Akebia Therapeutics Inc (AKBA) (Q2 2026) Earnings Call Highlights: Vafseo Surges 60% as VOICE ...

• Total revenues decreased to $49.1 million in Q2 2026 from $62.5 million in Q2 2025, primarily due to lower Erixia revenues from generic competition and pricing pressure.

• The company reported a net loss of $80.9 million in Q2 2026, a significant swing from a net income of $0.2 million in the same period last year.

• Akebia Therapeutics Inc ( NASDAQ:AKBA ) expects 2027 VASCO revenues to decrease compared to 2026 due to a planned price reduction to align with ESAs after the TDAPA period ends on December 31, 2026.

• Growth at DaVita, the largest potential opportunity, remains slow, with management not expecting a meaningful increase in adoption until late 2026 or 2027, despite increased engagement.

• The positive VOICE trial data has not yet been presented at a medical conference or published in a peer-reviewed journal, which may delay its full impact on provider adoption.

• The company incurred a $1.9 million expense related to a commercial reorganization, and R&D expenses increased due to higher headcount and clinical trial activities, contributing to the wider net loss.

Q & A Highlights

Q: Can you provide more color on the progress at DaVita, including any future step-up in uptake timing, and have any dialysis providers changed or accelerated their protocol decisions since the VOICE results were shared? A: John Butler (CEO) noted that DaVita has implemented a three-times-weekly observed dosing protocol, and recent market research shows all-time highs in physician awareness, likelihood to recommend, and preference for VASCO over ESAs at DaVita. While a meaningful increase in the DaVita adoption curve is not expected in Q3, there is heightened senior clinical team engagement regarding detailed operational implementation, which bodes well for more impactful growth at the end of the year and into 2027. Nicholas Grund (CCO) added that DaVita rolled out its three-times-weekly observed dosing protocol in early June, which should help physicians overcome compliance concerns. The feedback since VOICE has been more at the individual physician level, with Dr. Block actively discussing results, but no major protocol changes have been made yet.

Q: How much of VASCO's revenue growth was driven by ex-USRC uptake, and what are the key near-term growth drivers? A: Nicholas Grund (CCO) explained that roughly a third of prescribers are now non-USRC physicians, showing diversification. USRC has been growing strongly since the beginning, while IRC and DCI, which started at the beginning of 2026, together make up about the size of USRC and are demonstrating strong growth. The near-term growth is driven by new patients, new clinics, and new providers, with the number of prescribers growing 17% quarter-over-quarter. Additionally, about 25% of patients who discontinued therapy in 2025 have restarted under observed dosing protocols, contributing to growth.

Q: Can you better characterize persistence rates (e.g., 90-day and 180-day) and the principal reasons for discontinuation now that three-times-weekly dosing is available? Also, what is the timeline for getting VOICE data in front of medical organizations? A: Nicholas Grund (CCO) reported that first-refill adherence is strong at about 89%, and after that, discontinuation tapers down to normal churn in the dialysis patient population. Reasons for discontinuation include hospitalization (patients may go back on ESAs) and GI intolerance. John Butler (CEO) added that the initial adherence issues were due to hemoglobin drops with QD dosing, which have been resolved with observed dosing protocols. Regarding VOICE data, the results have not yet been presented or published, but Dr. Block is actively discussing them with peers. The data is being shared with dialysis providers, and there is significant excitement, particularly among USRC, IRC, and DCI, which together have about 66,000 patients, most of whom are on ESAs today.

Q: Can you provide an update on the enrollment progress for the pipeline programs, particularly the Phase II FSGS trial for prolisiguat, and how do you see the potential for combination use with recently approved therapies? A: John Butler (CEO) stated that enrollment is progressing in the competitive FSGS space, and the team is adding more sites. He noted that the recent approval of Sparsentan in FSGS validates the large commercial opportunity, and multiple products will make a difference for patients. Steven Burke (CMO) explained that prolisiguat works through a completely different pathway (soluble guanylate cyclase) than Sparsentan (endothelin/angiotensin receptor blockade), and there is no reason the two drugs shouldn't work well together. For Ebri, he noted that complement inhibitors could be used in combination with B-cell-directed therapies like APRIL and APRIL/BAFF inhibitors, as Ebri's tissue-specific mechanism avoids systemic complement inhibition, making it inherently safer for long-term use.

Q: What were the key drivers of the strong VASCO revenue growth in Q2 2026, and how should we think about the impact of the VOICE trial results on future growth? A: Nicholas Grund (CCO) reported that VASCO net product revenue grew 34% sequentially to $21.3 million, with over 10,500 patients on therapy, a 41% increase from Q1. The quarter saw the highest number of new patient starts since launch. John Butler (CEO) highlighted that the VOICE trial met its pre-specified stopping criteria with a win odds of 1.16 and p-value of 0.0016, demonstrating a statistically significant 10% reduction in hospitalization. This is the first head-to-head study of ESAs to show a significant benefit in hospitalization, and the data is expected to accelerate adoption. The company is working to present and publish the data as quickly as possible.

Q: What is the financial outlook for VASCO given the expected end of the TDAPA period on December 31, 2026, and how will this impact 2027 revenues? A: Erik Ostrowski (CFO) explained that upon the expected end of VASCO's TDAPA period, the company plans to price VASCO within the price range of ESAs, which is significantly lower than its current price. While VASCO unit sales volumes are expected to increase in 2027 compared to 2026, 2027 revenues are expected to decrease due to the lower planned price. The company believes its existing cash resources, along with cash generated from product, royalty, supply, and license revenues, and a plan to refinance its senior secured term loan facility, will fund operations for at least two years.

Q: Can you elaborate on the differentiation of Ebri (AKB-097) and its potential in complement-mediated kidney diseases? A: Steven Burke (CMO) explained that Ebri is a next-generation complement inhibitor designed to be targeted specifically to sites of complement activation in the glomeruli, avoiding complement inhibition in the blood. This tissue-specific mechanism is expected to provide efficacy without the boxed warning for significant infection risk associated with systemic complement inhibitors. The Phase II basket trial is evaluating Ebri in IgA nephropathy, lupus nephritis, and C3 glomerulopathy, with a once-weekly subcutaneous dose for 26 weeks. The primary endpoint is the incidence of adverse events, with secondary endpoints including changes in proteinuria and kidney function. Initial data is expected in 2027.

Q: What is the status of the Phase II basket trial for Ebri, and what are the key endpoints and design? A: Steven Burke (CMO) stated that the Phase II basket trial was recently initiated and will enroll up to 30 patients with IgA nephropathy, lupus neph

For the complete transcript of the earnings call, please refer to the full earnings call transcript .