. So obviously, there's a lot of headroom in the adult population. And I said earlier in response to a different question that we're now at a point where roughly half the patients on treatment are adults skewed slightly towards females. So there's still a lot of opportunity really across all the different patient populations, roughly 15% -- north of 15% now of the overall classic CH populations on treatment. And we're only about 7 quarters into the launch. So there's a long way to go and a lot of headroom here. I'll let Ari comment on the opportunity below 4.

Eiry Roberts

Yes, we're just initiating our study in the under 4-year-old patient population. And I mean, I think the belief is that in order to gain control of the hypothalamic adrenal axis as rapidly as possible. The ability to use Conecta early as possible would be beneficial because we know that even in those very young patients under the age 4 there's often a need for very high steroid dosing and the impact that, that has on growth, bone development and other developmental features really from the outset is -- can be very detrimental for patients.

And so that's why we are very keen to get that study up and running. We're working on that now with the goal of being able to expand the label to an earlier age group.

Operator

We will move next with Greg Suvannavejh.

Unknown Analyst

Question on Cranesity, please, on its growth prospects. As you look out over the next several years, can you just remind us how you were thinking about the potential impact of competition, and particularly the Vertex Kinetics candidate for CAH and while they realize we don't have Phase III data yet for that asset. What are your thoughts around differentiation between the 2 assets? And what is your market research telling you about like BID dosing that you have versus QD dosing?

Kyle Gano

Yes. This is Kyle. I appreciate the question. It's 1 of these were instances where I like talking about competition because they get to bring up all the good data that we have. Crenestihas really set a very high bar out there not only for competition, but our own next-generation programs in the pipeline. That's actually concerning to me because we're investing in those in our pipeline right now. But if you look at efficacy, safety and tolerability, we have patients out to 5 years now and our long-term data.

We have, from our 2-year data, which is turning into a 3-year data that we'll be able to publish on 70% of patients are on a physiological dose of their 70% of patients have normal levels of androgens. We've seen sustained and control levels of ACTH and cardiometabolic improvements as well as improvements on pediatric growth trajectory. So there's a lot to get a guide about with Kinect and Irene and her team did a great job pulling those teams through a very simple and broad label that allows us to treat pediatrics, the adult patient population, and we have multiple formulations.

So I really feel good and happy about the position that we're in, regardless of its competition or our own next-generation medicines in the portfolio. I think we really have an excellent opportunity here to change the standard of care. And with the demand that we see, we have plenty of runway here to do so over the next couple of years. So that's where the focus is for now.

Operator

Thank you. We will move next with Evan Seigerman with BMO Capital Markets.

Unknown Analyst

On for Evan. I wanted to touch again on the muscarinic that you have in your pipeline. I saw that you had discontinued 986, the M4 antagonist for movement to sort I was just wondering if you could give a little regulator is that due to a safety or a tolerability issue or just more of a broad strategic decision for the pipeline?

Eiry Roberts

Thanks for the question. So 986 was an M4 antagonist which was focused on the potential use in movement disorders, including dystonia and potentially Parkinsonian tremor. We completed the Phase I program on that medicine, and you were able to look at pharmacodynamic markers in addition to the PK and tolerability. And looking at all of those data in totality, we didn't really meet the bar that we had set ourselves to be willing to go forward into a Phase II study in Parkinsonian tremor and for that reason, as we were doing our portfolio prioritization, posed and discontinued the development of that molecule at this time. There was no particular safety issue that per se stopped the program. It was basically the review of all of the data in aggregate. .

Operator

Our last question comes from David Hoang with Deutsche Bank.

Samuel Beck

This is Sam on for David. I'll try to be brief. Just on Kinect as you broaden how much of the real-world challenge here is now kind of around tapering glucocorticoids appropriately? And how should we think about dynamic as it relates to prescribing and I guess, potentially capping penetration down the road? I appreciate it. And congrats again.

Eric Benevich

Yes. I don't see it as an impediment to prescribing. Actually, I think it's the promise of treatment. Certainly, the label isn't specific in terms of that process, and it's very much individualized on a patient-by-patient basis. A few months ago, we published a essentially an expert opinion piece on how to down-titrate the GCs for these patients. And I certainly think that, that was well received in the community in terms of helping to provide a little bit more guidance ultimately, I don't see that as a deterrent at all. I think it's the promise. And frankly, we are seeing great results as reflected in the 2-year data. that was recently released. Anything to add, Eiry?

Eiry Roberts

I think it is really encouraging to see that a significant proportion majority of patients can reach physiologic dosing. And that's done in a safe and effective way without the risk of adrenal insufficiency, which is obviously what these patients are concerned about. And so we have not any increase or issue around adrenal insufficiency, which has been very encouraging. So to Eric's point, I do think this is the promise of the treatment rather than an impediment. .

Operator

Thank you. I will now turn the call back to Kyle Gano for closing comments.

Kyle Gano

Thanks, everyone, for joining our call today and for your thoughtful questions. As you heard, we continue to demonstrate strength across our commercial business and R&D pipeline. We're delivering strong commercial performance while advancing an increasingly broad an innovative pipeline of potential new medicines.

In fact, we remain on track to deliver 6 Phase Is, along with 5 new Phase I starts this year. Never Neurocrine's 35-year history, we achieved this level of already productivity in a single year. With that, thank you again for your continued interest, and I look forward to connecting with many of you at the remaining investor conferences this year and certainly at our R&D Day next month. Thanks again.

Operator

Thank you. This brings us to the end of today's meeting. We appreciate your time and participation. You may now disconnect.