Aliskiren Fumarate

GLP-1、ADC、双抗……是2024年创新药行业的高频词汇，相关交易层出不穷，以上热门靶点和创新技术为多个疾病领域带来了治疗突破，填补了诸多临床未满足需求。 创新药的故事持续演绎，不断有创新疗法经过临床研究的验证走向成功。去年末，医药魔方从疾病负担和靶点角度筛选了8项值得关注的研究，其中有6项在2024年揭晓结果，喜悲参半。当下，基于医药魔方TrialCube数据库，我们从843项预计在2025年完成的III期临床试验中筛选出特别值得关注的10项研究，供大家参考。 2025年值得期待的10项III期研究 注：医药魔方整理 NO.1 顽固的高血压有望迎来创新疗法 在β受体阻滞剂、血管紧张素转换酶抑制剂（ACEI）、血管紧张素II受体抑制剂（ARB）等多种类型降压药物出现后，高血压患者的降压需求得到了极大的满足。但是，仍然有一半的患者无法实现较好的血压控制效果。 大约25%的高血压源于醛固酮水平失调。醛固酮水平受肾素-血管紧张素-醛固酮系统（RAAS）调控，因而阻断RAAS是大部分现有降压药物的主要机制，例如阿利吉仑（肾素抑制剂，抑制血管紧张素原转化为血管紧张素I）、卡托普利（ACEI，抑制血管紧张素I转化为血管紧张素II）、缬沙坦（ARB，阻断血管紧张素II与其受体的结合）等。不过，目前还没有针对性抑制醛固酮（aldosterone）合成的药物上市。 醛固酮合成酶（ALDOS，由CYP11B2基因编码）是一个较为新颖的研究方向，其关键之处在于可调控醛固酮合成的最后3个步骤，因而是抑制醛固酮合成的理想靶点。 不过，由于CYP11B2基因与编码皮质醇合成酶的CYP11B1基因的序列同源性较高（93%），药物选择性差会导致患者的皮质醇水平也受到影响，因而控制选择性是开发ALDOS抑制剂必须解决的一个大难题。已上市的奥西卓司他（Novartis/Recordati）便是一款未能分离CYP11B1与CYP11B2选择性的产品，因而其仅获批了库欣综合征适应症。 目前，全球已有2款针对高血压的ALDOS抑制剂进入III期阶段，即Baxdrostat（阿斯利康）和Lorundrostat（Mineralys Therapeutics）。临床前数据显示，Baxdrostat和Lorundrostat的CYP11B2/CYP11B1选择性分别为>100倍和374倍。这两款药物均已有II期研究数据披露。 Baxdrostat和Lorundrostat的II期研究降压数据 从II期研究数据来看，Baxdrostat和Lorundrostat的降压效果差距不大，而且研究中均未出现皮质醇水平异常的情况。这两款药物的降压III期研究预计均将在2025年完成，届时可进一步知晓其抗高血压潜力。按登记数据来看，Lorundrostat将比Baxdrostat早7个月完成，我们可以先期待一下Lorundrostat的数据。 NO.2 丰富胶质母细胞瘤治疗选择 大多数肿瘤类型已经拥有多样化的治疗选择，但胶质母细胞瘤（GBM）是其中的例外。GBM是最常见也是最具侵袭性的一种脑肿瘤，被称为“脑瘤之王”，约占原发性恶性中枢神经系统肿瘤的46.1%。手术和放化疗是这类患者的传统治疗策略，但预后不佳。恶性胶质瘤患者5年总生存率不足10%。 目前，GBM的靶向治疗药物仅包括贝伐珠单抗和伯瑞替尼，其中后者仅限于PTPRZ1-MET融合基因的IDH突变型星形细胞瘤（WHO 4级）或有低级别病史的胶质母细胞瘤患者使用。除此之外，Novocure和再鼎医药合作开发的肿瘤电场疗法TTFields也可用于治疗GBM。 研究表明，脂肪酸合成酶（FASN）是调节脂质代谢的最重要的蛋白质之一。许多实体瘤和血液肿瘤都过度表达FASN，包括复发性GBM等。地尼法司他（ASC40）是歌礼制药自Sagimet Biosciences引进的一款脂肪酸合成酶（FASN）抑制剂，可抑制肿瘤细胞能量供应和扰乱肿瘤细胞膜磷脂组成。 II期临床数据显示，GBM患者接受地尼法司他联合贝伐珠单抗治疗后，客观缓解率（ORR）达到了65%，其中完全缓解（CR）和部分缓解（PR）分别占17%和39%。此外，无进展生存期（PFS）达到6个月的患者比例为47%，明显高于过往贝伐珠单抗单药治疗的6个月PFS历史数据（16%）。 歌礼制药针对GBM开展的III期ASC40-301研究将于2025年6月完成。该研究若能获得积极结果，地尼法司他有望成为GBM患者的突破性治疗药物。 NO.3 社恐人群的第二个希望 社恐是一种严重的焦虑症，其特征是对社交或与表现相关的情况持续、强烈的恐惧。美国大约有2370万成人社恐患者，我国每年大约有560万人确诊社恐。目前尚无速效、按需治疗社恐的疗法获批。当前的护理标准为抗抑郁药和苯二氮卓类药物的超说明书使用，其具有显著的潜在副作用和安全性问题。 此前鼻喷雾剂PH94B（fasedienol）曾在III期研究中展现出对社恐有疗效的迹象，但其疗效仍然存疑，并且临床设计也有不合理的地方，因此PH94B仍在反反复复验证其社恐治疗效果。 BNC210是Bionomics开发的一款靶向α7烟碱乙酰胆碱受体（α7 nAChR）的负向变构调节剂，已获FDA授予快速通道资格，用于治疗创伤后应激障碍（PTSD）、其他创伤和压力源相关疾病、急性治疗社恐和其他焦虑相关疾病。 2023年3月，BNC210（225mg或675mg）治疗社恐的II期PREVAIL研究顺利完成。数据显示，相比于安慰剂组，BNC210组患者的主观焦虑量表（SUDS）评分未显著改善（评分差异为5.69分，P=0.165），但结果具有临床意义且显示出了BNC210有益于改善社恐患者焦虑症状的趋势。 因而，Bionomics还是决定在III期研究（AFFIRM-1）中继续评估BNC210的社恐治疗潜力。这项III期研究将在2025年8月完成。社恐人群能否拥有缓解社交焦虑症状的药物，相信明年可以知晓答案。 NO.4 “万能”GLP-1的下一个惊喜 GLP-1从2023年火到了2024年，这不仅仅是因为GLP-1药物具备强大的降糖和减肥效果，还因为其出色的“破圈”能力。迄今为止，以司美格鲁肽和替尔泊肽为代表的GLP-1药物已经在阻塞性睡眠呼吸暂停（OSA）、代谢障碍相关脂肪性肝炎（MASH）、慢性肾病（CKD）等疾病领域展现了其“溢出效应”。阿尔茨海默病将是GLP-1“破圈”计划的下一站。 已经有不少文献揭示过GLP-1对阿尔茨海默病的有益治疗作用。近期，还有一项基于美国电子健康记录的模拟研究表明，接受司美格鲁肽（Ozempic）治疗的2型糖尿病患者，首次确诊阿尔茨海默病的风险降低了67%。这为诺和诺德开展的司美格鲁肽治疗阿尔茨海默病的III期研究提供了更高的成功确定性。 NO.5 强效降脂靶点有望迎来首个口服药物 Enlicitide（MK-0616）是默沙东开发的一款口服环肽类前蛋白转化酶枯草溶菌素9（PCSK9）抑制剂。PCSK9主要在肝脏表达，是“坏胆固醇”LDL-C升高的帮凶。PCSK9可与肝细胞表面负责清除LDL-C的受体结合，导致LDL-C堆积。 针对高胆固醇血症的IIb期研究（n=381）结果显示，治疗第8周，接受Enlicitide（6/12/18/30mg，每日1次）治疗的患者的LDL-C水平均实现了统计学意义的降低，具体降幅分别为-41.2%、-55.7%、-59.1%和-60.9%。 目前，全球共6款PCSK9靶向药物获批上市，分别为英克司兰（诺华）、托莱西单抗（信达生物）、依洛尤单抗（安进/安斯泰来）、阿利西尤单抗（再生元/赛诺菲）、伊努西单抗（康方生物）和昂戈瑞西单抗（君实生物），这6款产品均已在中国上市。此外，还有恒瑞医药的瑞卡西单抗和Lib Therapeutics/海森生物的莱达西贝普处于申请上市阶段。 PCSK9赛道的白热化竞争足以说明该靶点在降脂上的市场潜力。作为目前进展最快的口服PCSK9药物，Enlicitide的III期研究能否取得足够显著的疗效数据，值得期待。 NO.6 鼻喷疫苗扩圈至RSV领域 虽然RSV赛道在今年遇到了不小的挫折，但是RSV疫苗的前景仍然值得期待，毕竟消除这个威胁婴幼儿和老年人生命的呼吸道疾病仍然是全球国家的共同目标。 赛诺菲此前布局的RSV中和抗体Beyfortus（尼塞韦单抗）已经上市，可保护新生儿在第一个RSV流行季（当年10月-次年3月）不受感染。不过，该产品面临来自辉瑞、GSK和Moderna的RSV疫苗的激烈竞争。 RSVt疫苗（SP0125）是赛诺菲与美国国家过敏和传染病研究所（NIAID）合作开发的一款针对RSV感染的鼻喷减毒活疫苗，适用于全年龄段幼儿。 可以说，RSVt疫苗是赛诺菲在RSV赛道选择的差异化策略。公开资料显示，RSVt疫苗可以在保护新生儿在第二个RSV流行季（次年4月-次年9月）不受感染。因此，Beyfortus和RSVt疫苗提供的双防线保障可以更大程度降低新生儿发生RSV感染的机率。若是能顺利完成III期研究，赛诺菲预计最早将在2026年提交该疫苗的上市申请。 NO.7 椎间盘退行性疾病的手术“救星” 椎间盘退行性疾病是一种常见的脊柱问题，主要影响中老年人群以及长期久坐人群。据估计，至少30%的30-50岁人群和大约90%的50岁以上人群会出现椎间盘退行。腰痛是这类疾病最常见的症状，其它症状还包括下肢疼痛麻木、间歇性跛行等。 症状轻的患者可以通过物理治疗或者锻炼缓解症状，但是症状严重者需要手术治疗。椎体间融合术是目前治疗腰椎退行性疾病经典而有效的手术方法，其目的是通过将不稳定椎体进行融合消除因脊柱结构完整性丢失所致的脊柱病理性运动，以缓解疼痛、提高功能活动能力并改善生存质量。但据文献报道，腰椎融合术后不融合发生率可高达56%。长期未融合的腰椎假关节会带来诸多问题。因而，提高脊柱融合率是一个亟待解决的问题。 AGA111是安济盛开发的一款重组人骨形态发生蛋白6（BMP-6），与体内BMP主要拮抗剂Noggin的结合具有可逆性，低剂量下即可在体内实现良好的成骨效果。此外，AGA111采用了无免疫原性、无致炎性的内源性生物相容性材料——自体血凝块作为递送载体，可以有效减少局部水肿和炎性反应的风险。 II期研究结果显示，在椎体间融合术后12个月时，AGA111（0.25/0.5mg）组受试者的新骨形成比例中位数高于对照组（安慰剂+自体血凝块），疼痛评分较基线改善幅度也明显优于对照组。此外，AGA111在研究中还显示出了在促进脊柱融合、改善功能障碍等方面的初步临床疗效。 NO.8 夜盲症治疗的曙光 夜盲症是指在光线昏暗环境下或夜晚视物不清或完全看不见东西的症状，其致病原因多种多样，例如缺乏维生素A、视网膜病变、遗传因素、屈光手术影响等。 据统计，美国约有3800万例夜盲症患者，我国约有1500万例夜盲症患者。因维生素A缺乏引起的暂时性夜盲可以通过服用维生素A补充剂或摄入富含维生素A的食物来缓解症状，但因视网膜病变和遗传因素等原因导致的夜盲症还没有可用的治疗药物。 Nyxol（0.75%甲磺酸酚妥拉明滴眼液）是目前唯一一款处于III期阶段的在研夜盲症治疗药物，可通过阻断虹膜扩张肌上的α1肾上腺素能受体（α1-AR）和α2肾上腺素能受体（α2-AR）起到适度缩瞳作用（昏暗环境下瞳孔会放大），从而改善患者在昏暗环境下的视觉功能。 Nyxol已在2022年顺利完成了一项针对夜盲症的III期研究（LYNX-1）。结果显示，治疗第8天，Nyxol组达到中间视觉低对比度视力（mLCVA）改善10个及以上字母的患者比例更高（41% vs 22%，P<0.05），达到mLCVA改善15个及以上字母的患者比例也更高（13% vs 3%，P<0.05）。 为了进一步验证Nyxol在夜盲症上的疗效和安全性，Opus Genetics（已被Ocuphire Pharma收购）开展了第2项III期研究（LYNX-2）。Opus Genetics预计在2025年第一季度便可以获得这项研究的顶线结果。 NO.9 暴食症治疗手段有望革新 暴食症会导致胃肠道疾病、高血压、肥胖及由此引起的代谢和各系统功能紊乱等躯体问题，危害患者的身心健康。大约3.5%的女性和2%的男性存在暴食性障碍，超重或肥胖人群更为常见。 目前，临床上的暴食症治疗手段包括心理治疗和药物治疗。药物治疗以抗抑郁药和食欲抑制药物为主，但真正获批可用于治疗暴食症的药物只有利右苯丙胺，而利右苯丙胺存在成瘾性风险。 索安非托是一款多巴胺重摄取抑制剂和去甲肾上腺素重摄取抑制剂，已在2019年3月获FDA批准上市，用于治疗嗜睡。今年4月，Axsome Therapeutics宣布启动治疗暴食症的III期ENGAGE研究，在此之前其并未披露过相关临床数据。该药物是目前唯一一款正在III期研究中验证暴食症治疗潜力的药物。 NO.10 卵巢癌治疗选择有待丰富 卵巢癌是治疗突破较少的常见肿瘤之一。目前，卵巢癌的标准治疗仍然是化疗。然而大多数患者会对化疗产生耐药性。耐药后卵巢癌的治疗药物仅包括PARP抑制剂、贝伐珠单抗和索米妥昔单抗，而PARP抑制剂和索米妥昔单抗的使用受限于生物标志物水平。 化疗仍是卵巢癌的治疗方案中的重要一环，因而着力解决化疗耐药问题是药物研发方向之一。研究表明，化疗耐药的驱动因素之一可能是糖皮质激素，糖皮质激素过度激活其受体后会导致化疗对肿瘤细胞的杀伤能力下降。 Relacorilant是Corcept Therapeutics基于此机制开发的一款糖皮质激素受体拮抗剂，能够通过竞争性拮抗糖皮质激素的抗凋亡作用来恢复化疗敏感性并提高化疗效果。 Relacorilant的作用机制 针对卵巢癌的II期研究结果显示，相比于白蛋白紫杉醇组，Relacorilant联合白蛋白紫杉醇组患者的无进展生存期显著延长（5.6 vs 3.8个月，HR=0.66，P=0.038），总生存期有所延长（HR=0.67，P=0.066）。 推荐阅读 2025年，这20款重磅新药有望在中国获批 2024年医药并购交易：肿瘤降温，自免热潮 2025年全球畅销药TOP10预测，GLP-1产品占4款，Skyrizi飞升 2024年值得关注的8项临床研究：强迫症、万能GLP-1、首个口服Aβ靶向药…… Copyright © 2024 PHARMCUBE. All Rights Reserved. 欢迎转发分享及合理引用，引用时请在显要位置标明文章来源；如需转载，请给微信公众号后台留言或发送消息，并注明公众号名称及ID。 免责申明：本微信文章中的信息仅供一般参考之用，不可直接作为决策内容，医药魔方不对任何主体因使用本文内容而导致的任何损失承担责任。

FILSPARI® (sparsentan) received full FDA approval as the only non-immunosuppressive treatment that significantly slows kidney function decline in IgAN Type C meeting scheduled with FDA to discuss potential sNDA submission for FILSPARI in FSGS sNDA requesting modification of liver monitoring for FILSPARI submitted to FDA Net product sales of FILSPARI totaled $35.6 million for the third quarter of 2024; 505 new PSFs received in the period Total revenue for the third quarter of 2024 was $62.9 million, including net product sales of $61.0 million SAN DIEGO, Oct. 31, 2024 (GLOBE NEWSWIRE) -- Travere Therapeutics, Inc., (NASDAQ: TVTX) today reported its third quarter 2024 financial results and provided a corporate update. “Our performance in the third quarter was exceptional. FILSPARI received full approval as the only medicine that can provide superior preservation of kidney function and replace current standard of care in IgAN, and our commercial team delivered strong growth in sales of FILSPARI in the U.S. Additionally, I am pleased to report that in the weeks since full approval we have seen a meaningful increase in demand, supporting our expectation that the broader label granted upon full approval coupled with the recent draft KDIGO guidelines will strengthen FILSPARI’s growth,” said Eric Dube, Ph.D., president and chief executive officer of Travere Therapeutics. “As we look ahead, we are very well-positioned to further accelerate our growth with FILSPARI. At ASN Kidney Week, we illustrated the potential benefits of using FILSPARI as a first-line treatment, and presented data in combination with other therapies. Our European partner CSL Vifor has launched FILSPARI commercially in the first EU countries. And following the recent PARASOL group recommendation of a proteinuria-based clinical trial endpoint for FSGS, we have scheduled a meeting with the FDA to discuss a potential path forward for FILSPARI in FSGS.” Financial Results for Continuing Operations for the Quarter Ended September 30, 2024 The following financial results discussion compares Travere’s continuing operations. All periods unless otherwise specified have been adjusted to exclude discontinued operations related to the divestiture of the bile acid product portfolio completed on August 31, 2023. Net product sales for the third quarter of 2024 were $61.0 million, compared to $33.9 million for the same period in 2023. The increase is attributable to sales from the ongoing commercial launch of FILSPARI. Research and development (R&D) expenses for the third quarter of 2024 were $51.7 million, compared to $60.6 million for the same period in 2023. For the nine months ended September 30, 2024, R&D expenses were $155.4 million, compared to $185.2 million for the same period in 2023. The decrease is largely attributable to previously announced restructuring initiatives and a decline in costs associated with the development of sparsentan as the Phase 3 programs advance towards completion. On a non-GAAP adjusted basis, R&D expenses were $48.4 million for the third quarter of 2024, compared to $53.8 million for the same period in 2023. Selling, general, and administrative (SG&A) expenses for the third quarter of 2024 were $65.6 million, compared to $67.8 million for the same period in 2023. For the nine months ended September 30, 2024, SG&A expenses were $194.6 million, compared to $202.0 million for the same period in 2023. The decrease is primarily driven by the previously announced restructuring and other cost saving initiatives. On a non-GAAP adjusted basis, SG&A expenses were $49.7 million for the third quarter of 2024, compared to $51.8 million for the same period in 2023. Total other income, net, for the third quarter of 2024 was $1.3 million, compared to total other income, net, of $3.4 million for the same period in 2023. The difference is largely attributable to a decrease in interest income during the period. Net loss including discontinued operations for the third quarter of 2024 was $54.8 million, or $0.70 per basic share, compared to a net income of $150.7 million, or $1.97 per basic share for the same period in 2023. For the nine months ended September 30, 2024, net loss including discontinued operations was $261.3 million, compared to $21.2 million for the same period in 2023. On a non-GAAP adjusted basis, net loss including discontinued operations for the third quarter of 2024 was $35.6 million, or $0.46 per basic share, compared to a net income of $173.5 million, or $2.27 per basic share for the same period in 2023. As of September 30, 2024, the Company had cash, cash equivalents, and marketable securities of $277.4 million. Program Updates FILSPARI® (sparsentan) – IgA Nephropathy (IgAN) On September 5, 2024, the U.S. Food and Drug Administration (FDA) granted full approval to FILSPARI to slow kidney function decline in adults with primary IgAN who are at risk of disease progression. The expanded indication made FILSPARI available to patients with IgAN at risk of progression and the updated label includes data showing superior long-term durable benefit on proteinuria and kidney function preservation that accrued over two years when compared to 300 mg of the active comparator irbesartan.Commercial progress in the ongoing launch has resulted in: 505 new patient start forms (PSFs) received in the third quarter of 2024; a total of 2,989 PSFs have been received since launch in February of 2023.Net product sales of $35.6 million for the third quarter; year-to-date FILSPARI net product sales total $82.6 million. The Company has submitted a supplemental New Drug Application (sNDA) requesting a modification to the frequency of liver monitoring for FILSPARI.In connection with full approval and an expanded indication, the FDA granted an additional term of Orphan Drug Exclusivity for FILSPARI in IgAN expiring in September 2031.In August 2024, Kidney Disease Improving Global Outcomes (KDIGO) published its draft guidelines for IgAN, recommending FILSPARI as a foundational kidney-targeted therapy and lowering the targeted proteinuria level for all IgAN patients to under 0.5 g/day or ideally complete remission (under 0.3 g/day).At ASN Kidney Week (October 23 – 27), the Company presented 9 abstracts on FILSPARI in IgAN, including: An analysis from the PROTECT Study examining the clinical benefit of FILSPARI in IgAN regardless of participants’ baseline proteinuria demonstrating that treatment with FILSPARI reduced proteinuria and preserved kidney function in patients with lower ranges of proteinuria (<1.0 g/g); and patient-reported outcomes from PROTECT suggesting that patients receiving FILSPARI had less burden of kidney disease over time and trend toward improved health-related quality of life compared with maximally dosed irbesartan.Data from a pre-specified interim analysis of the SPARTAN Study demonstrating that as a first-line treatment in patients newly diagnosed with IgAN, FILSPARI delivered a rapid and sustained reduction in proteinuria of approximately 70% from baseline over 24 weeks and was generally well tolerated. In addition, nearly 60% of patients achieved complete remission at any point of time during the treatment period. Throughout the 24 weeks, estimated glomerular filtration rate was stable.Interim data from the SPARTACUS Study demonstrating that FILSPARI when added to stable SGLT2 inhibitors was generally well tolerated and at 24 weeks approximately one-third of patients had their proteinuria reduced by at least 50% after the addition of FILSPARI. The Company also presented new combination data from the ongoing PROTECT open label extension, and real-world clinical experience of FILSPARI in IgAN demonstrating FILSPARI induced further proteinuria reduction and showed favorable safety and additive efficacy results when used in combination with SGLT2 inhibitors or steroids. In the third quarter, the Company’s commercial partner CSL Vifor launched FILSPARI in Germany and Austria, and recently received temporary marketing approval in Switzerland. Sparsentan – Focal Segmental Glomerulosclerosis (FSGS) The Company has scheduled a Type C meeting with FDA to discuss a potential regulatory pathway for a sparsentan FSGS indication. The Company expects to provide an update on the FSGS program by its fourth quarter 2024 earnings call.At ASN Kidney Week 2024, the Company presented two abstracts illustrating the potential benefit of sparsentan in patients with FSGS. A late-breaking presentation in patients with genetic FSGS, a small subgroup of patients that are often resistant to treatment, with results that demonstrated a rapid and sustained proteinuria reduction, including some patients who achieved complete remission and long-term kidney health benefits.Patient-reported outcomes from the DUPLEX Study suggesting health-related quality of life with sparsentan was stable over the two-year treatment period. Pegtibatinase (TVT-058) – Classical Homocystinuria (HCU) In September 2024, the Company announced a voluntary pause of enrollment in the Phase 3 HARMONY Study of pegtibatinase to allow for necessary process improvements in manufacturing scale-up to support commercial scale manufacturing as well as full enrollment in the HARMONY Study.Currently enrolled patients will be able to continue uninterrupted on study medication for the duration of the trials they are participating in.The Company expects to further evaluate the necessary commercial process improvements to enable the continuation of the Phase 3 program and anticipates the earliest date to restart enrollment in the Phase 3 HARMONY Study will be in 2026. Conference Call Information Travere Therapeutics will host a conference call and webcast today, October 31, 2024, at 8:30 a.m. ET to discuss company updates as well as third quarter 2024 financial results. To participate in the conference call, dial +1 (888) 394 8218 (U.S.) or +1 (323) 994-2093 (International), confirmation code 1616163 shortly before 8:30 a.m. ET. The webcast can be accessed on the Investor page of Travere’s website at ir.travere.com/events-presentations. Following the live webcast, an archived version of the call will be available for 30 days on the Company’s website. Use of Non-GAAP Financial Measures To supplement Travere’s financial results and guidance presented in accordance with U.S. generally accepted accounting principles (GAAP), the Company uses certain non-GAAP adjusted financial measures in this press release and the accompanying tables. The Company believes that these non-GAAP financial measures are helpful in understanding its past financial performance and potential future results. They are not meant to be considered in isolation or as a substitute for comparable GAAP measures and should be read in conjunction with the consolidated financial statements prepared in accordance with GAAP. Travere’s management regularly uses these supplemental non-GAAP financial measures internally to understand, manage and evaluate its business and make operating decisions. In addition, Travere believes that the use of these non-GAAP measures enhances the ability of investors to compare its results from period to period and allows for greater transparency with respect to key financial metrics the Company uses in making operating decisions. Investors should note that these non-GAAP financial measures are not prepared under any comprehensive set of accounting rules or principles and do not reflect all of the amounts associated with the Company’s results of operations as determined in accordance with GAAP. Investors should also note that these non-GAAP financial measures have no standardized meaning prescribed by GAAP and, therefore, have limits in their usefulness to investors. In addition, from time to time in the future the Company may exclude other items, or cease to exclude items that it has historically excluded, for purposes of its non-GAAP financial measures; because of the non-standardized definitions, the non-GAAP financial measures as used by the Company in this press release and the accompanying tables may be calculated differently from, and therefore may not be directly comparable to, similarly titled measures used by the Company’s competitors and other companies. As used in this press release, (i) the historical non-GAAP net loss measures exclude from GAAP net loss, as applicable, stock-based compensation expense, amortization and depreciation expense, and income tax; (ii) the historical non-GAAP SG&A expense measures exclude from GAAP SG&A expenses, as applicable, stock-based compensation expense, and amortization and depreciation expense; (iii) the historical non-GAAP R&D expense measures exclude from GAAP R&D expenses, as applicable, stock-based compensation expense, and amortization and depreciation expense. About Travere Therapeutics At Travere Therapeutics, we are in rare for life. We are a biopharmaceutical company that comes together every day to help patients, families and caregivers of all backgrounds as they navigate life with a rare disease. On this path, we know the need for treatment options is urgent – that is why our global team works with the rare disease community to identify, develop and deliver life-changing therapies. In pursuit of this mission, we continuously seek to understand the diverse perspectives of rare patients and to courageously forge new paths to make a difference in their lives and provide hope – today and tomorrow. For more information, visit travere.com. FILSPARI® (sparsentan) U.S. Indication FILSPARI (sparsentan) is indicated to slow kidney function decline in adults with primary immunoglobulin A nephropathy (IgAN) who are at risk for disease progression. IMPORTANT SAFETY INFORMATION BOXED WARNING: HEPATOTOXICITY AND EMBRYO-FETAL TOXICITY Because of the risks of hepatotoxicity and birth defects, FILSPARI is available only through a restricted program called the FILSPARI REMS. Under the FILSPARI REMS, prescribers, patients and pharmacies must enroll in the program. Hepatotoxicity Some Endothelin Receptor Antagonists (ERAs) have caused elevations of aminotransferases, hepatotoxicity, and liver failure. In clinical studies, elevations in aminotransferases (ALT or AST) of at least 3-times the Upper Limit of Normal (ULN) have been observed in up to 3.5% of FILSPARI-treated patients, including cases confirmed with rechallenge. Measure transaminases and bilirubin before initiating treatment and monthly for the first 12 months, and then every 3 months during treatment. Interrupt treatment and closely monitor patients who develop aminotransferase elevations more than 3x ULN. FILSPARI should generally be avoided in patients with elevated aminotransferases (>3x ULN) at baseline because monitoring for hepatotoxicity may be more difficult and these patients may be at increased risk for serious hepatotoxicity. Embryo-Fetal Toxicity FILSPARI can cause major birth defects if used by pregnant patients based on animal data. Therefore, pregnancy testing is required before the initiation of treatment, during treatment and one month after discontinuation of treatment with FILSPARI. Patients who can become pregnant must use effective contraception before the initiation of treatment, during treatment, and for one month after discontinuation of treatment with FILSPARI. Contraindications FILSPARI is contraindicated in patients who are pregnant. Do not coadminister FILSPARI with angiotensin receptor blockers (ARBs), ERAs, or aliskiren. Warnings and Precautions Hepatotoxicity: Elevations in ALT or AST of at least 3-fold ULN have been observed in up to 3.5% of FILSPARI-treated patients, including cases confirmed with rechallenge. While no concurrent elevations in bilirubin >2-times ULN or cases of liver failure were observed in FILSPARI-treated patients, some ERAs have caused elevations of aminotransferases, hepatotoxicity, and liver failure. To reduce the risk of potential serious hepatotoxicity, measure serum aminotransferase levels and total bilirubin prior to initiation of treatment and monthly for the first 12 months, then every 3 months during treatment. Advise patients with symptoms suggesting hepatotoxicity (nausea, vomiting, right upper quadrant pain, fatigue, anorexia, jaundice, dark urine, fever, or itching) to immediately stop treatment with FILSPARI and seek medical attention. If aminotransferase levels are abnormal at any time during treatment, interrupt FILSPARI and monitor as recommended. Consider re-initiation of FILSPARI only when hepatic enzyme levels and bilirubin return to pretreatment values and only in patients who have not experienced clinical symptoms of hepatotoxicity. Avoid initiation of FILSPARI in patients with elevated aminotransferases (>3x ULN) prior to drug initiation because monitoring hepatotoxicity in these patients may be more difficult and these patients may be at increased risk for serious hepatotoxicity. Embryo-Fetal Toxicity: FILSPARI can cause fetal harm when administered to a pregnant patient and is contraindicated during pregnancy. Advise patients who can become pregnant of the potential risk to a fetus. Obtain a pregnancy test prior to initiation of treatment with FILSPARI, monthly during treatment, and one month after discontinuation of treatment. Advise patients who can become pregnant to use effective contraception prior to initiation of treatment, during treatment, and for one month after discontinuation of treatment with FILSPARI.FILSPARI REMS: Due to the risk of hepatotoxicity and embryo-fetal toxicity, FILSPARI is available only through a restricted program called the FILSPARI REMS. Prescribers, patients, and pharmacies must be enrolled in the REMS program and comply with all requirements (www.filsparirems.com).Hypotension: Hypotension has been observed in patients treated with ARBs and ERAs. There was a greater incidence of hypotension-associated adverse events, some serious, including dizziness, in patients treated with FILSPARI compared to irbesartan. In patients at risk for hypotension, consider eliminating or adjusting other antihypertensive medications and maintaining appropriate volume status. If hypotension develops, despite elimination or reduction of other antihypertensive medications, consider a dose reduction or dose interruption of FILSPARI. A transient hypotensive response is not a contraindication to further dosing of FILSPARI, which can be given once blood pressure has stabilized.Acute Kidney Injury: Monitor kidney function periodically. Drugs that inhibit the renin-angiotensin system (RAS) can cause kidney injury. Patients whose kidney function may depend in part on the activity of the RAS (e.g., patients with renal artery stenosis, chronic kidney disease, severe congestive heart failure, or volume depletion) may be at particular risk of developing acute kidney injury on FILSPARI. Consider withholding or discontinuing therapy in patients who develop a clinically significant decrease in kidney function while on FILSPARI.Hyperkalemia: Monitor serum potassium periodically and treat appropriately. Patients with advanced kidney disease, taking concomitant potassium-increasing drugs (e.g., potassium supplements, potassium-sparing diuretics), or using potassium-containing salt substitutes are at increased risk for developing hyperkalemia. Dosage reduction or discontinuation of FILSPARI may be required.Fluid Retention: Fluid retention may occur with ERAs, and has been observed in clinical studies with FILSPARI. FILSPARI has not been evaluated in patients with heart failure. If clinically significant fluid retention develops, evaluate the patient to determine the cause and the potential need to initiate or modify the dose of diuretic treatment then consider modifying the dose of FILSPARI. Most common adverse reactions The most common adverse reactions (≥5%) are hyperkalemia, hypotension (including orthostatic hypotension), peripheral edema, dizziness, anemia, and acute kidney injury. Drug interactions Renin-Angiotensin System (RAS) Inhibitors and ERAs: Do not coadminister FILSPARI with ARBs, ERAs, or aliskiren due to increased risks of hypotension, syncope, hyperkalemia, and changes in renal function (including acute renal failure).Strong and Moderate CYP3A Inhibitors: Avoid concomitant use of FILSPARI with strong CYP3A inhibitors. If a strong CYP3A inhibitor cannot be avoided, interrupt FILSPARI treatment. When resuming treatment with FILSPARI, consider dose titration. Monitor blood pressure, serum potassium, edema, and kidney function regularly when used concomitantly with moderate CYP3A inhibitors. Concomitant use with a strong CYP3A inhibitor increases sparsentan exposure which may increase the risk of FILSPARI adverse reactions.Strong CYP3A Inducers: Avoid concomitant use with a strong CYP3A inducer. Concomitant use with a strong CYP3A inducer decreases sparsentan exposure which may reduce FILSPARI efficacy.Antacids and Acid Reducing Agents: Administer FILSPARI 2 hours before or after administration of antacids. Avoid concomitant use of acid reducing agents (histamine H2 receptor antagonist and PPI proton pump inhibitor) with FILSPARI. Sparsentan exhibits pH-dependent solubility. Antacids or acid reducing agents may decrease sparsentan exposure which may reduce FILSPARI efficacy.Non-Steroidal Anti-Inflammatory Agents (NSAIDs), Including Selective Cyclooxygenase-2 (COX-2) Inhibitors: Monitor for signs of worsening renal function with concomitant use with NSAIDs (including selective COX-2 inhibitors). In patients with volume depletion (including those on diuretic therapy) or with impaired kidney function, concomitant use of NSAIDs (including selective COX-2 inhibitors) with drugs that antagonize the angiotensin II receptor may result in deterioration of kidney function, including possible kidney failure.CYP2B6, 2C9, and 2C19 Substrates: Monitor for efficacy of concurrently administered CYP2B6, 2C9, and 2C19 substrates and consider dosage adjustment in accordance with the Prescribing Information. Sparsentan decreases exposure of these substrates, which may reduce efficacy related to these substrates.P-gp and BCRP Substrates: Avoid concomitant use of sensitive substrates of P-gp and BCRP with FILSPARI. Sparsentan may increase exposure of these transporter substrates, which may increase the risk of adverse reactions related to these substrates.Agents Increasing Serum Potassium: Monitor serum potassium frequently in patients treated with FILSPARI and other agents that increase serum potassium. Concomitant use of FILSPARI with potassium-sparing diuretics, potassium supplements, potassium-containing salt substitutes, or other drugs that raise serum potassium levels may result in hyperkalemia. Please see the full Prescribing Information, including BOXED WARNING, for additional Important Safety Information. Forward-Looking Statements This press release contains “forward-looking statements” as that term is defined in the Private Securities Litigation Reform Act of 1995. Without limiting the foregoing, these statements are often identified by the words “on-track,” “positioned,” “look forward to,” “will,” “would,” “may,” “might,” “believes,” “anticipates,” “plans,” “expects,” “intends,” “potential,” or similar expressions. In addition, expressions of strategies, intentions or plans are also forward-looking statements. Such forward-looking statements include, but are not limited to, references to: statements regarding the potential for FILSPARI to replace current standard of care in IgAN and the potential to further accelerate growth with FILSPARI; statements relating to clinical studies, including but not limited to trial design, results and timing related thereto; statements regarding the continuing commercial launch of FILSPARI and trends related thereto; statements regarding the sNDA requesting a modification to the frequency of liver monitoring for FILSPARI and the expected outcome and timing thereof; statements regarding plans to meet with the FDA on a potential sNDA submission for FILSPARI in FSGS and the anticipated timing and outcome thereof; statements and expectations regarding the draft KDIGO guidelines; and statements regarding the voluntary pause of enrollment in the HARMONY Study, including expectations regarding process improvements and the potential timeline to restart enrollment. Such forward-looking statements are based on current expectations and involve inherent risks and uncertainties, including factors that could delay, divert or change any of them, and could cause actual outcomes and results to differ materially from current expectations. No forward-looking statement can be guaranteed. Among the factors that could cause actual results to differ materially from those indicated in the forward-looking statements are risks related to the timing and outcome of the studies described herein and uncertainties associated with the regulatory review and approval process, as well as risks and uncertainties associated with enrollment of clinical trials for rare diseases, and risks that ongoing or planned clinical trials may not succeed or may be delayed for safety, regulatory or other reasons. The Company also faces risks related to its business and finances in general, the success of its commercial products and risks and uncertainties associated with its preclinical and clinical stage pipeline. Specifically, the Company faces risks associated with the ongoing commercial launch of FILSPARI, market acceptance of its commercial products including efficacy, safety, price, reimbursement, and benefit over competing therapies, risks related to the challenges of manufacturing scale-up, as well as risks associated with the successful development and execution of commercial strategies for such products, including FILSPARI. The risks and uncertainties the Company faces with respect to its preclinical and clinical stage pipeline include risk that the Company’s clinical candidates will not be found to be safe or effective and that current or anticipated future clinical trials will not proceed as planned. There is no guarantee that regulators will grant approval of sparsentan for FSGS. The Company also faces the risk that it will be unable to raise additional funding that may be required to complete development of any or all of its product candidates, including as a result of macroeconomic conditions; risks relating to the Company’s dependence on contractors for clinical drug supply and commercial manufacturing; uncertainties relating to patent protection and exclusivity periods and intellectual property rights of third parties; risks associated with regulatory interactions; and risks and uncertainties relating to competitive products, including current and potential future generic competition with certain of the Company’s products, and technological changes that may limit demand for the Company’s products. The Company also faces additional risks associated with global and macroeconomic conditions, including health epidemics and pandemics, including risks related to potential disruptions to clinical trials, commercialization activity, supply chain, and manufacturing operations. You are cautioned not to place undue reliance on these forward-looking statements as there are important factors that could cause actual results to differ materially from those in forward-looking statements, many of which are beyond our control. The Company undertakes no obligation to publicly update any forward-looking statement, whether as a result of new information, future events, or otherwise. Investors are referred to the full discussion of risks and uncertainties, including under the heading “Risk Factors”, as included in the Company’s most recent Form 10-K, Form 10-Q and other filings with the Securities and Exchange Commission. TRAVERE THERAPEUTICS, INC.CONSOLIDATED BALANCE SHEETS(in thousands, except share amounts) September 30, 2024 December 31, 2023Assets(unaudited) Current assets: Cash and cash equivalents$36,409 $58,176 Marketable debt securities, at fair value 241,030 508,675 Accounts receivable, net 25,170 21,179 Inventory 6,356 9,410 Prepaid expenses and other current assets 15,775 19,335 Total current assets 324,740 616,775 Long-term inventory 36,522 31,494 Property and equipment, net 6,162 7,479 Operating lease right of use assets 15,662 18,061 Intangible assets, net 104,205 104,443 Other assets 17,119 10,661 Total assets$504,410 $788,913 Liabilities and Stockholders' Equity Current liabilities: Accounts payable$23,195 $41,675 Accrued expenses 83,916 118,991 Convertible debt, current portion 68,599 — Deferred revenue, current portion 3,799 7,096 Operating lease liabilities, current portion 5,297 4,909 Other current liabilities 5,232 5,237 Total current liabilities 190,038 177,908 Convertible debt 309,957 377,263 Deferred revenue, less current portion — 1,835 Operating lease liabilities, less current portion 18,581 22,612 Other non-current liabilities 16,288 8,485 Total liabilities 534,864 588,103 Stockholders' Equity: Preferred stock $0.0001 par value; 20,000,000 shares authorized; 0 issued and outstanding as of September 30, 2024 and December 31, 2023 — — Common stock $0.0001 par value; 200,000,000 shares authorized; 77,909,042, and 75,367,117 issued and outstanding as of September 30, 2024 and December 31, 2023, respectively 8 7 Additional paid-in capital 1,357,457 1,327,881 Accumulated deficit (1,386,903) (1,125,622)Accumulated other comprehensive loss (1,016) (1,456)Total stockholders' equity (30,454) 200,810 Total liabilities and stockholders' equity$504,410 $788,913 Note: Certain adjustments / reclassifications have been made to prior periods to conform to current year presentation. TRAVERE THERAPEUTICS, INC.CONSOLIDATED STATEMENTS OF OPERATIONS(in thousands, except share and per share data)(unaudited) Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 (unaudited) Net product sales: Tiopronin products$25,382 $25,888 $70,583 $73,112 FILSPARI 35,619 8,044 82,578 14,509 Total net product sales 61,001 33,932 153,161 87,621 License and collaboration revenue 1,897 3,163 5,227 12,558 Total revenue 62,898 37,095 158,388 100,179 Operating expenses: Cost of goods sold 1,626 1,289 5,191 6,886 Research and development 51,679 60,590 155,429 185,244 Selling, general and administrative 65,619 67,801 194,618 201,954 In-process research and development — — 65,205 — Restructuring 123 — 1,035 — Total operating expenses 119,047 129,680 421,478 394,084 Operating loss (56,149) (92,585) (263,090) (293,905) Other income, net: Interest income 3,570 5,842 14,022 14,616 Interest expense (2,777) (2,821) (8,365) (8,513)Other income (expense), net 520 335 (2,737) 220 Total other income, net 1,313 3,356 2,920 6,323 Loss from continuing operations before income tax provision (54,836) (89,229) (260,170) (287,582)Income tax benefit (provision) on continuing operations 84 (12) (192) (155) Loss from continuing operations, net of tax (54,752) (89,241) (260,362) (287,737)(Loss) income from discontinued operations, net of tax (59) 239,976 (919) 266,511 Net (loss) income$(54,811) $150,735 $(261,281) $(21,226) Per share data: Net (loss) income per common share$(0.70) $1.97 $(3.37) $(0.29)Weighted average common shares outstanding 77,779,379 76,305,603 77,473,161 73,523,620 Note: Certain adjustments / reclassifications have been made to prior periods to conform to current year presentation. TRAVERE THERAPEUTICS, INC.RECONCILIATION OF GAAP REPORTED TO NON-GAAP ADJUSTED INFORMATION(in thousands, except share and per share data)(unaudited) Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 GAAP operating loss$(56,149) $(92,585) $(263,090) $(293,905) R&D operating expense (51,679) (60,590) (155,429) (185,244) Stock compensation 3,321 4,372 10,752 13,372 Amortization & depreciation — 2,447 — 7,261 Subtotal non-GAAP items 3,321 6,819 10,752 20,633 Non-GAAP R&D expense (48,358) (53,771) (144,677) (164,611) SG&A operating expense (65,619) (67,801) (194,618) (201,954) Stock compensation 4,700 6,949 16,946 22,730 Amortization & depreciation 11,242 9,032 31,462 21,785 Subtotal non-GAAP items 15,942 15,981 48,408 44,515 Non-GAAP SG&A expense (49,677) (51,820) (146,210) (157,439) Subtotal non-GAAP items 19,263 22,800 59,160 65,148 Non-GAAP operating loss$(36,886) $(69,785) $(203,930) $(228,757) GAAP net (loss) income$(54,811) $150,735 $(261,281) $(21,226)Non-GAAP operating loss adjustments 19,263 22,800 59,160 65,148 Income tax benefit (provision) (84) 12 192 155 Non-GAAP net (loss) income (1)$(35,632) $173,547 $(201,929) $44,077 Per share data: Net (loss) income per common share$(0.46) $2.27 $(2.61) $0.60 Weighted average common shares outstanding 77,779,379 76,305,603 77,473,161 73,523,620 (1) Non-GAAP net income (loss) includes income from discontinued operations but excludes non-GAAP adjustments for the effect of discontinued operations. Note: Certain adjustments / reclassifications have been made to prior periods to conform to current year presentation. Contact: Investors:888-969-7879ir@travere.comMedia:888-969-7879mediarelations@travere.com