Akebia Therapeutics, Inc. Q4 FY2025 earnings call

• 2025 was important for Akibia with commercial launch of Vafsio. Vafsio, along with Orixia, generated $227M in net product revenue. • Addressed challenges with Vafsio, seeing signs of demand growth. Over a year into launch, over 1,000 prescribers at 24 dialysis orgs wrote prescriptions and 290,000 patients have access. • Presented data at ASN meeting and ADC in Kansas City showing Vafsio benefits. Late 2025 to have VOCAL study results, early 2027 VOICE trial data. • Introduced rare kidney disease pipeline including Perlisiguat in Phase II for FSGS, AKB097 in Phase II basket trial, and AKB 9090 in Phase I in 2026. • Nick provided details on Vafsio launch, including Q4 2025 performance, adherence trends, and commercial trends for 2026. • Eric discussed financial results, noting revenue increases and expense management.

In 2025, Vafsio (VASIO) and Orixia generated $227 million in net product revenue. Vapcio net product revenue in Q4 2025 was $6.2 million, with $45.8 million for the calendar year. Arixia net product revenue was $48.1 million in Q4 2025 and $181.5 million for the calendar year. Cost of goods sold in Q4 2025 was $12.5 million vs $20.4 million in Q4 2024, and $39.5 million for calendar 2025 vs $63.2 million for 2024. R&D expenses in Q4 2025 were $26.6 million vs $11.8 million in Q4 2024, and $62.4 million for calendar 2025 vs $37.7 million for 2024. SG&A expenses in Q4 2025 were $26.1 million vs $27.7 million in Q4 2024, and $107.5 million for calendar 2025 vs $106.5 million for 2024. Cash and cash equivalents as of Dec 31, 2025 were $184.8 million vs $51.9 million as of Dec 31, 2024.

• Not guiding for Vafsio revenue growth specifically but expect growth from current demand levels. • Anticipate Arixia revenues to decrease in 2026 due to generic competition expansion. • Catalyst-rich next 12 months including VOCAL study results in late 2025, VOICE trial data in early 2027, initiation of AKB097 basket trial in second half, Phase 1 study of AKB 9090 in 2026, and continuing Perlisiguat Phase 2 enrollment.

Q: Can you talk more about your expectations for sequential VAPCO growth in 2026? How to think about it in relation to inventory adjusted demand in Q4 2025? To what extent do you expect data from the voice study to potentially accelerate uptake next year across dialysis providers? How operationalized the VAFCO access at DaVita currently?

A: Expect growth from current demand levels, not guiding revenue. Dialysis providers' adoption is measured. Data from studies like ASN, ADC, VOICE, VOCAL need publication for influence. DaVita made Vafsio available, field teams educate physicians.

Q: Encouraging to hear about improvement in first refill adherence. Comment on how second and third refill rates are trending? Any other comments just on the anemia manager education? Comment on 90-90 asset?

A: First refill adherence improved from 75% to 91% in Q4, 87% in Jan for observed dosing. Second and third refill rates show significant continuation. Anemia manager education done through medical affairs, MSLs expanded. 90-90 has different pharmacokinetics, more widespread tissue penetration, better in non-clinical models of ischemia reperfusion injury.

Q: For vocal study, sense of what success looks like? Powering for superiority on any endpoints? How important is the RBC sub-study in differentiating Bastio's mechanism?

A: Vocal study is 350 patients, primary endpoint non-inferiority for hemoglobin control. Suspect superiority on hemoglobin-related safety endpoints. RBC sub-study important as Vafsio is different from ESAs, red blood cells made under Vafsio's influence are different.

Q: Have you reactivated the IND for AKB097 yet? Any changes to the protocol from Q32?

A: Reworking protocol to be simpler, not activated until resubmission of finalized protocol.

Q: On the R&D day on April 2nd, frame expectations for investors?

A: Focus on Prolisiglot and AKB097, bring in KMEs to discuss, provide depth on data underlying decisions, introduce AKB 9090 and its differentiation, give opportunity to understand rare kidney pipeline.