Akebia Q2 2026 earnings: Vafseo growth did not offset Auryxia decline

Akebia Therapeutics (Nasdaq: AKBA) reported Q2 2026 revenue of $49.1 million, down 21.4% from $62.5 million a year earlier, while diluted EPS was a loss of $0.03 versus $0.00. Vafseo continued to scale, but its growth did not offset declining Auryxia sales and higher R&D and commercialization costs, resulting in a $6.3 million operating loss and an $8.9 million net loss.

Core earnings data

Revenue declined by $13.3 million year over year. Cost of goods sold still increased to $10.4 million, while total operating expenses rose 17.1% to $45.0 million, creating pressure at both the gross-profit and operating levels.

The following figures are for the three months ended June 30, with amounts in USD millions except per-share data.

Gross profit and gross margin are calculated from reported revenue and cost of goods sold. Akebia noted that Vafseo cost of goods sold in both periods came from pre-launch inventory for which part of the manufacturing cost had previously been recorded as R&D expense. The reported margin therefore does not reflect Vafseo’s full manufacturing cost.

Business and product performance

Vafseo delivered meaningful commercial growth, but Auryxia remained the larger year-over-year driver. The $8.0 million increase in Vafseo revenue was outweighed by a $21.7 million decrease in Auryxia revenue.

Vafseo revenue also increased 34% from Q1 2026. More than 10,500 patients were active on the therapy during the quarter, up 41% from the end of Q1, while the number of prescribers increased about 17% to approximately 1,200.

Auryxia continued to face generic competition and pricing pressure. Akebia expects its revenue to decline in 2026 compared with 2025, making the pace of Vafseo adoption central to the company’s ability to stabilize total product revenue.

Clinical and pipeline developments

A planned interim analysis of the 2,116-patient VOICE trial met its predefined stopping criteria. Vafseo administered three times per week showed a statistically significant improvement versus erythropoiesis-stimulating agents on the hierarchical composite endpoint of all-cause mortality and hospitalization, with win odds of 1.16, a 95% confidence interval of 1.06 to 1.28, and a p-value of 0.0016. The result was driven by fewer hospitalizations, and U.S. Renal Care plans to submit the data for presentation at a medical meeting.

Akebia also initiated a Phase 2 open-label basket trial of ebribafusp in IgA nephropathy, lupus nephritis and C3 glomerulopathy. The study is expected to enroll up to 30 patients, with initial data planned for 2027. Enrollment is also continuing in the Phase 2 study of praliciguat in focal segmental glomerulosclerosis.

For Vafseo, the company added a new Orange Book-listed patent expiring in June 2034. Its portfolio now includes 14 listed patents with expiration dates extending through 2036.

Profitability, cash and the balance sheet

The increase in R&D expense was driven by clinical-trial activity for praliciguat and ebribafusp, as well as higher headcount costs. SG&A increased because of commercialization activities, and Akebia recorded a separate $1.9 million restructuring charge related to reorganizing its commercial operations.

Cash and cash equivalents were $155.5 million at June 30, 2026, down about $7.1 million from March 31 and down from $184.8 million at the end of 2025. Working capital declined to $68.7 million from $90.0 million at year-end. Management believes existing resources, expected product and partnership-related cash generation, and a planned refinancing of its senior secured term loan will fund the current operating plan for at least two years.

Recent insider transactions

The provided insider data shows 283,470 shares categorized as purchases and 56,019 shares sold during the past six months, resulting in net acquisitions of 227,451 shares. That represented 2.10% of the 10.89 million shares held by insiders, although the transaction list includes zero-price director awards and should not be interpreted as open-market buying alone.

These transactions are presented as reported and do not, by themselves, establish insiders’ views of Akebia’s prospects.

Risks investors need to watch

• Auryxia erosion: Generic competition and pricing pressure are expected to keep reducing Auryxia revenue, and Vafseo has not yet grown enough to offset that decline.
• Vafseo adoption and safety: Commercial progress depends on patient and prescriber adoption. Vafseo carries a boxed warning covering increased risks of death and thrombotic vascular events, among other safety considerations.
• Gross-margin comparability: Current Vafseo cost of goods sold excludes part of the full manufacturing cost because that amount was expensed before approval. Product economics may look different after pre-launch inventory is depleted.
• Liquidity and refinancing: Management’s two-year funding assessment includes expected revenue-related cash generation and the planned refinancing of a senior secured term loan.
• Pipeline execution: The ebribafusp trial is an open-label Phase 2 study with initial data not expected until 2027, while the praliciguat program remains in Phase 2 enrollment. Clinical results and timelines may change.

Summary

Akebia’s Q2 2026 results show that Vafseo is gaining patients, prescribers and revenue, supported by favorable interim VOICE trial data. However, the product’s growth has not yet replaced the revenue lost from Auryxia, while commercial and pipeline investment has increased expenses and moved the company back into a loss. Future results will depend on Vafseo’s adoption rate, the pace of Auryxia’s decline, expense control and execution of the company’s financing and clinical-development plans.