Vera Therapeutics (VERA) Q3 2026 Earnings Call: TRUTAKNA Launch and ORIGIN 3 Results

Key Takeaways

• Vera Therapeutics reported $10.3 million in TRUTAKNA net product revenue for Q3 2026, its first partial quarter of commercial sales following accelerated FDA approval on July 7.
• The company had received approximately 700 patient start forms as of November 5. Management said adoption was not concentrated among a small group of physicians and included patients with proteinuria both above and below 1 gram.
• ORIGIN 3 showed an annualized eGFR slope through 104 weeks of minus 0.6 mL/min/year for TRUTAKNA versus minus 5.6 for placebo. TRUTAKNA reduced the risk of kidney disease progression by 76%, with a hazard ratio of 0.24.
• Vera submitted a supplemental biologics license application seeking full U.S. approval. Management anticipates potential full FDA approval in mid-2027 and plans a European marketing authorization application in Q1 2027.
• Q3 net loss widened to $93.7 million, or $1.30 per share, as SG&A expenses rose to $61.4 million due primarily to investment in the TRUTAKNA commercial launch.
• Vera ended September with $384 million in cash equivalents and marketable securities. Including a $75 million debt draw in October, the pro forma balance was $459 million.

Core Financial Data

Business and Operating Performance

TRUTAKNA became the first U.S.-approved therapy targeting both BAFF and APRIL to reduce proteinuria in adults with primary IgA nephropathy at risk of disease progression. Vera received approximately 700 patient start forms between the July 7 launch and November 5.

Management said early use came largely from the existing diagnosed patient pool receiving background therapies such as steroids, ACE inhibitors or ARBs, and SGLT2 inhibitors. Many patients had also previously received FILSPARI or TARPEYO. Physicians prescribed TRUTAKNA across a broad patient range, including those with proteinuria below 1 gram.

The company has completed more than 29,000 sales calls. Its initial commercial focus includes high-volume nephrologists and academic centers. Vera is also supporting benefit verification, prior authorization, appeals and financial assistance through TRUTAKNA Tru Support.

Management said approximately half of Q3 product revenue represented underlying demand and half represented inventory. The company expects the demand component to account for a larger share in subsequent quarters.

ORIGIN 3 clinical results

The ORIGIN 3 final efficacy analysis included 428 adults and met all prespecified endpoints. At week 52, the placebo-adjusted eGFR benefit was 5.6 mL/min, with a change of minus 0.1 for TRUTAKNA versus minus 5.7 for placebo.

Through 104 weeks, the placebo-adjusted annualized eGFR slope benefit was 5.0 mL/min/year. The respective slopes were minus 0.6 for TRUTAKNA and minus 5.6 for placebo.

TRUTAKNA reduced the risk of the composite kidney disease progression endpoint by 76%, with a hazard ratio of 0.24. A sustained eGFR decline of at least 30% occurred in 5% of TRUTAKNA patients and 18% of placebo patients. No TRUTAKNA-treated patient progressed to dialysis, kidney transplantation or death, compared with seven placebo patients.

At 104 weeks, the placebo-adjusted reduction in UPCR was 60%, while hematuria resolved in 97% of TRUTAKNA-treated patients who had hematuria at baseline.

Overall adverse events occurred in 75% of TRUTAKNA patients versus 78% on placebo. Serious adverse events were reported in 7% and 15%, respectively, while discontinuations due to adverse events occurred in 2% and 10%. Infection rates were similar, and the company reported no opportunistic infections, clinically relevant hypogammaglobulinemia or deaths in the TRUTAKNA group.

Pipeline expansion

In the Phase II PIONEER basket trial, atacicept reduced proteinuria by 52% from baseline at week 24 across broader IgA nephropathy populations. These included patients with eGFR as low as 20 mL/min, proteinuria below 1 gram, IgA vasculitis with nephritis and recurrent disease after kidney transplantation.

In 16 adults with anti-PLA2R-positive primary membranous nephropathy, antibody reductions were detectable by week four, while proteinuria declined during the first 12 weeks. Vera is also enrolling pediatric patients aged 10 and older and expects to expand enrollment to children aged two to 10 in the future.

Management Outlook

• Vera anticipates potential full FDA approval of TRUTAKNA in mid-2027, subject to the regulatory review of its recently submitted sBLA.
• Following discussions with the European Medicines Agency’s Committee for Medicinal Products for Human Use, the company plans to submit a European marketing authorization application in Q1 2027.
• Management is targeting payer coverage representing 50% of covered lives by the end of 2026.
• Vera expects to review data from the de novo cohorts in its monthly atacicept dose-ranging study later in Q4 2026. Results from the weekly-to-monthly switch cohort are expected to be reviewed in Q2 2027.
• Up to $350 million remained available under the company’s debt facility as of the earnings call, subject to specified conditions.

Risks and Areas to Watch

Commercial adoption remains at an early stage. Management said nephrologists need time to identify eligible patients, complete access requirements and gain experience with TRUTAKNA. It was also too early to determine whether IgA nephropathy diagnosis rates or coding had increased.

Payer policies continue to develop. Some policies require branded step-throughs involving products such as FILSPARI or VANRAFIA, although management said these requirements affect the B-cell modulator class similarly.

Approximately half of initial product revenue came from inventory rather than demand, making future prescription conversion and patient starts important measures of launch progress.

The monthly dosing program remains under evaluation. Management said it would review pharmacokinetic, pharmacodynamic, efficacy and safety data internally before providing further detail. The final wording of a potential full-approval label also remains subject to FDA review.

Analyst Q&A Highlights

• Post-ASN demand: Management said demand continued at a healthy pace after ASN Kidney Week, but it was too early to identify an inflection. The company expects the ORIGIN 3 presentation to support Q4 activity.
• Prescriber breadth: The approximately 700 patient start forms were not driven by a small cohort of physicians. Vera said it was encouraged by the breadth of adoption but wanted another quarter of data before providing more detail.
• Repeat prescriptions: Management said the timing of repeat patient start forms partly depends on how frequently IgA nephropathy patients visit nephrologists. Early follow-up visits and laboratory results were described as supportive of additional prescribing.
• Immunoglobulin monitoring: Vera said TRUTAKNA does not require immunoglobulin monitoring. In ORIGIN 3, discontinuation would have occurred after two IgG readings below 200, but no patient reached that threshold.
• Potential full-approval label: Management expects language stating that the impact on GFR and kidney function has not been established to be removed if full approval is granted. It declined to provide further expectations while the FDA review is pending.
• Future disclosures: Vera plans to report patient start forms through the end of each completed quarter rather than through the date of future earnings calls.

Full Earnings Call Transcript

Complete Earnings Call Transcript

Management Remarks

Operator

Good day, and welcome to the Vera Therapeutics Business Update and Financial Results Webcast for the quarter ended September 30. [Operator Instructions] As a reminder, this webcast is being recorded. If you have any objections, please disconnect at this time. I would now like to turn the call over to Josh Qin, Vice President of Corporate Finance and Investor Relations at Vera. Please go ahead.

Joshua Qin

Thank you, operator, and thank you, everyone, for joining us. Earlier today, we issued a press release announcing our business highlights and financial results for the quarter ended September 30, 2026. A copy of the press release is available in the Investors and Media section of our website at ir.veratx.com.

Before we begin, I would like to remind everyone that we will be making various remarks about future expectations, plans, and prospects, which constitute forward-looking statements for the purposes of the safe harbor provisions under the Private Securities Litigation Reform Act of 1995. The company cautions that these forward-looking statements are subject to risks and uncertainties that could cause actual results to differ materially from those indicated. We encourage everyone to review the company's filings with the SEC, including without limitation the company's most recent Form 10-K and Form 10-Q, which identify specific factors that may cause actual results or events to differ materially from those described in the forward-looking statements.

In addition, today's discussion includes results from ongoing clinical trials of atacicept in investigational uses that have not been approved by the FDA or any other regulatory authority. The full prescribing information for TRUTAKNA, including important safety information, is available on our website. Furthermore, the content of this webcast contains time-sensitive information that is accurate only as of the date of the live broadcast, November 5, 2026. Vera undertakes no obligation to revise or update any statements to reflect events or circumstances after the date of this broadcast. This webcast is being recorded and an archive will be available on our website for 30 days.

With that, I will turn the call over to Dr. Marshall Fordyce, Founder and Chief Executive Officer. Marshall?

Marshall Fordyce

Thank you, Josh, and welcome, everyone. Joining me today are Dr. Robert Brenner, our Chief Medical Officer; Matt Skelton, our Chief Commercial Officer; and Sean Grant, our Chief Financial Officer. The third quarter marked a major turning point for Vera. Following accelerated approval from the FDA in July, we launched TRUTAKNA, the first therapy approved in the U.S. that targets both BAFF and APRIL to reduce proteinuria in adults with primary IgA nephropathy at risk for disease progression.

Since the accelerated approval of TRUTAKNA on July 7, we have received approximately 700 patient start forms to date. This early momentum exemplifies our longstanding confidence in TRUTAKNA's potential to become a foundational therapy for IgA nephropathy, and it represents an important first step in delivering on our commitment to people living with this disease. We're sharing this figure today because we believe it's the best measure of demand at this early stage of launch.

Moving forward, we expect net product revenue to become the primary indicator of progress in addition to quarterly patient start forms. The ORIGIN 3 final efficacy results presented at ASN Kidney Week in October strengthens the clinical foundation for this next phase of growth. As Rob will discuss, in the ORIGIN 3 final efficacy analysis, TRUTAKNA held the rate of kidney function decline to a physiologic level and reduced the risk of kidney disease progression by 76% compared with placebo through 104 weeks. We are pleased with the overall product profile and believe that we have one of the most robust data packages in the B-cell modulator class. These findings build on the proteinuria reduction at 36 weeks that supported accelerated approval.

This week, we submitted a supplemental biologics licensing application to the FDA, seeking full approval of TRUTAKNA in adults with primary IgA nephropathy based on the ORIGIN 3 final efficacy analysis. In addition, following a meeting with the Committee for Medicinal Products for Human Use at the European Medicines Agency, we plan to submit a marketing authorization application in the first quarter of 2027 for standard marketing authorization. Importantly, this application will leverage the same results presented at Kidney Week. These are important regulatory milestones as we advance toward potential full FDA approval in mid-2027, with potential approvals in other regions to follow.

Alongside the U.S. launch and our pursuit of full approval in the U.S. and other regions, we are advancing the ongoing development program to expand the opportunity for atacicept. This includes the Phase II PIONEER basket trial in broader IgA nephropathy populations and other antibody-mediated kidney diseases, including encouraging interim results presented at ASN, as well as the once-monthly dose range finding study. This integrated program reflects our ambition to build on our progress in adult IgA nephropathy and bring new treatment options to more patients over time.

With the early launch progress and expanding clinical evidence, Vera is now viewed as a leading kidney disease company. We are entering this next phase with enthusiasm and a clear focus on execution, bringing TRUTAKNA to more eligible patients today while developing opportunities to improve care for more patients in the future.

With that, I'll turn the call over to Dr. Robert Brenner for a recap of ASN and an update on our development activities. Rob?

Robert Brenner

Thank you, Marshall. Having spent the past few years working to advance atacicept through clinical development and U.S. regulatory approval, it is deeply rewarding to now see TRUTAKNA reaching patients. I want to recognize our colleagues across the organization for the strong start to the product launch and their commitment to helping patients access treatment. Vera is advancing the ongoing clinical development program with the objective to bring atacicept to more patients and broaden its potential across autoimmune kidney diseases. That work begins with pursuing full approval in adults with primary IgA nephropathy at risk for disease progression, supported by the ORIGIN 3 final efficacy results.

Two weeks ago, Dr. Jonathan Barratt presented the ORIGIN 3 final efficacy analysis as a late-breaking oral presentation in the opening plenary session of ASN Kidney Week with simultaneous publication in the New England Journal of Medicine. ORIGIN 3 randomized and dosed 428 adults with IgA nephropathy, and the final efficacy analysis met all prespecified endpoints. On the key secondary endpoint, the placebo-adjusted eGFR change from baseline at 52 weeks was 5.6 mL per minute. eGFR was minus 0.1 mL per minute with TRUTAKNA compared with minus 5.7 with placebo on top of background therapy. Through 104 weeks, the placebo-adjusted annualized eGFR slope was 5.0 mL per minute per year with minus 0.6 with TRUTAKNA versus minus 5.6 with placebo. The eGFR benefit observed with TRUTAKNA was preserved across all prespecified subgroups.

These data demonstrate that patients treated with TRUTAKNA lose kidney function at a physiologic rate of approximately minus 1 mL per minute per year, while patients on placebo and background therapy continue to lose eGFR at a pathologic rate and a high probability of developing kidney failure during their lifetime. TRUTAKNA also reduced the risk of the composite kidney disease progression endpoint by 76% compared with placebo through 104 weeks with a hazard ratio of 0.24, 11 patients on TRUTAKNA, or 5%, had a sustained decline in eGFR of 30% or more, compared with 38 patients, or 18%, on placebo. Zero patients on TRUTAKNA progressed to dialysis, kidney transplantation, or death compared with 7 patients on placebo.

At 52 weeks, the placebo-adjusted reduction in UPCR was 51%, and in galactose-deficient IgA1 was 67%, and hematuria resolved in 81% of TRUTAKNA-treated patients who had hematuria at baseline. And at 104 weeks, the placebo-adjusted reduction in UPCR was 60%, and hematuria resolved in 97% of TRUTAKNA-treated patients who had hematuria at baseline.

In the ORIGIN 3 final efficacy analysis, TRUTAKNA was well tolerated with a safety profile generally comparable to placebo. Overall adverse events occurred in 75% of patients on TRUTAKNA versus 78% on placebo. Serious adverse events occurred in 7% of patients on TRUTAKNA versus 15% on placebo, and adverse events leading to discontinuation occurred in 2% versus 10%, respectively. The most common adverse events associated with TRUTAKNA and placebo, respectively, were infections 51% versus 52%, and local administration reactions 30% versus 8% (sic) [ 5% ]. Infection rates were similar between the 2 arms. There were no opportunistic infections or clinically relevant hypogammaglobulinemia, and no deaths occurred in the TRUTAKNA group.

In the final efficacy analysis, 93% of TRUTAKNA-treated patients remained on therapy compared with 79% on placebo. These results form the basis of the recently submitted sBLA seeking full approval of TRUTAKNA in adults with primary IgA nephropathy, which is anticipated in mid-2027. ORIGIN 3 placebo participants are transitioning to open-label TRUTAKNA for the remainder of the trial. We reiterate our gratitude to the patients, investigators, employees, and collaborators who helped make this trial possible.

Next, I'll turn to PIONEER, a Phase II basket trial evaluating atacicept in broader IgA nephropathy populations and in other antibody-mediated kidney diseases. At ASN Kidney Week, Dr. Richard Lafayette presented interim results from the adult IgA nephropathy and primary membranous nephropathy cohorts as a late-breaking oral presentation. At the time of this interim analysis, the IgA nephropathy cohorts enrolled 101 adults with baseline characteristics distinct from what is studied in Phase III IgA nephropathy trials, including patients with eGFR as low as 20 mL per minute, patients with proteinuria below 1 gram, patients with IgA vasculitis with nephritis, and patients with recurrent IgA nephropathy after kidney transplantation. In these populations, atacicept reduced proteinuria by 52% from baseline at week 24, similar to the results from ORIGIN 3. Reductions were consistent across cohorts with low baseline eGFR, low baseline proteinuria, and IgA vasculitis with nephritis.

At the time of this interim analysis, the primary membranous nephropathy cohort had enrolled 16 adults with anti-PLA2R-positive disease, most of whom had nephrotic-range proteinuria. Reductions in anti-PLA2R antibody levels were detectable as early as week 4, and proteinuria declined over the first 12 weeks of treatment. These early data are consistent with what we would expect from a mechanism that acts upstream of autoantibody production.

In this interim analysis of PIONEER, the safety profile was consistent with the broader atacicept experience, with no adverse events leading to discontinuation and no opportunistic infections. We believe these results support continued investigation of atacicept in antibody-mediated glomerular diseases. Finally, in a separate poster, we outlined the PIONEER investigation of pediatric patients with IgA nephropathy. The trial is currently enrolling children aged 10 and older, and we expect to open enrollment to children aged 2 to 10 in the future. We will also be reviewing data from the ongoing monthly dose range finding study of atacicept later this quarter. Our goal is to build on the evidence in adult IgA nephropathy while pursuing the most promising opportunities to bring this important therapy to additional patient populations.

I'll now turn the call over to Matt Skelton to discuss our commercial progress. Matt?

Matt Skelton

Thank you, Rob. The TRUTAKNA launch is off to a strong start. As Marshall mentioned, we have received approximately 700 start forms since launch to date. We are encouraged by this early demand, which reflects both the significant unmet need in IgA nephropathy and the receptivity to the TRUTAKNA product profile. At the same time, we are just scratching the surface of the large potential for TRUTAKNA. As we have said from the outset, adoption will build over time as nephrologists identify appropriate patients, work through access requirements, and gain experience with TRUTAKNA. Our sales, market access, and patient support teams are working together to help eligible patients move from a treatment decision to starting therapy.

Beyond the safety and efficacy data, we believe that the experience of once-weekly self-administration at home with a small-volume autoinjector adds to TRUTAKNA's appeal for patients and physicians. Based on field feedback and over 29,000 sales calls to date, many patients like the ease of weekly at-home administration, while many physicians like the flexibility of weekly dosing should an adjustment be needed based on clinical judgment.

Helping eligible patients access treatment is a key launch priority. We are encouraged by the payer coverage policies taking shape. Our focus is on securing coverage that allows eligible patients to begin treatment without unnecessary delay. Through TRUTAKNA Tru Support, our patient support program, we are helping TRUTAKNA patients navigate insurance coverage, including benefit verification, prior authorization, and appeals, and are working to connect them with financial assistance options. Eligible commercially insured patients may pay as little as $0 out of pocket through our copay assistance program. And finally, our patient assistance program may provide TRUTAKNA at no cost to eligible uninsured or underinsured patients.

We are building a strong foundation for sustained growth by broadening adoption and expanding access for eligible patients. We are encouraged by the progress so far and confident in the opportunity ahead for TRUTAKNA. I'll now turn the call over to Sean to review our financial results. Sean?

Sean Grant

Thank you, Matt. I'll provide an overview of our financial results for the third quarter ended September 30, 2026. Additional details are available in today's press release and our Form 10-Q. Net product revenue from sales of TRUTAKNA was $10.3 million for the third quarter of 2026, our first partial quarter of commercial sales. Cost of sales was $3.3 million. Research and development expenses were $41.3 million for the third quarter of 2026, compared with $56.5 million for the same period in 2025. The decrease was primarily due to a reduction in contract manufacturing expenses recorded in research and development.

Following accelerated approval on July 7, 2026, manufacturing costs for TRUTAKNA commercial supply are now capitalized as inventory, whereas they were previously expensed as research and development. Selling, general and administrative expenses were $61.4 million compared with $27.5 million for the prior year period. The increase primarily reflected investment in the commercial launch of TRUTAKNA. Net loss for the quarter was $93.7 million, or $1.30 per share, compared with a net loss of $80.3 million, or $1.26 per share for the prior year period.

For the 9 months ended September 30, 2026, net cash used in operating activities was $305.9 million compared with $171.1 million for the prior year period, primarily reflecting increased investment in the commercial launch of TRUTAKNA. As of September 30, 2026, we had $384 million in cash equivalents, and marketable securities. In late October, we drew $75 million on our debt facility. On a pro forma basis, adjusting solely to reflect the October borrowing as if it had occurred on September 30, our balance of cash, cash equivalents, and marketable securities would have been $459 million.

As of today, up to $350 million remain available under our debt facility, subject to the satisfaction of certain conditions. Together, our cash resources and borrowing capacity provide the financial flexibility to support the TRUTAKNA launch and our ongoing trials. This concludes our prepared remarks. Operator, we are ready to open the call for questions.

Operator

[Operator Instructions] Our first question comes from Anupam Rama with J.P. Morgan.

Question-and-Answer Session

Joyce Zhou

Can you hear me now? Sorry.

Operator

Yes, indeed.

Joyce Zhou

This is Joyce on for Anupam. I know it's only been 2 weeks since ASN, but we were just wondering if there's been any early signs of pull-through in terms of demand or patient start forms after the final ORIGIN 3 presentation?

Marshall Fordyce

Yes. Matt, maybe you could answer that question for us.

Matt Skelton

Yes. The demand continues at a nice pace since ASN. It would be probably too early to see an inflection at this point. But we were super pleased with the Vera showing at ASN and think that, that's going to be a catalyst for us in Q4.

Operator

Our next question comes from Gavin Clark-Gartner with Evercore ISI.

Gavin Clark-Gartner

On the monthly data, so Rob, you noted in your prepared remarks that you will be seeing monthly data later this quarter. Are you expecting to present that data publicly? Or are you waiting for some additional data next year? Or are you waiting to have some more regulatory clarity before giving an update here? Really just overall, what is your level of confidence on the monthly program at this point?

Robert Brenner

Yes. Thanks for the question. The atacicept dose range finding study is ongoing. The study includes 3 different de novo monthly dose cohorts, a cohort switching from weekly to monthly dosing, and a control weekly cohort. We're going to be looking at all the data -- PK/PD, efficacy measures, and safety -- from the de novo cohorts with the analysis forthcoming with this quarter. And we'll be looking at the results from the switch cohort in Q2 of 2027. We're not very far away from having those data in hand. I think we'll stare into them internally, and then we'll have more to say after we've looked at the results.

Operator

Our next question comes from Ritu Baral with TD Cowen.

Ritu Baral

Can you hear me okay?

Marshall Fordyce

Yes, indeed.

Ritu Baral

I wanted to ask about -- questions for Matt specifically. What are you seeing now and maybe retrospectively in the last 3 months or so on trends of diagnosis in IgAN, now that there's 2 players in the market and disease awareness by at least 1 more? Are you seeing rising trends, increased diagnostic codes being utilized? And then my second question has to do about the current prescriber characteristics and call points. Can you walk us through how you're prioritizing call points and prescribers? Like, do you have tiering based on whether they're at centers of excellence versus community? Just that sequencing.

Matt Skelton

Sure. Ritu, yes, I think it would be too early for us to comment on if we're seeing increased diagnosis rates or coding. I think right now what we're seeing is we know that there's a large prevalent pool of patients that are already diagnosed with IgAN that are already receiving backbone treatments of IgAN. Those are the patients that we're seeing that are being moved to TRUTAKNA, and those are the ones we're discussing with nephrologists. As far as what the prescribers look like, what our call points are, in these early months, we're spending our time where the business is with the high decile physicians, 8, 9, 10 deciles. Also, we're in the academic centers as well. So that's been a real emphasis in these early months of launch.

Operator

Our next question comes from Pete Stavropoulos with Cantor Fitzgerald.

Unknown Analyst

Marshall, Sean, Rob, and Matt, this is [ Samantha ] on the line for Pete. Congrats on the early commercialization updates. Could you give us some more granularity on the types of patients represented in the patient start forms received to date? Are physicians initiating TRUTAKNA in a broad population or sticking to higher-risk patients? Trying to understand how broad of a population you are seeing adoption with, including patients closer to the KDIGO threshold of 0.5 grams per day.

Marshall Fordyce

Thanks for the question, [ Samantha ]. We're thrilled with the early momentum. And Matt, maybe I'd have you reiterate the indication statement breadth and maybe some color on what we're seeing early here.

Matt Skelton

I think we are seeing the benefits of the broad indication statement, Samantha. We're seeing patients with more than 1 gram of protein, and we're seeing patients prescribed that have less than 1 gram of protein. So we're pleased. I think it's a pretty broad swath we're seeing, and I think that mix will continue. And hopefully, we're tapping into what is currently viewed as less severe patients. So yes, but right now, a good mix.

Operator

Our next question comes from Rami Katkhuda with LifeSci Capital.

Rami Katkhuda

Congrats on the progress. I know it's still early, but what are you guys seeing in terms of prescriber breadth and depth? Are early TRUTAKNA prescriptions concentrated among a smaller number of high-volume nephrologists? Or are you seeing broader adoption with fewer prescriptions per physician?

Marshall Fordyce

Matt?

Matt Skelton

Yes, happy to take that. I'd like to get another quarter under my belt before we really start diving into depth and breadth, but we are pleased so far. The 700 patient start forms are not being driven by a small cohort of physicians. We feel good about the breadth to date.

Operator

Our next question comes from Mohit Bansal with Wells Fargo.

Mohit Bansal

A couple of questions, if I may. One is, have you disclosed out of the $10 million, how much was stocking versus the demand-driven sales? That's number one. And number two, you mentioned that there were no cases of clinically relevant hypogamma in Phase III trial. Would you be able to explain how it was defined and if there were cases falling below 300 during this trial. Congrats on the quarter.

Marshall Fordyce

Thanks so much, Mohit. Maybe Matt, first on the stocking question and then Rob, on the hypogamma handling.

Matt Skelton

Yes, I can start. Mohit, yes, about half of that is demand, about half is inventory. And we fully expect that ratio to go much higher for demand in the next quarters.

Robert Brenner

Yes. And in terms of hypogammaglobulinemia, we haven't seen clinically relevant hypogammaglobulinemia in the program. In ORIGIN 3, patients received their drug assignment without interruption and were not withheld due to their IgG levels. In the Phase III protocol, we used an IgG threshold below 200, and if there were 2 values below 200, there would be discontinuation of treatment. No patient reached that threshold. There has been no imbalance of infections across the program and no opportunistic infections.

Operator

Our next question comes from Vamil Divan with Guggenheim Securities.

Vamil Divan

Maybe just following up on that last question around immunoglobulin levels. Can you just share what you're seeing in terms of doctors as they start patients on this, or maybe broadly on these new B-cell modulators? Are they monitoring their patients' immunoglobulin levels? I know it's not required or mandated by the FDA, but I'm just curious if in the real world, if you're seeing any doctors doing that just as they get used to using these new products.

And then, Marshall, I just have a quick clarification question I'm getting from a couple of people. It sounds like going forward on the earnings updates, we should expect you'll give PSFs through the end of the prior quarter, not to the date of the call. Can you just clarify that's what you meant, and would you be providing any updates intra-quarter? Just getting a couple of people asking me that question. So maybe you can clarify.

Marshall Fordyce

Yes, happy to clarify that. Going forward, we'll use the quarter definitively moving forward. We think in this early stage, it's important to give an up-to-date view of demand in the early stage of launch. I would clarify that there is no monitoring required for the use of TRUTAKNA, and that's been true both in clinical as well as our experience out in the field with commercial utilization.

Operator

Our next question comes from Farzin Haque.

Farzin Haque

I wanted to get some more color on the PSFs. Like what is the split between the treatment-naive patients versus like switches off an existing agent? And within the switches, how much is coming off FILSPARI, TARPEYO and even VOYXACT for that matter?

Marshall Fordyce

Yes. Matt, I'll have you take that and just clarify what we mean by switch versus standard of care out there.

Matt Skelton

Farzin, these 700 PSFs are almost all from the prevalent patient pool. So these patients are on the backbone of therapy, be that steroids, ACE/ARB, SGLT2s. Many have been on FILSPARI and our TARPEYO. So that really is the patient that physicians are choosing to move onto TRUTAKNA at this point. I wouldn't -- and Marshall said it, I wouldn't call it switching. I think it's just almost a graduation and a move to a truly disease-modifying agent like TRUTAKNA.

Operator

Our next question comes from Dina Ramadane with Bank of America.

Dina Ramadane

Congrats on all the progress this quarter and the updates. Just 2 quick ones from us. Among physicians who have submitted 1 patient start form, what determines whether they progress to a second, third and so forth patient? Are repeat prescribers responding primarily to ease of access, patient experience with the autoinjector, early proteinuria measurements or confidence created by the final ORIGIN 3 data?

And second one, you guys previously described your access objective as parity with other products in the market. What does that mean in operational terms today, specifically across covered commercial lives? Like, what proportion of policies are permitting TRUTAKNA without a branded product step edit? And do those requirements differ from VOYXACT?

Marshall Fordyce

Matt, could you take that?

Matt Skelton

I'm happy to take that. I'll handle. On the covered lives, we're progressing well there. We're on track to meet a goal of 50% of covered lives by the end of the year. Any branded step-throughs that are out there with payers impact the B-cell class in the same way, and some of the branded step-throughs that are out there usually involve FILSPARI or VANRAFIA. But on the payer front, as each week goes by, we're seeing improvements, and we feel good about our progress there.

Regarding the physicians that have written or submitted a PSF, keep in mind, Dina, that a busy nephrologist for us in the community has 6, 7 IgAN patients. So one patient's start form, they may have just seen one of their IgAN patients since we've been on the market, right? So it's the rate at which IgAN patients are coming to the office. But there's nothing stopping them from writing that second. I think it's just the opportunity to use the product to get it.

What is a really rewarding part of -- we've been out there long enough now where many patients have come back in for a second visit once they've been on TRUTAKNA and are seeing fantastic results from the lab values. That is certainly a validation to the nephrologist and the patient of what TRUTAKNA can provide and certainly is a great stimulus for that second, third, and fourth patient start form.

Marshall Fordyce

I'll just add that this is a transformative product profile, and just presented at ASN and published in the New England Journal, looking at renal endpoints. These are data that we expect will be very impactful in terms of the launch going forward. So very encouraged by these early signs of a successful launch.

Operator

Our final question comes from Ryan Deschner with Raymond James.

Ryan Deschner

Congrats on the sBLA submission and strong early launch data. Curious on label expectations now that you've submitted your sBLA for full approval, how you're thinking about what data might make it onto the label, and what differences on the first page of the label you're expecting versus your accelerated approval label and how that thinking has evolved over time?

Marshall Fordyce

Yes. Rob, I'll have you take that.

Robert Brenner

Yes. So the accelerated approval is based on a proteinuria reduction endpoint, and the label calls out that the impact of TRUTAKNA on GFR and kidney function has not yet been established. Expectation is that with full approval now based on the GFR results, that language will be removed, and so the indication will be based on the impact on GFR and kidney function. There is precedent in product labels that have used composite kidney progression endpoints for that information to be in the label, and so we are thrilled that we've been able to move so quickly to submit the sBLA this month to the FDA, and we're eager to go through the review cycle with them. I really don't want to make any other comments about what the label might look like until we get further into that process.

Operator

This concludes our Q&A session. I will now turn the call back to Dr. Fordyce for closing remarks.

Marshall Fordyce

Thank you, operator. Just to close, we are proud of the progress we've made to date as a commercial-stage company. As we look ahead, our focus is on continuing to build out the TRUTAKNA launch, to advance toward potential full approval and developing atacicept for additional patients who need new treatment options. With that, I want to thank the patients, investigators, physicians, and the Vera employees who have made this progress possible. We're excited about the opportunity ahead and are committed to executing with urgency and with discipline. Thank you for your time and have a good day. We'll close the call now.