유나이티드 테라퓨틱스(UTHR) 2026년 3분기 실적 발표: 사상 최대 타이바소 매출, 흡입기 NDA 지연
유나이티드 테라퓨틱스는 기초 수요와 영업 성과에 힘입어 2026년 3분기 총매출 8억 3,300만 달러, 티바소 매출 5억 400만 달러로 역대 최대 실적을 기록했다. 10월에는 월간 기준 역대 최다인 1,000건 이상의 진료 의뢰를 확보했다. 반면, 소프트 미스트 흡입기(SMI)의 신약 허가 신청(NDA)은 FDA와의 논의에 따른 추가 데이터 생성 필요성으로 기존 2026년 말에서 2027년으로 연기될 것으로 예상된다. 구용 랄리네파그는 2027년 6월 24일이 심사기한이며, API 공급업체의 규정 준수 상태가 리스크로 꼽히나 시정 조치 및 비상 계획이 진행 중이다.
핵심 요약
- 유나이티드 테라퓨틱스(NASDAQ: UTHR)는 기초 수요와 전분기 대비 성장세에 힘입어 2026년 3분기 총매출 8억 3,300만 달러, 티바소(Tyvaso) 매출 5억 400만 달러로 모두 분기 역대 최대 실적을 기록했다고 발표했다.
- 경영진은 티바소의 실적 호조가 진료 의뢰 및 치료 개시 증가, 투여량 확대, 의료진 참여 강화, 일관된 월별 영업 집행 덕분이라고 설명했다. 재고 및 계절적 요인은 실적에 실질적인 영향을 미치지 않았다.
- 회사는 10월 한 달 동안 유나이티드 테라퓨틱스 제품에 대해 월간 기준 역대 최대인 1,000건 이상의 진료 의뢰를 받았다. 경영진은 확충된 영업 인력이 2026년 4분기와 2027년에 더 의미 있게 기여할 것으로 기대하고 있다.
- 미국 식품의약국(FDA)과의 논의에 따라 추가 데이터를 생성해야 함에 따라, 소프트 미스트 흡입기의 신약 허가 신청(NDA) 제출 시기는 기존 2026년 말에서 2027년으로 연기될 것으로 예상된다.
- 구용 랄리네파그(ralinepag)는 폐동맥고혈압 적응증으로 FDA의 심사를 받고 있으며, 처방약 유저피법(PDUFA)에 따른 심사기한은 2027년 6월 24일이다. 원료의약품(API) 공급업체의 규정 준수 상태가 규제 리스크로 꼽히나, 시정 조치 및 비상 계획이 진행 중이다.
- 유나이티드 테라퓨틱스는 14개의 개발 프로그램을 보유하고 있으며, 특발성 폐섬유증(IPF), 진행성 폐섬유증(PPF), 만성폐쇄성폐질환 동반 폐고혈압(PH-COPD) 분야의 미국 내 대상 환자 수가 총 100만 명에 달한다고 밝혔다.
주요 재무 데이터
| 지표 | 2026년 3분기 실적 | 경영진 코멘트 |
|---|---|---|
| 총매출 | 8억 3,300만 달러 | 분기 역대 최대 매출 |
| 티바소 매출 | 5억 400만 달러 | 견조한 전분기 대비 성장세와 기초 수요에 힘입은 역대 최대 매출 |
사업 및 영업 성과
티바소는 주요 상업적 성장 동력이었다. 경영진은 폐동맥고혈압과 간질성 폐질환 동반 폐고혈압(PH-ILD) 분야 전반에서 치료 개시, 진료 의뢰, 환자 수요, 투여량, 의료진 참여가 늘어났다고 지적했다.
회사는 이번 분기 동안 실질적인 재고나 계절적 수혜는 없었다고 밝혔다. 대신 한층 더 일관된 월별 상업적 집행이 실적에 반영됐다. 확충된 현장 영업 인력은 9월 중순경부터 진료 의뢰의 뚜렷한 변곡점을 만들어내기 시작했으나, 경영진은 3분기 매출 기여도가 제한적이었으며 4분기와 2027년에 더욱 가시화될 것으로 예상된다고 밝혔다.
고용량 티바소 DPI(Tyvaso DPI) 카트리지 역시 매출과 환자 유지율 향상에 기여했다. 경영진은 고용량 키트가 출시된 이후 티바소 DPI를 시작한 환자 3명 중 약 1명이 고용량에 도달했으며, 이는 이전 비율의 약 2배 수준이라고 말했다.
리키디아(Liquidia)와의 합의 이후, 유나이티드 테라퓨틱스는 기존 환자의 티바소 DPI 전환 규모가 완만할 것으로 예상하고 있다. 경영진은 PH-ILD의 더 큰 기회가 의료진의 인지도 제고, 적합한 환자 발굴 및 신규 처방 창출에 있다고 강조했다. 회사는 이번 합의로 PH-ILD 분야에서 경쟁 제품의 판촉 및 적응증 외 사용(off-label) 권장이 금지된다고 밝혔다.
유나이티드 테라퓨틱스는 티바소 외에도 네뷸라이저 및 분말 흡입제 치료제, 소프트 미스트 흡입기, 1일 1회 복용 약물, 복합제 등을 개발 중이다. 경영진은 규제 당국의 승인 및 성공적인 상업화를 전제로 IPF 적응증의 네뷸라이저 제형 티바소와 PAH 적응증의 랄리네파그를 잠재적인 주요 성장 동력으로 꼽았다.
회사는 또한 인공 장기 대안에 대한 연구를 지속하고 있으며, 경영진은 이를 독자적인 장기 성장 플랫폼으로 보고 있다.
경영진 가이던스
유나이티드 테라퓨틱스는 소프트 미스트 흡입기의 NDA 제출 시기를 기존 2026년 말 제출 계획에서 2027년 제출로 수정해 예상하고 있다. 경영진은 FDA가 새로운 종류의 작업을 요구한 것은 아니지만 추가 데이터를 생성하는 데 시간이 더 필요하다고 밝혔다. 구체적인 제출 일정은 개발 파트너와 함께 계속 수립 중이다.
경영진은 영업 인력 확충과 PH-ILD 합의에 따른 진료 의뢰 모멘텀이 향후 몇 주에서 2027년 초에 걸쳐 더욱 가시화될 것으로 예상한다. 회사는 2026년 진입 당시보다 훨씬 강한 상업적 모멘텀을 확보한 상태로 2027년에 들어설 것으로 기대하고 있다.
흡입형 랄리네파그의 경우, 회사는 임상시험계획(IND) 신청 준비 작업을 진행 중이며 건강한 성인을 대상으로 한 임상 1상을 계획하고 있다. 해당 임상은 초기 PH-ILD를 시작으로 IPF 및 PPF로 이어지는 향후 허가 임상 프로그램의 기초가 될 것으로 기대된다.
리스크 및 관전 포인트
- 소프트 미스트 흡입기 허가 신청은 FDA 제출 전략 승인 과정에서 요청된 추가 데이터를 생성함에 따라 2027년으로 연기되었다.
- 구용 랄리네파그의 API 공급업체는 실사 결과 '공식 조치 지시(Official Action Indicated, OAI)' 규정 준수 상태에 놓여 있다. 유나이티드 테라퓨틱스는 2027년 6월 24일 PDUFA 심사기한에 대한 잠재적 리스크를 줄이기 위해 시정 조치를 지원하고 대체 플랜을 추진하고 있다.
- 추진 중인 경구용 3제 복합제는 완료된 생물학적 동등성 시험만으로는 승인을 신청할 수 없다. 경영진은 FDA가 수용 가능한 대체 개발 경로를 검토하고 있다.
- 합의안에 기존 환자의 전환 의무가 포함되어 있지 않기 때문에 단기적으로 경쟁 흡입제 제품에서 티바소 DPI로의 전환은 완만한 수준에 그칠 것으로 예상된다.
- PH-COPD, PH-ILD, IPF, PPF 관련 개발 프로그램은 여전히 임상 및 규제 리스크에 노출되어 있다. 경영진은 계획된 흡입형 랄리네파그 적응증에 대해 핵심적인 안전성 및 유효성 임상시험이 요구될 것이라고 언급했다.
애널리스트 Q&A 하이라이트
티바소 모멘텀: 경영진은 리키디아와의 합의 전부터 이미 진료 의뢰가 호조를 보이고 있었다고 설명했습니다. 2026년 말과 2027년 초에 PH-ILD의 추가적인 변곡점이 나타날 수 있으나, 주요 기회는 강제적인 환자 전환이 아니라 신규 처방에 있습니다.
소프트 미스트 흡입기 연기: FDA와의 논의 결과 추가 데이터의 필요성이 발생한 것이며, 새로 디자인된 개발 요구 사항이 추가된 것은 아닙니다. 경영진은 이 문제를 주로 소요 시간의 문제로 규정했습니다.
랄리네파그 공급 리스크: 회사는 PDUFA 심사기한 전까지 API 공급업체의 규정 준수 상태를 해결하는 데 집중하고 있습니다. FDA에 시정 조치 정보가 제출되었고 대화가 열려 있으며 비상 계획도 병행하여 진행되고 있습니다.
랄리네파그의 경제성: 유나이티드 테라퓨틱스는 아레나(Arena)의 로열티를 인수한 결정이 구용 랄리네파그 및 여러 폐 적응증에 대해 계획 중인 분말 제형에 대한 확신을 반영한 것이라고 말했습니다. 회사는 이번 거래를 기회주의적인 자본 활용으로 설명했으나 실적 발표 전화회의 중 구체적인 가치 평가 세부 사항은 제공하지 않았습니다.
PH-COPD 개발: 경영진은 흡입형 트레프로스티닐(treprostinil)이 폐의 환기가 더 잘 되는 부위를 표적으로 삼아 환기-혈류 불균형을 줄일 수 있다고 말했습니다. 임상 2상 프로그램은 IND 승인을 받았으며, 회사는 임상 대상군을 한층 고도화하고 개발 리스크를 줄이기 위해 대상 자격 기준을 다듬었습니다.
실적 발표 전화회의 녹취록 전문
전체 실적 발표 컨퍼런스 콜 녹취록
경영진 발표
Operator
Good morning, and welcome to the United Therapeutics Corporation Third Quarter 2026 Corporate Update. My name is Christa, and I will be your conference operator today. [Operator Instructions] Please note that this call is being recorded. I will now turn the webcast over to Harrison Silvers, Investor Relations at United Therapeutics.
Harrison Silvers
Thank you, Christa. Good morning, everyone. It is my pleasure to welcome you to the United Therapeutics Corporation Third Quarter 2026 Corporate Update Webcast. Remarks today will include forward-looking statements representing our expectations or beliefs regarding future events. These statements involve risks and uncertainties that may cause actual results to differ materially. Our latest SEC filings, including Forms 10-K and 10-Q, contain additional information on these risks and uncertainties.
We assume no obligation to update forward-looking statements. Today's remarks may discuss the progress and results of clinical trials or other developments with respect to our products. These remarks are intended solely to educate investors and are not intended to serve as the basis for medical decision-making or to suggest that any products are safe and effective for any unapproved or investigational uses. Full prescribing information for the products is available on our website.
Accompanying me on today's call are Dr. Martine Rothblatt, our Chairperson and Chief Executive Officer; Michael Benkowitz, our President and Chief Operating Officer; James Edgemond, our Chief Financial Officer and Treasurer; Dr. Leigh Peterson, our Executive Vice President of Product Development and Zeno Transplantation; and Pat Poisson, our Executive Vice President of Strategic Development.
Note that James Edgemond and I will participate in a fireside chat and one-on-one sessions at the UBS Global Biopharma Conference and Jefferies Global Healthcare Conference in London on November 16 and 17, respectively. Additionally, members from our management team will participate in a fireside chat in one-on-one meetings at the 45th Annual JPMorgan Healthcare Conference in San Francisco in January of next year.
Our scientific commercial and medical affairs teams will be President present at phenomenal Hope 2026 on December 4 in Boston and at the Pulmonary Vascular Research Institute Annual Congress in Bangkok in late January of next year. Now I will turn the webcast over to Martine for an overview of our development pipeline and business activities. Martine?
Martine Rothblatt
Thank you, Harry, and good morning, everyone. We have slides available for reference, and I encourage you to review those at your leisure. I'm not going to speak directly to the slides. As we look back on the third quarter, I'm incredibly proud of what our teams have accomplished. .
We executed at a high level across our business and across our company, delivering for patients while advancing one of the most ambitious growth strategies in biotechnology. The significance of this quarter extends beyond any individual results or milestone. It reflects the broader transformation underway at United Therapeutics as we build a comprehensive cardiopulmonary and respiratory medicine franchise capable of reaching dramatically more patients than ever before.
For most of our history, UT has been known as a pulmonary hypertension company. Today, that legacy serves as the foundation for a much bigger UT. Over the next several years, we expect to introduce wave after wave of innovation across multiple therapeutic and device platforms. From nebulized and dry powder therapies to softness inhalers, once-daily medicines and combination products.
We have 14 programs in development. Together, these advances are intended to address some of the largest unmet needs in pulmonary fibrosis and pulmonary hypertension. We are building an integrated portfolio designed around the needs of individual patients.
Our strategy is to keep innovating, so we can offer more patients the right therapy in the right format at the right time. The scale of that opportunity extends far beyond our historic pulmonary hypertension market across IPS, PPS and PH-COPD alone, we are pursuing patient populations totaling approximately 1 million people in the United States. Supporting this strategy are significant and durable competitive advantages.
Our portfolio features extensive intellectual property protections, including fibrosis-related patents, device protections and composition of matter protection for ralinepag, many of which extend into the 2040s, just as important, our market advantages include decades of expertise, extensive engagement with physicians, specialized commercialization capabilities manufacturing investments and a proven ability to bring complex drug device combinations to market.
We are building on our strength through the philosophy that has guided us for years, approve, then improve. We first established a therapy as quickly as possible because our patients do not have time. Then we continue to enhance convenience, administration and treatment experience through new devices, formulations and next-generation medicines. This disciplined approach creates a pipeline in which every new product builds on the foundation established by the last and provides improvements for the next.
And as compelling as our cardiopulmonary and respiratory franchises are they represent only 1 pillar of our long-term vision. In parallel, we continue to advance our manufactured organ alternatives programs and build the infrastructure we need to address one of medicine's greatest unmet needs. We believe this platform has the potential to revolutionize transplantation over the next decade, just as our therapies have revolutionized pulmonary hypertension over the past 2 decades.
When I step back, I see a United Therapeutics stronger than at any point in our history with a growing commercial business, late-stage assets of significant potential multiple upcoming launches and a clear strategy for creating value over the long term. In closing, thank you to our fellow Unitarians, patients, physicians, shareholders and our other stakeholders for helping us fulfill our purpose. And with that, I'll turn the call over to our President, Michael Benkowitz, for an overview of our commercial performance for the quarter. Mike?
Michael Benkowitz
Thanks, Martine, and good morning, everybody. For the third quarter of 2026, we delivered record total revenue of $833 million and record Tyvaso revenue of $504 million. Highlighted by strong sequential growth and underlying demand. 3 months ago, I said confidence is earned through execution, not projections.
This quarter's results are best quarter ever demonstrate that execution and reinforce our conviction that our business has regained meaningful momentum. A huge shout out to all of our commercial, commercial operations and medical teams for their hard work, persistence and performance.
Tyvaso's performance was driven by strong underlying demand as the patient metrics we highlighted last quarter translated into commercial results. Starts, referrals, patient demand, increased dosing and physician engagement all continue to support growth and emphasize the value of differentiated products, disciplined execution, a clear understanding of physician and patient needs and our expertise and support in the field of pulmonary hypertension.
Most importantly, we see meaningful room to grow from here. The investments we made earlier this year in resources and sharpening our messaging are working as intended by expanding our reach deepening physician engagement, increasing disease awareness and driving greater penetration across PAH and PH ILD. We have greater conviction in our strategy than ever. Elsewhere, the recent court decision upholding our intellectual property, together with the settlement we reach, provide important clarity and reinforce the long-term durability of our base business.
The terms of our settlement were highly favorable for United Therapeutics, ultimately removing PH-ILD from the tropo label, preventing its promotion and marketing into that indication and prohibiting Liquidia from encouraging off-label usage, which we will be monitoring very closely. With no direct branded competition on the horizon, we can remain focused on growing the large underpenetrated PH-ILD market.
Based upon the provisions contemplated in the settlement and damages structure, near-term expectations for transitions from UTP to Tyvaso should be moderate. The larger opportunity in PH-ILD continues to remain focused on expanding physician awareness, identifying more eligible patients and growing new prescriptions.
That gives Tyvaso a long runway for largely uncontested growth. Step back, our story is not about stabilizing our business. It is about building on renewed momentum from our durable commercial foundation with 2 of the most important potential launches in our street still ahead. Once approved, we expect nebulized Tyvaso and IPF and ralinepag in PAH will each address significant unmet need. Both are supported by compelling clinical data and both have the potential to become multibillion-dollar growth drivers for United Therapeutics.
These opportunities do not replace our current growth story, they accelerate it. In closing, our base business is performing. Our commercial strategy is working. Our competitive position is strong and we expect to enter 2027 with substantially more momentum than we had entering 2026.
To highlight this continued momentum, we received over 1,000 referrals for a UT product in October, the most ever received in a single month. We remain focused, accountable and committed to continue delivering compelling results. And as proud as we are of this quarter, we believe we are just getting the full scale of what we are determined to achieve. And with that, I'll pass the call back to Harry to run the Q&A.
Harrison Silvers
Thanks, Michael. Thanks, Martine. Great updates from both of you. [Operator Instructions] Operator, you can start.
Operator
[Operator Instructions] Your first question comes from Joseph Thome with TD Hain.
질의응답
Joseph Thome
Maybe could you talk a little bit more about the patient switch dynamic now that PHLD will be off-label for you [indiscernible] , what are sort of your expectations of current patients switching over? And maybe for new start markets, you mentioned that you are monitoring their off-label use potential. Can you just kind of go into how you're doing that in the field. .
Unknown Executive
Thanks for the question, Joe. I'm going to pass this 1 to Michael.
Michael Benkowitz
Sure. Yes. So Joe, thanks for the question. On the patient switch is the -- per the terms of the settlement agreement, we sort of contemplated -- we didn't -- there was no requirement or expectation that patients would have to switch from [indiscernible] to Tyvaso DPI and so we kind of contemplated that in the damage structure, as I mentioned.
And so I think, obviously, we're going to continue to talk about the benefits the differentiation of DP relative to Trebia, but it's really going to be, I think, a physician patencies to whether or not they want to transition existing patients over to Titaso-DPI. But that's not something that's going to be required for the terms of the settlement.
So like I said, I think what you're going to see is if you've got patients on Metropia that for are having issues, obviously, Tyvaso remains an option, you can switch, but there's not -- I think if a patient's doing well on. There's not really going to be, I think, a push on the part of doctors to switch patients over. So as I said, the real opportunity here is with new prescriptions and continuing to penetrate the pH ILD market, which we're starting to see with the benefit of the expanded sales force.
In terms of monitoring that, I mean, look, we kind of -- I'm not going to really get into kind of sources and methods of how we're going to do that. But I think we have pretty good visibility into how things are playing out in terms of prescriptions and indications, and we're just going to continue to kind of keep an eye on that and see how that plays out along with what we're hearing in the market through our interactions with physicians.
Harrison Silvers
Thanks, Michael. Operator next question.
Operator
Your next question comes from the line of Olivia Brayer with Cantor.
Olivia Brayer
Michael, I just quickly wanted to follow-up on PHLD. Are you guys actually seeing any acceleration in new starts on Tyvaso in the fourth quarter just on the back of that settlement? Or do you really expect that to become more meaningful as patients come up for reauthorization in January? Just trying to kind of reconcile your comments around October trends. And then I'm sorry, Harry, -- but my real question is on the softness inhaler program, where are you guys in the submission process at this point? And is a filing still on track for the end of the year? And then as you think about softness kind of looking ahead to PH-COPD, what have you guys actually seen in the SMI product profile that's giving you so much confidence that it could succeed in this patient population, just given some of the challenges that we've already -- or that others have experienced, right, with prior approaches?
Harrison Silvers
Sound more like 3. I'll give Michael the first question. And then if you could pass it to Pat on the NDA expectations for SMI and then perhaps we can close it off with expectations in PH COP.
Michael Benkowitz
Yes. Olivia, you never disappoint with your multi question. So on PLD, so if you kind of think about the time line of everything, as I said, I think even before the settlement, right, going back to like mid-September, I think we saw this inflection in the referrals coming in. Really across both cations, PAH and PLD for Tyvaso that has persisted through the end of October into November, in terms of working out the litigation decision, the settlement, I mean, all of that stuff really didn't really get worked out until, I guess, what was that second, third week of October.
So still a little early to see I think another sort of inflection in terms of PH ILD. I would expect that we're going to start to see that here over the next couple of weeks. And into December than obviously the first part of the year. So that's kind of where things are right now. I mean we do expect to see that I've seen -- I kind of monitor the daily referral trends. We have a couple of days where we spiked, but I expect us to see kind of a new baseline in terms of referrals here over the next few weeks. Pat, do you want to take the other question?
Patrick Poisson
We recently met with the FDA to discuss our NDA filing strategy, and that was preplanned. And following that discussion, we've now determined that additional work is going to be needed to support the application. So as a result of that, we now expect to submit the NDA in 2027 and not at the end of this year. We are actively working with our development partner to complete the necessary activities and establish an updated filing time line. Leigh pass it on to you.
Leigh Peterson
Yes. As far as PH-COPD, goes, our Phase II trial, as you know, we have IND clearance for that study. And in terms of the biological rationale for COPD, mean the pharmacology of inhaled treprostinil is really well characterized with our commercially approved treatments for PH and PH-ILD.
And as you know, in these patients with [indiscernible] with group through PH, such as ILD and COPD, the inhaled treprostinil directly targets more ventilated portions of the lungs. And so that can minimize the VQ mismatch that's with the concern with more systemic therapies that are also vasodilators.
So it's really important to note that not only do we have a more robust design in our study. But we've really, really looked very carefully at the patient population that was enrolled into the prior study, COPD study and really worked hard with our steering committees to enrich this current population through the inclusion exclusion criteria to improve the chances of success as well as just decrease the risk of this program.
Harrison Silvers
Thanks, Lee. That was a great overview by all 3 of you.
Operator
Your next question comes from the line of Ash Verma with UBS.
Ashwani Verma
So on ralinepag, I wanted to ask about this open action indicated that you have mentioned in the Q about this API manufacturer. Can you talk about what is the contingency plan ahead of the potential regulatory approval for this?
Harrison Silvers
Thanks for the question, Ash. Pat, we'll kick that over to you.
Patrick Poisson
Yes. Thanks, Ash. So as you saw in the Q, our API supplier has an OAI compliance status as the result of an inspection earlier this year. We're actively working with them to remediate their compliance status so that it doesn't impact our PDUFA date. So that's kind of priority one.
We do have some alternative plans that are progressing in parallel. But on a positive note, they've recently provided FDA updated information on their corrective actions. And there's open dialogue between the parties. So we remain hopeful that this will get resolved fairly quickly, but we do have contingency plans in place.
Harrison Silvers
Great. Thanks, Pat. .
Operator
Your next question comes from the line of Roger Song with Jefferies.
Jiale Song
Great. Maybe related to the triplet oral pill, since the bioequivalent study is not sufficient for filing. So what is the current plan for development and funding plan for the [indiscernible]
Harrison Silvers
Thanks for your question, Roger. Pat, can I ask you to answer this 1 again?
Patrick Poisson
Yes. So we had a discussion with FDA and they share that, that was their feedback to us. And so right now, we're looking at what our options are really, if there's an alternate path that they would accept that's going to take us a little while. So -- but right now, we're just treading water. And while we work on different options that we can present to them. .
Operator
Your next question comes from the line of Rowan Ruiz with Leerink Partners. .
Unknown Analyst
A quick question. Could you elaborate on the -- what you saw as the biggest drivers behind the Tevas strength in the quarter? And if any could increase into year-end? I'm specifically focused on if there is more traction from the upsized field force or any inventory or seasonal dynamics that we should consider in addition to underlying demand growth?
Harrison Silvers
For your question. This 1 will go to Michael.
Michael Benkowitz
Sure. Yes, thanks for the question. So no inventory or seasonal dynamics really, I think, played into the quarter. I think it's really kind of a multifactorial thing. One is just honestly, just great execution by the sales team. I think we've like we talked about in the last quarter came out of the quarter with really strong momentum. .
We've been able to maintain that through -- even through October, as I talked about earlier. I think as we've talked about on prior calls, I think some of the challenges we faced in the prior quarters are we'd have 2 really good months and 1 soft month and the 2 good months weren't enough to offset the soft mine. So we've been kind of flat for several quarters. But now we've got, I think, really consistent performance month to month to month. And so we're stocking good months on top of good months. And so that's really just, I think, plays into really strong execution by our commercial teams.
I think the other thing that we've seen is at the beginning of the year, we -- we introduced a 80-microgram cartridge. So one breath gives you the equivalent of 15 nebulized breath and then some higher dose kits. I think there's been this misinformation out there that you can't get to higher doses on Tyvaso DPI. I think we've effectively debunk that for patients that have started on Tyvaso DPI since we introduced those cartrids.
We introduced those higher strength kids, like 1 in 3 patients are, have achieved these higher doses which is twice what it was beforehand. So that certainly, I think, played into the performance is that we're getting patients to higher dose which helps from a revenue standpoint, but also helps from a retention standpoint because patients are obviously benefiting from the product.
I think in terms of the effect of the sales force expansion. I think in terms of region frequency, that played a role in some of the consistent performance month-to-month. But in terms of like what we've seen in terms of increase in referrals increase in starts. I think we -- as I said, we start to see kind of this inflection point, probably mid-September. As a result of that. So that didn't really you can't really -- I don't think you can draw a straight line through to the revenue line for Q3. I think we'll start to see the benefit of that here in Q4 and then into next year. But it's clear that the expansion is working, and we're seeing the benefit of that. But probably limited revenue impact of that in Q3, but we certainly expect to see that, like I said, this quarter and heading into next year.
Harrison Silvers
Great color.
Operator
Our next question comes from the line of Jessica Fye with JPMorgan.
Jessica Fye
Congrats on the quarter. a quick follow-up. I think it was 1 of Olivia's questions. Pat, can you just expand on what was new that's needed for the softness filing?
Patrick Poisson
Yes. It's not necessarily anything new. It's just additional data in some areas that we need to provide. So really -- it's really just that. It wasn't anything you've asked us to do in addition to what we had already planned.
Jessica Fye
So [indiscernible] versus generating more data.
Patrick Poisson
It's just generating additional data. And I don't think we're particularly worried about it. It's just a lead time to do it. .
Harrison Silvers
Great. Thanks, Jess, for the question and Pat for the answer.
Operator
Your next question comes from the line of Ben Burnett with Wells Fargo.
Benjamin Burnett
I want to ask about ralinepag and just what was behind the decision to buy out Arena's economics to ralinepag. And I guess how did you value that transaction?
Harrison Silvers
Thanks for the question, Ben. I'm going to pass this 1 to James. .
James Edgemond
Yes. Thanks, Harry. Ben, overall, this transaction to buy down the royalty demonstrates really our confidence in the revenue opportunity for oral ralinepag which, as you know, has a pending new drug application under review by the FDA for pulmonary arterial hypertension, which you know is a PDUFA date of June 24 of next year. .
But in addition, the reason why we pursue this opportunity is we have conviction in the new dry powder inhalation formulations that we're developing for a variety of pulmonary indications going forward. And I would say the price was the result of really extensive negotiations, and we're not going to get into the details regarding that. But we looked at this more as an opportunistic use of capital kind of in our overall capital allocation waterfall. So thanks for the question.
Harrison Silvers
Thanks for that, James. Operator, we have time for 1 more question. Go ahead.
Operator
And that question is going to come from the line of Lisa Walter at RBC.
Lisa Walter
Congrats on a strong quarter. Maybe another 1 on ralinepag, DPI. Curious as plans have changed around developing this for PAA -- or is PH still part of the plan, along with PH-ILD, IPS and PPS? And how are you thinking about the clinical development plan for ralinepag DPI in these indications? Any color here would be helpful.
Harrison Silvers
Yes, absolutely. Good to hear your voice, Lisa. I'm going to pass this 1 over to Leigh to provide some color.
Leigh Peterson
Yes. Thanks for the question. So we are in the process, as you know, of conducting the IND-enabling studies as well as planning for the Phase I study in healthy volunteers. Now that Phase I study prestudy safety. That will actually inform any other registrational study that we want to do. So we're initially planning on doing a PH-ILD study and they're very, very soon thereafter or essentially at the same time, seeking approval for IPF, PPF, all of those will require some pivotal studies assessing the safety and efficacy.
But again, we're confident that the mechanism, both of the very, very potent drug, self the ralinepag being a very, very potent IP receptor agonist as well as the inhaled route for these indications where there's either some fibrosis or later for COPD, but that's not in the immediate plan. But anyway, this inhaled route to minimize VQ mismatch is really probably will make what we're calling route pie, a very transformative product in these larger indications.
Harrison Silvers
Excellent overview, Lee, and that will conclude the Q&A. So I'll pass it back to the operator to close this out. .
Operator
Thank you for participating in today's United Therapeutics Corporation's earnings webcast. A rebroadcast of this webcast will be available for replay for 1 week by visiting the Events and Presentations section of the United Therapeutics Investor Relations our website at ir.unither.com. This now concludes today's call, and you may now disconnect.
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