Nabeel Nassar

Nabeel Nassar asked for an update on Vafseo's second and third refill rates, following encouraging first refill adherence, and sought comments on anemia manager education. He also inquired about the mechanistic differentiation of the AKB-9090 asset from prior HIFs.

Answer

Chief Commercial Officer Nicholas Grund reported a significant improvement in first refill adherence, from approximately 75% historically to 91% in Q4 2025 for a small subset, and 87% in January for a larger subset. He noted that high adherence rates continue through the second prescription, despite a 2-4% monthly discontinuation rate due to patient comorbidities. CEO John Butler added that physician belief in Vafseo's clinical benefit helps patients work through transient GI tolerability issues. Nicholas Grund also mentioned that observed therapy allows for patient restarts. Chief Medical Officer Steven Burke explained AKB-9090's differentiation through its unique pharmacokinetics and widespread tissue penetration (lung, kidney), making it effective for ischemia-reperfusion injury, unlike vadadustat's liver preference. John Butler highlighted the expansion of Akebia's medical affairs group (MSLs) to enhance anemia manager education, a sentiment echoed by Nicholas Grund, who noted dialysis organizations' participation in this education.