IBSRELA Surges 73% While XPHOZAH Falters

Date of Call: Feb 19, 2026

Financials Results

• Revenue: $407.3M for full year 2025, up 22% YOY; IBSRELA revenue $274.2M, up 73% YOY; XPHOZAH revenue $103.6M, down 36% YOY
• EPS: Net loss of $0.26 per share for 2025, compared to net loss of $0.17 per share for 2024

Guidance:

• IBSRELA 2026 revenue guidance of $410M to $430M, representing at least 50% YOY growth at low end.
• IBSRELA expected to reach $1B in revenue in 2029 with CAGR of 38% thereafter.
• XPHOZAH 2026 revenue guidance of $110M to $120M.
• XPHOZAH expected to reach $750M before method of use patent expiration in 2034.
• Overall 2026 operating expenses expected to increase ~25% to up to $520M.

Business Commentary:

IBSRELA Revenue and Growth:

• Ardelyx reported IBSRELA revenue of $274.2 million for 2025, up 73% compared to 2024.
• The growth was driven by strong demand, with a 73% increase in revenue and a 61% year-over-year growth in the fourth quarter, supported by increased total prescription volume and a focus on patient engagement.

XPHOZAH Access and Revenue:

• Despite a 36% decrease in XPHOZAH revenue to $103.6 million in 2025 compared to 2024, the company grew paid dispenses by 41% when excluding Medicare.
• This was due to a focus on patient access and clinical conviction among healthcare providers, ensuring prescriptions were filled despite the loss of Medicare reimbursement.

Financial Performance and Cash Position:

• Ardelyx reported total revenue of $407.3 million for 2025, a 22% year-over-year increase.
• The company ended the year with a strong cash position of $264.7 million, an increase from $250.1 million at the end of 2024, and generated positive cash flow for two consecutive quarters.

Strategic Development and IP Protection:

• The company issued a new patent for the commercial formulations of IBSRELA and XPHOZAH, expiring in 2042, and listed it in the Orange Book.
• This was part of a strategy to create additional valuable intellectual property to support the franchises and maximize their value.

Sentiment Analysis:

Overall Tone: Positive

• Management expressed high confidence in growth targets and strategic execution. Quotes: '2025 was an extraordinary year... establishes a strong foundation', 'We are in a great position. I'm excited about where we're going', 'Our confidence is high', 'We are united with a common purpose... committed to act with urgency to reach our true potential', 'We remain focused on discipline execution and long-term value creation'.

Q&A:

• Question from Anthea Li (Jefferies LLC): Could you talk about your level of confidence on the underlying volume growth for IBSRELA to get to your $410 million to $430 million IBSRELA guidance? What's really driving that outside of big TAM? And how much of that guidance assumes improvements on the pull-through and the shift to specialty pharmacies?
  Response: Management has great confidence in the guidance, driven by a vast patient population needing an alternative to secretagogues, optimization of sales force, and investments in reimbursement managers and specialty pharmacy network to improve pull-through.

• Question from Allison Bratzel (Piper Sandler & Co.): Could you provide any more color on the cadence of the RV and SG&A step-ups for '26? And with those increases, how should we be thinking about the path toward sustained cash flow positivity? Also, is existing commercial infrastructure sufficient for hitting longer-term IBSRELA guidance?
  Response: OpEx will increase ~25% YOY, but top line is growing >38%; investments are in high-ROI commercial and R&D activities. Cash flow has been positive for last two quarters, and company will continue to drive toward positivity. Commercial team will be expanded (15-20 roles) and infrastructure optimized to support growth.

• Question from Samuel Alexander Leach (Raymond James & Associates, Inc.): Can you talk more about the 2 lower doses you're testing in the CIC trial? What are your expectations for how these dose levels will perform?
  Response: The trial includes three doses (low, middle, high) to evaluate safety and efficacy; the low dose is expected to provide minimal effect, the middle dose is for CIC, and the high dose (used in IBS-C trials) provides probability of success. Data will determine optimal dose.

• Question from Matthew Caufield (H.C. Wainwright & Co, LLC): With IBSRELA offering its differentiated NHE3 inhibitor profile, what do you see being the greatest distinctions in the future for the CIC market compared to other mechanisms?
  Response: CIC and IBS-C are closely related conditions; there is a need for different mechanisms of action as many patients on other drugs remain symptomatic. Tenapanor's NHE3 inhibition offers a differentiated approach, similar to its utility in IBS-C.

• Question from Roanna Clarissa Ruiz (Leerink Partners LLC): For CIC, what will prescribers focus on most in terms of primary and secondary endpoints in the Phase III study? Is there an efficacy bar for a highly successful trial?
  Response: Primary focus is on durable complete spontaneous bowel movement (CSBM) responder rate; secondary endpoints include quality of life and patient-reported outcomes. Success will be demonstrated by showing efficacy in constipation and overall patient benefit.

• Question from Jin-Wook Kim (Citigroup Inc.): Any additional color on additional patents or other layers of protection you could provide?
  Response: Company is focused on strengthening IP for IBSRELA and XPHOZAH; recent formulation patent is important and Orange Book-listed, with more work ongoing to further build the IP portfolio.

• Question from Jin-Wook Kim (Citigroup Inc.): How are you thinking about long-term XPHOZAH growth post 2026 given potential adjustments in Medicare base rates for phosphate binders?
  Response: Medicare base rate adjustments are not relevant as company does not participate in Medicare Part D for XPHOZAH; focus is on Medicaid, commercial, and patient access, with 41% paid dispense growth (ex-Medicare) in 2025.

• Question from Wing Yip (Wedbush Securities Inc.): As you're now projecting over $400 million in revenue for IBSRELA this year, is there more leverage to reengage with payers for frontline use? Does frontline utilization factor into your 2029 peak revenue target?
  Response: Frontline therapy is not an objective; current positioning is as first branded product post-generic, typically second or third line. IBSRELA's clinical differentiation and payer engagement efforts aim to ensure appropriate access without needing frontline shift.

• Question from Julian Harrison (BTIG, LLC): How does the recently issued 299 patent contribute to your overall IP strategy? Also, can you expand on how CIC labeling could potentially bolster ongoing efforts in IBS-C?
  Response: The formulation patent is a strong, Orange Book-listed bulwark supporting commercial formulations until 2042. CIC indication, if approved, would improve physician confidence across both CIC and IBS-C, reinforcing IBSRELA's position as a product of choice.

• Question from Aydin Huseynov (Ladenburg Thalmann & Co. Inc.): Do you have any forecast for 2033 for IBSRELA, and when do you think PPA may happen? Also, why start the CIC trial now after several years?
  Response: $1 billion target for 2029 reflects internal projections; growth thereafter will continue with market expansion. CIC trial was initiated due to strengthened capital position and confidence to invest in pipeline, not due to financial constraints.

• Question from John Peyton Bohnsack (TD Cowen): Could you talk about how the CIC trial is powered and what proportion of patients need to be CSBM responders?
  Response: Trial powered at 95% confidence with ~700 patients (173 per arm). Target difference is 18-20% CSBM responder rate improvement over placebo for the 25mg and 50mg doses.

• Question from Jennifer Kim (Cantor Fitzgerald & Co.): Where is the greatest opportunity for IBSRELA in IBS-C, what is driving double-digit market growth, and how sustainable is it? Also, how do you get to $750M peak for XPHOZAH?
  Response: Greatest opportunity is capturing a fraction of large IBS-C patient population; growth driven by clinical differentiation and patient need. For XPHOZAH, reaching $750M involves targeting a subset of dialysis patients, with growth supported by commercial execution and patient access.

Contradiction Point 1

IBSRELA's Peak Sales Target Timeline

The projected timeline for reaching the $1 billion peak sales target has shifted forward.

Aydin Huseynov (Ladenburg Thalmann & Co. Inc.)? - Aydin Huseynov (Ladenburg Thalmann & Co. Inc.)

2025Q4: The $1 billion target in 2029 reflects internal projections; growth will continue thereafter. - Michael Raab(CEO)

Do you have any guidance or forecasts for 2033? - Christopher Raymond (Raymond James)

20251031-2025 Q3: The company's peak sales target of $1 billion+ is based on capturing the established second-line patient population. - Michael Raab(CEO), Eric Foster(CCO)

Contradiction Point 2

Rationale for Initiating the CIC Trial

The stated reason for starting the CIC trial has changed between quarters.

Aydin Huseynov (Ladenburg Thalmann & Co. Inc.)? - Aydin Huseynov (Ladenburg Thalmann & Co. Inc.)

2025Q4: For the CIC trial, the decision was driven by strengthened financial position (cash increase) to invest in the pipeline. - Michael Raab(CEO)

Were financial constraints the reason the trial wasn't started previously? - Dennis Ding (Jefferies)

20251031-2025 Q3: The company has not spoken about conducting trials in IBS-C with diarrhea-predominant (CIC). - Michael Raab(CEO)

Contradiction Point 3

IBSRELA 2029 Peak Revenue Target Assumptions

Contradiction on whether the 2029 target assumes frontline use.

What are your key financial highlights for the quarter? - Wing Yip (Wedbush Securities Inc.)

2025Q4: The $1 billion 2029 target does not factor in frontline use; confidence stems from capturing a small fraction of the large IBS-C patient population. - Michael Raab(CEO)

Given the $400M revenue projection for IBSRELA this year, is there potential to reposition it for frontline use and reengage with payers? - Christopher Raymond (Raymond James)

2025Q3: The strategy resonates because IBSRELA offers a differentiated mechanism... The company's peak revenue projections are based on this established patient population. - Eric Foster(CCO)

Contradiction Point 4

Timeline and Outlook for Cash Flow Positivity

Conflicting statements on the nearness of achieving cash flow positive.

Allison Bratzel of Piper Sandler & Co., what are your key takeaways? - Allison Bratzel (Piper Sandler & Co.)

2025Q4: Cash flow has been positive for two consecutive quarters. - Sue Hohenleitner(CFO)

Can you detail the cadence of RV and SG&A increases in 2026 and how these should shape expectations for the path toward sustained cash flow positivity? - Louise Alesandra Chen (Scotiabank)

2025Q2: On cash flow, the company always considers breakeven and free cash flow to reinvest; based on guidance, it is not that far off on the horizon. Cash flow positive is a goal to reinvest. - Michael Raab(CEO)

Contradiction Point 5

Strategy and Expectations for IBSRELA's First-Line Use

Conflicting emphasis on the role of first-line use in IBSRELA's growth forecast.

What are your thoughts on the earnings report? - Wing Yip (Wedbush Securities Inc.)

2025Q4: The $1 billion 2029 target does not factor in frontline use... - Michael Raab(CEO)

Given IBSRELA's $400M revenue projection, how can the company leverage this growth to reengage payers and explore frontline use in IBS-C treatment? - Julian Reed Harrison (BTIG)

2025Q2: The company is aware of some first-line use. IBSRELA is indicated for first-line use, and physicians may choose it earlier as confidence grows. - Eric Foster(CCO)