BridgeBio Pharma (NASDAQ:BBIO) highlighted accelerating U.S. uptake for its transthyretin (TTR) stabilizer Attruby and laid out key timelines for upcoming launches and pipeline programs during a presentation at the 2026 Leerink Partners Global Healthcare Conference. Chinmay Shukla, the company’s SVP of Strategic Finance, also discussed international launch dynamics through partner Bayer, the company’s expectations around combination therapy in TTR cardiomyopathy, and how management is thinking about margin progression as additional products approach commercialization.
TTR launch: patient adds accelerate and pricing remains stable
Shukla said Attruby’s weekly patient adds have increased meaningfully since launch, rising from about 60 patients per week at an update roughly a year ago to “more than 150 patients a week” as of the company’s most recent update. He described the trajectory as featuring “two waves” of acceleration, which he characterized as unusual for genetic disease launches.
On commercial mix, Shukla said the company’s strength has been primarily in treatment-naïve patients, where BridgeBio has “north of 25%” share about one year into the launch and continues to target exceeding 30% over time. He added that net pricing has been “very, very stable,” with gross-to-net in the 30% to 40% range that the company has cited as a long-term expectation, noting it could move within that band quarter to quarter.
Europe: Bayer-led rollout begins in Germany
Shukla said BridgeBio is “very pleased” with the progress of Bayer’s European commercialization of acoramidis (marketed by Bayer as Beyonttra). He noted that Germany was the first European country launched and said Bayer has reported “north of 50% treatment-naive share” there, which he contrasted with the U.S. environment, citing Germany’s single-payer system and fewer access hurdles.
Looking ahead, Shukla said the next European launch is expected to be Denmark, followed by broader markets including Spain, Italy, and France. He also said it has been disclosed that Bayer “won the bid in Denmark.” In terms of economics, Shukla stated that BridgeBio’s royalties on Beyonttra sales start at 30% and can increase to the mid- to high-30% range, which he said could become a meaningful income stream.
Combination therapy and a new in-house “depleter” program
Asked about the potential for combination therapy and the impact of possible tafamidis generic entry, Shukla said BridgeBio has mapped three scenarios: Pfizer prevailing in intellectual property litigation, a settlement, or generic entry in 2029. He said BridgeBio views it as more likely that Pfizer prevails, either through a win or a settlement that could push generic entry into the 2030s.
On combination therapy more broadly, Shukla said “no benefit” has been shown, citing both available data and U.S. guidelines, and he characterized combination use today as limited to a relatively small group of physicians. He said BridgeBio’s goal is to establish Attruby as “the most potent stabilizer” as a foundational therapy, with add-on approaches considered later if needed.
Shukla also discussed BridgeBio’s decision to develop an in-house TTR “depleter” rather than acquire an external program. He described the disease biology as a “mass action” process in which destabilized tetramers dissociate into monomers that deposit in the heart. While stabilizers aim to prevent dissociation, he said a depleter could theoretically remove deposited material and potentially “almost reverse the disease.” Shukla said the company’s in-house depleter is expected to enter the clinic “probably at the end of next year or early in 2028,” and that upcoming readouts from other depleter programs may inform trial design and patient selection.
Achondroplasia: NDA timing and commercial strategy for an oral option
Turning to infigratinib in achondroplasia, Shukla argued that the clinical profile supports both switching and market expansion. He said infigratinib targets FGFR3 gain-of-function conditions at the source and affects both the JAK/STAT and MAPK pathways. He highlighted a height point estimate of 2.1 cm per year, but emphasized proportionality as a key outcome, stating the drug was the only agent in a placebo-controlled trial at 12 months to show a “static effect on proportionality.” He also described the safety profile as “remarkably safe,” including less than 4% hyperphosphatemia and no other major adverse events highlighted during the discussion.
Commercially, Shukla said an oral therapy could drive meaningful switching given the burden of long-term injections. He also suggested the market could expand by reaching families who have opted out of existing interventions due to injections and other concerns. He cited internal analyses of hundreds of launches and said that, across analogs where an oral product entered a market previously served by injections, market size expanded by about threefold after five years.
On timing, Shukla said BridgeBio expects to file a U.S. NDA in the second half of the year and believes breakthrough designation could support priority review, potentially enabling a U.S. launch in the first half of next year. For ex-U.S. plans, he said regulatory filings and launch timing in Europe are expected to trail the U.S. by about three to four months, starting with Germany and then cascading to additional countries, though he noted plans are still being finalized.
Margins and launch cadence: small molecules and operating leverage
Shukla declined to provide specific margin guidance but described key drivers. He said BridgeBio’s products are small molecules that are “very easy to manufacture,” with low cost of goods sold, adding that he has seen sell-side models around 95% gross margin, while emphasizing that is not company guidance. He also noted a sold royalty interest on Attruby of 5% to Blue Owl and CPP (which he said hits below the line), plus a royalty obligation to Novartis and Inserm on infigratinib, with “de minimis” royalties for ADH1 and limb-girdle.
On operating expenses, Shukla said R&D spending is expected to be roughly flat from 2025 into 2026 and could decline for the existing portfolio starting in 2027 and 2028 as certain programs mature. He said SG&A will rise with commercialization, describing a progression of total operating cash spend from about $100 million prior to the acoramidis Phase III readout to around $200 million to launch acoramidis, and potentially around $300 million (or somewhat higher) by the end of 2026 into 2027 as additional launches occur.
Shukla also briefly addressed other pipeline elements. For limb-girdle muscular dystrophy, he said the company achieved statistical significance on biomarker and functional endpoints including FVC, a 100-meter time test, and NSAD, with additional data slated for a plenary presentation at the MDA meeting. He reiterated the company’s public estimate of roughly 2,000 U.S. patients and suggested patient identification could expand as misdiagnoses are corrected. For ADH1, he said the condition remains underdiagnosed, estimating U.S. prevalence around 12,000 and describing efforts to identify patients through algorithms, family mapping, and testing among non-surgical hypoparathyroidism patients; he noted disclosure of more than 1,700 patients in claims databases over the last two years. Shukla also said BridgeBio holds an equity stake in GondolaBio, which he described as an early-stage R&D engine that could be considered for integration over time depending on the company’s cost of capital.
About BridgeBio Pharma (NASDAQ:BBIO)
BridgeBio Pharma, Inc is a clinical-stage biopharmaceutical company headquartered in Palo Alto, California. Founded in 2015 by Neil Kumar, the company is dedicated to discovering, developing and delivering transformative medicines for patients with genetic diseases and cancers. BridgeBio operates an integrated model that spans target identification, preclinical research, clinical development and commercialization, aiming to streamline the process from bench to bedside.
BridgeBio’s pipeline comprises multiple therapeutic modalities, including small molecules, biologics and genetic therapies.
