Rhythm Q2 2026 earnings: IMCIVREE sales rise 47% as SG&A climbs

Rhythm Pharmaceuticals (Nasdaq: RYTM) reported Q2 2026 net product revenue of $71.3 million, up approximately 47% from $48.5 million a year earlier, while basic and diluted loss per share narrowed to $0.73 from $0.75. U.S. IMCIVREE sales accelerated following approval in acquired hypothalamic obesity, but a 47% increase in SG&A expense contributed to wider operating and attributable net losses.

Core earnings data

Revenue growth was accompanied by an approximately 45% increase in gross profit. However, cost of sales grew faster than revenue, lowering the calculated gross margin by about 1.1 percentage points.

Net loss attributable to common stockholders widened by 5% to $50.4 million. The per-share loss nevertheless improved by $0.02, alongside an approximately 8% increase in weighted-average common shares outstanding.

Gross profit and gross margin are calculated from reported product revenue and cost of sales. All other figures reflect the company’s reported GAAP results.

Business and geographic performance

The United States produced most of the sequential revenue growth. U.S. revenue increased by $14.1 million from the first quarter, while ex-U.S. revenue declined after a retrospective charge in France.

The U.S. increase primarily reflected new demand for IMCIVREE in acquired hypothalamic obesity, or HO, as well as continued growth in Bardet-Biedl syndrome. Rhythm received more than 400 patient start forms for acquired HO from approximately 300 prescribers between FDA approval on March 19 and June 30, 2026. These forms indicate early demand but do not represent the number of patients who have completed reimbursement and begun therapy.

Globally, the number of patients on reimbursed therapy increased by more than 20% from the first quarter. Outside the United States, reimbursed patient numbers also continued to rise, but reported revenue was reduced by a $3.8 million charge associated with France’s Contribution M mechanism. Of that amount, $3.1 million related to revenue recorded before Q2 2026.

Rhythm also reported preliminary Phase 1/2 data showing a mean BMI reduction of 11.6% after 16 weeks for RM-718 in seven acquired HO patients. The result supports further development, although the disclosed sample was small. The company plans to initiate a pivotal Phase 3 trial of bivamelagon in acquired HO by the end of 2026.

Revenue growth has not yet outpaced SG&A expansion

Calculated gross profit increased by approximately $19.4 million from the prior-year quarter, but SG&A expense rose by about $21.5 million and R&D expense increased by $1.1 million. As a result, the additional gross profit generated by IMCIVREE did not fully absorb the expansion in operating costs, and operating loss widened by approximately $3.3 million.

Rhythm attributed the SG&A increase primarily to higher personnel costs, including stock-based compensation, associated with expanded operations. R&D expenses were comparatively stable: higher personnel, genetic-testing analytics, preclinical work and bivamelagon trial costs were partly offset by lower manufacturing-related and clinical trial spending as the EMANATE and TRANSCEND Phase 3 studies wound down.

Liquidity and balance sheet

Cash, cash equivalents and short-term investments totaled $330.9 million on June 30, 2026, down $58.0 million, or approximately 15%, from December 31, 2025. This six-month change should not be treated as quarterly free cash flow because the release did not provide a cash flow statement.

Accounts receivable increased to $40.4 million from $26.1 million at year-end, while inventory rose to $30.5 million from $25.8 million. Management said the June 30 liquidity balance should fund planned operations for at least 24 months under its current operating plans.

Earnings guidance

Rhythm’s fiscal 2026 guidance calls for $363 million to $397 million of non-GAAP operating expenses. The measure excludes stock-based compensation and fixed consideration related to in-licensing.

The spending ranges reflect continued investment in commercial operations and clinical development. Rhythm did not provide a quantitative reconciliation to forecast GAAP operating expenses because it could not estimate future stock-based compensation with sufficient confidence.

Upcoming operating milestones

Rhythm expects several commercial and clinical events to shape its next phase of execution:

• Complete enrollment in the congenital HO setmelanotide substudy during the second half of 2026.
• Complete enrollment in Part D of the RM-718 Phase 1/2 trial in Prader-Willi syndrome during the second half of 2026.
• Potentially launch IMCIVREE for acquired HO in Japan, subject to a regulatory decision by the end of 2026.
• Begin a pivotal Phase 3 trial of bivamelagon in acquired HO by year-end 2026.
• Start country-level European launches of IMCIVREE for acquired HO in 2027.

Risks investors should watch

• Conversion of launch demand into reimbursed therapy: More than 400 patient start forms show early interest, but future revenue depends on patients completing access and reimbursement processes and remaining on treatment.
• International pricing and reimbursement adjustments: The $3.8 million French retrospective charge demonstrates how country-specific mechanisms can reduce reported revenue even when reimbursed patient numbers are increasing.
• Operating costs and continued losses: SG&A growth exceeded the increase in gross profit during the quarter. Continued commercial and clinical investment could keep losses elevated despite higher IMCIVREE sales.
• Clinical and regulatory execution: The RM-718 result was preliminary and based on seven patients. Planned trials, Japan’s pending decision and European country launches remain subject to clinical, regulatory and execution risks.

Summary

Rhythm’s Q2 2026 results showed a meaningful IMCIVREE revenue increase led by the U.S. acquired HO launch, while ex-U.S. sales were affected by a French retrospective charge. Higher gross profit was not enough to offset expanding SG&A and R&D costs, leaving the company with a wider operating loss. The main issues to monitor are conversion of U.S. start forms into reimbursed patients, international launch progress, expense control and delivery of the upcoming clinical and regulatory milestones.