Good evening all. My name is Susie Lisa and as the Senior Vice President of Investor Relations, it is my pleasure to welcome you to our first quarter 2026 financial results conference call. On tonight's call, making prepared Remarks, we have Dr. Reshma Kewalramani, Vertex's CEO and President, Charlie Wagner, Chief Operating Officer and Chief Financial officer and Duncan McKechnie, chief commercial officer. We recommend that you access the webcast slides as you listen to this call. The call is being recorded and a replay will be available on our website. We will make forward looking statements on this call that are subject to the risks and uncertainties discussed in detail in today's press release and in our filings with the securities and Exchange Commission. These statements including without limitation, those regarding Vertex's marketed medicines for cystic fibrosis, sickle cell disease, beta thalassemia and moderate to severe acute pain. Our pipeline and Vertex's future financial performance are based on management's current assumptions. Actual outcomes and events could differ materially. I would also note that select financial results and guidance that we will review on the call this evening are presented on a non GAAP basis. I'll now turn the call over to Reshma. Thanks Suzy. Good evening all and thank you for joining us on the call today. Vertex is off to a terrific start in 2026, which we see as a year defined by execution. Q1 revenue growth was strong across the portfolio as we reach more patients with more products and delivered total product revenue of 2.99 billion, reflecting 8% growth year on year. Importantly, we achieved key commercial milestones for each of the newer products since launch through end of Q1, Aliftrek exceeded 1 billion in cumulative revenue, more than 500 people have initiated their Kashgevi treatment journey and over 1 million prescriptions have been written for Journavix. Another highlight in Q1 was that products from the new disease areas, namely Kashevi and Journavix, drove approximately 25% of total product revenue growth. Execution in R and D was equally strong with multiple regulatory submissions recently completed and more anticipated. Combined with rapid progress across clinical trials and important advancement in research, let me spotlight a few accomplishments. First on POVI. The interim analysis results from the Phase 3 Rainier study in IGAN on efficacy and safety from top to bottom were sparkling and and further fueled our enthusiasm for POVI as a potentially best in class BAF April inhibitor. I was exceptionally pleased with the rapidity and quality of the recently submitted BLA filing for POVI in Igan. Indeed, at 27 days from database lock to regulatory submission, this was the fastest submission in Vertex history. Equally notable is the urgency with which the POVI primary membranous nephropathy and the POVI Myasthenia gravis programs are advancing in Membranous. The Phase two study has been fully enrolled and the Phase three program has already initiated. In addition, the Phase two Proof of concept Myasthenia gravis trial is underway. Second on Kasgevi I'm also very pleased with the rapidity and quality of this SBLA submission for Kashgevy in 5 to 11 year olds with sickle cell disease or beta thalassemia. The Kashgevi filing has been granted a Commissioner's National Priority Voucher Review reflecting the importance of treating this younger age group before some of the most serious complications of the disease can begin. Overall, Vertex continues to extend its leadership in cf, drive growth with new product launches while building out our next disease area franchise in nephrology, accelerate programs in mid and late stage development and advance the earlier stage R and D pipeline. Tonight I'll limit my R and D comments to CF as well as the pipeline programs with the most significant new information to share. Certain renal programs POVIne Myasthenia gravis and zamilacel in type 1 diabetes starting with CF.4 quick R& D updates for this quarter we recently reached a significant milestone in the US with label expansions for both ALIFTREC and trikaftor. With this expansion, patients with a clinical diagnosis of CF who have at least one variant in the CFTR gene they that is responsive based on clinical and or in vitro data are now covered by the ALIFTREC and Trikafta labels, reinforcing the impact of these medicines regardless of the location of the variant in the CFTR protein. This is a significant expansion of eligibility that reflects decades of investment, effort and a relentless pursuit of the science. It is also a great example of innovation using using results from clinical trials complemented by in vitro data to expand the benefit of Vertex CFTR modulators to about 95% of people with CF, including those with rare and even N of 1 genotypes. As we expand the ALIFTREC and Trikafta labels to additional mutations. We're also expanding the labels to younger patients. We will soon submit for approval for ALIFTREC in patients 2 to 5 years of age, where you may recall our pivotal trial demonstrated of a remarkable 65% of children reaching normal levels of CFTR function, and we also plan to submit for Trikafta in children 1 to 2 years of age in the near term. In addition, we continue to advance our Next Generation 3.0 CFTR modulators, including VX828, which is currently in a study of patients with CF. We are on track to complete the study and share results in the second half of this year. Following closely behind VX828 in the family of Next Gen 3.0 are VX581 and VX272, both of which are currently in the clinic in Phase 1 Healthy Volunteer Studies. As we have consistently said, if it is possible to do better in cf, we're committed to being the ones who do so. And finally, on VX522, the MRNA therapy we've been developing for people who produce no CFTR protein and therefore cannot benefit from our modulators. We we previously disclosed tolerability issues in this program. Despite actions we have taken in the trial to overcome these issues, we have not been able to do so and as such we have chosen to discontinue the program. Given this early termination, we will not be able to assess the efficacy or full safety of VX522. We will be working with CITES to close out the study in the coming weeks, moving on to our renal franchise, which continues to make quick progress and is rapidly establishing itself as Vertex's fourth franchise along cf, heme and pain. In total, we have four programs in mid and late stage development in renal POVI in Igan, POVI in primary membranous nephropathy, Enoxaplin in AMKD and VX407 in 80 PKD. Tonight I'll cover the first three programs starting with POVI and Igan recall. POVI's differentiated potential best in Class profile stems from its specific design as an engineered tachy fusion protein with binding affinity, potency and PK properties that deliver optimal dual BAF April inhibition. The dual inhibition and engineering advantage is evident in both the interim analysis data of the Rainier study where we saw rapid, deep and sustained improvement in proteinuria, a favorable safety profile and consistency across all subgroups, as well as in three Key patient dosing benefits once monthly dosing, small volume and subcutaneous administration via an auto injector. Overall, the phase three interim analysis data represent a home run in terms of study design, execution and the results with POVEY achieving statistically significant and clinically meaningful results across all primary and secondary endpoints. Patients in this trial received excellent standard of care with high rates of background medicines including the highest rates of of SGLT2s seen in any IGAN study. Baseline characteristics were well matched to real world IGAN patients in terms of age, renal function and degree of proteinuria. In addition, as a measure of study quality, it's important to look at discontinuations. In this study, treatment discontinuations were low and trial discontinuations were even lower at a rate of 1.5% in the placebo group and 0.8% in the POVI group. To replay the top line primary and secondary efficacy results for the primary endpoint, POVI achieved a 52% reduction from baseline in peritoneuria as measured by 24 hour UPCR. That's a 49.8% reduction versus placebo. For the first secondary endpoint, POVI treatment led to a 77.4% reduction from baseline in serum GDIGA1 levels. That's a 79.3% reduction versus placebo for the second secondary endpoint. Of those patients with hematuria at baseline, 85.1% of POVI treated patients achieved hematuria resolution which is a 61.7% reduction versus placebo. In addition, 42.2% of patients reach the exploratory endpoint of 24 hour UPCR of less than 0.5 grams per gram, an important clinical threshold. These are remarkable results and particularly noteworthy considering that at the time of the interim analysis, patients had received just 36 weeks of POV treatment. On safety, POV was generally safe and well tolerated. The majority of adverse events were mild to moderate and there were no serious adverse events related to pov. Importantly, in terms of infections, most were mild to moderate. The rate of SAEs of infection was low at 0.5% observed in both the placebo and POV groups. There were no opportunistic infections and no discontinuations related to POV overall, including no discontinuations due to infections. Lastly, on antidrug antibodies or adas, adas were observed as expected with biologics but had no impact on povi's efficacy or risk profile. We look forward to sharing more details of the interim analysis results and anticipate doing so at upcoming medical meetings this fall. Shifting to POVI and primary membranous nephropathy I am pleased to share we have completed enrollment of the Phase 2 portion of the Olympus Phase 2.3study and have already initiated the Phase 3 portion ahead of our previously announced Mid2026 goal and finally on POVI as part of its pipeline in the product potential for B cell mediated diseases beyond renal I'm also pleased to share that the Phase two proof of concept study of POVI in generalized myasthenia is underway. This is a 30 patient study of people with GMG evaluating both the 80 and 240 mg dose for 12 weeks with the primary endpoints of safety and the percent change from baseline in IgG at week 12. The rationale for studying POV and myasthenia is compelling and it's a serious B cell mediated disease with high morbidity affecting approximately 175,000 people in the US and Europe. There is high unmet need as current therapies have meaningful limitations, which means there's room for improved efficacy, a better benefit risk profile and more patient friendly dosing and administration, which we have discussed in the context of IGAN as being critically important when considering a chronic biologics market. We believe povi's mechanism of action, striking at the heart of autoantibody production with an engineered protein format provides best in class promise in myasthenia and we are excited to develop this opportunity. Shifting back to renal to finish up with enoxaplin in Apol1 mediated kidney disease or AMKD. First on amplitude, the pivotal phase 3 study of primary AMKD, that is to say patients with two Apol1 variants for nurture kidney disease and no other renal related comorbidities. We are on track to conduct the interim analysis which occurs after 48 weeks of treatment, and to share data from this Cohort in early 2027. If positive, we will be poised to file for potential accelerated approval in the US thereafter. Second, on amplified our Phase 2b study of enoxapline in separate populations, patients with 2 APOL1 variants, modest peritoneuria and no other kidney disease and patients with two APOL1 variants, moderate to severe peritoneuria and a second disease, type 2 diabetes that could impact the kidney. These two populations are not being studied in amplitude. We recently completed enrollment in the Amplified study which is a study of 13 weeks in duration. Given the clear differences in these populations, we made the decision early on to study them in separate trials. Emerging data in the field confirm the wisdom of this decision. We are excited to learn from the Amplified study and look forward to sharing results in the second half of this year. Finally, on type 1 diabetes, a reminder that Zamylacel has very strong clinical results to date, as detailed in last year's New England Journal of Medicine. Among patients who received a full dose and had at least one year of follow up, 10 out of 12 patients who were insulin free. These results are unprecedented and are particularly noteworthy given that these patients are those with 20 plus years of type 1 diabetes, undetectable endogenous insulin production at baseline, taking 40 plus units of exogenous insulin per day and with two or more severe hypoglycemic events per year despite best available care. You may recall that in the second half of last year we paused dosing of the phase 1, 2, 3 study in order to conduct a manufacturing analysis which we have now completed. I am pleased to report that dosing in the study has resumed and multiple patients have been dosed with dosing now restarted. We will update you in the coming months on the revised timelines for study completion and regulatory filings. With that, I'll turn the call over to Duncan for for a commercial update.

Thanks very much Reshma. I'll start with cf, which continues to perform very well year over year. Revenue growth was 6% globally, balanced nicely between US growth of 5% and international growth of 8% in quarter one. Global growth reflects continued ALIFTREC uptake as its once daily dosing and improved sweat chloride profile continue to resonate with the clinical and patient communities. As mentioned, a Liftrek has now surpassed $1 billion in cumulative global revenue since its approval in the U.S. in late December 2024 and Europe in July 2025. Outside the U.S. we have signed reimbursement agreements in 11 countries for ALIFTREC in quarter one alone, building on the access generated in the second half of last year. The tremendous scientific and regulatory achievements represented by the label expansions for elliftrek and Trikafta also also represent a meaningful incremental commercial opportunity of approximately 800 people in CF who are newly eligible in the U.S. this broad labeling is one of several key CF growth drivers for the remainder of 2026, along with the global rollout of a LiftRec treating younger patients and expanding into additional geographies. We have worked closely with the CF population for two decades and remain focused on continuing to serve the CF community and and expand our leadership across all genotypes, age groups and geographies shifting to heme. The rollout of Kashgevi continues to gather momentum across all three regions and I'm pleased to highlight another significant commercial milestone. Since launch, over 500 patients have now initiated the Kashgevi treatment journey. Hundreds have had their first cell collection and many patients have had their cells edited and are ready for infusion. During the first quarter we delivered $43 million in Kashgevi revenue. Importantly, we worked on securing a pricing agreement for Kashgevi in Germany in quarter one and are currently working through the implementation steps. This is a historic moment and we're excited that German patients with sickle cell disease and TDT may soon be benefiting from long term access to Kashgevi at a sustainable price. Overall, we are very encouraged by the robust flow of patients in the US in in Europe and the Middle east moving from referral to cell collection and infusion. First quarter revenue reflects expected variability quarter to quarter as patients choose the timing for their infusion that suits them best for the full year 2026. The Kashgevi Outlook is very promising as we have built our ATC network, secured reimbursements and now have many patients at all stages of the treatment journey. We therefore have very strong visibility to revenue for the rest of 2026 for Kashgevi to contribute meaningfully to our $500 million plus revenue goal for non CF products this year and towards Kashgevi's ultimate multibillion dollar potential for Journavix in moderate to severe acute pain. Prescriptions, prescribers and awareness all continue to build. More than 350,000 prescriptions were filled in the quarter compared to compared to approximately 550,000 in all of 2025, which was in line with our expectations. We also surpassed the milestone of over a million genavix prescriptions written since launch. Prescriptions this quarter were once again split roughly 5050 between the hospital and retail channels and generated $29 million in revenue. Also in line with our expectations. Overall prescription growth remains strong. Although quarter one revenue reflects some normal inventory destocking, we remain on track to more than triple the 550,000 prescriptions for 2025 and for revenue growth to significantly exceed prescription growth. I'll now outline some of the key drivers of our continued growth and expected success for Genavix in 2026. Firstly, physician and patient clinical experiences on Genavix continue to be excellent, which provides a great foundation for continued growth. We also continue to see outstanding breadth of physician uptake as well as genavic's additions to hospital and IDN formularies protocols and order sets. Secondly, we continue to make good progress in the payer space with 240 million lives now covered in addition to the big three commercial PBMs. I'm delighted to announce that we've reached an agreement with the first of the big four Medicare Part D plans to start covering Journavix effective as of May 1st. Given the multiple and well documented challenges that opioids present seniors, this is welcome news and we're in discussions with the remaining Medicare Part D plans as well as the smaller regional plans. Thirdly, we have completed doubling the size of our field Force to 300 representatives, slightly ahead of plan. As we've communicated before, Genavix is highly promotionally responsive and we're excited about the impact of this new field team on genavics growth. Lastly, we also continue to execute multiple initiatives to drive awareness growth and provide new mechanisms for patient access, including the launch of Vertex's first direct to patient telehealth platform, Informed Pain Care. This platform is accessible from genavics.com and provides appropriate and independent telehealth evaluations for non surgical acute pain patients if eligible. We're also pleased that genavix was recently added to the list of non opioid medicines eligible for separate payment under the no Pain act, effective retroactively to January 23rd. In summary, with the increased size of our field organization, our continued progress in securing payer and hospital coverage, as well as strong gains in formulary status, we remain confident we will triple prescriptions for Genavix in 2026. In addition, our strong reimbursement progress continues to position us to taper our patient support program over the course of 2026 and enter 2027 with a normalized gross to net. We continue to expect Journavix to contribute meaningfully to the $500 million plus we expect in revenue outside CF this year. I'll conclude with an update on the commercial initiatives for our emerging renal business. We're investing in the nephrology community for the long term and Povatacept is the first in a series of potentially transformative medicines that tackle the underlying cause of four serious renal diseases, namely IgAN, PMN, AMKD and ADPKD. We were thrilled with the interim analysis results of the Rainier Phase 3 study with excellent results across the board in efficacy, safety and across all subgroups and in the areas of greatest interest to nephrologists and patients. The results create a superb foundation for the commercial launch of a potentially best in class medicine. Our goal for POVItaZCEPT is to be physicians first choice for their IGAN patients given POVI's compelling trifecta of differentiated efficacy results, well tolerated profile and patient centric administration characteristics due to its low volume monthly dosing via Sub Q autoinjector. Based on our market research and discussions with nephrologists plus feedback from our field team engagements, we know nephrologists are looking for treatments in IGAN that meaningfully and rapidly reduce proteinuria in the patients they treat as they see proteinuria as the key indicator of where the patient is headed clinically. Nephrologists also seek a favorable tolerability profile and both physicians and patients communicate to us the need for a seamless treatment experience which includes everything from access to patient support to monthly dosing, size of dose and administration in an autoinjector. We believe that uniquely POVI has the clinical profile and that Vertex has the capabilities to meet all of these needs. Our renal field force will be specialty sized and large enough to cover nephrologists who see approximately 80% of US Igan patients. We will target key facilities that represent a combination of renal centers of excellence, glomerular disease clinics and key high volume private practices. Our payer conversations are proceeding well in a US market where approximately 70% of patients have commercial coverage. We have a proven track record in securing broad and rapid access for our medicines and plan to establish the same for POVI and igan. And lastly, we know that the quality of the patient support provided is critical in the biologics space. With that in mind, Vertex programs to support POVI patients will enable speed to therapy and personalized support through the treatment journey, delivering a seamless experience of onboarding for patients and physicians alike. POVI and IGAN is the first component of our emerging renal franchise. We're excited to bring it to nephrologists and their patients. Based upon our work with them, we know they're excited to try it as well. We believe POVI delivers exactly what nephrologists are looking for in igan. And just as we've done for over a decade in cf, povi's success will be driven by a field force delivering a high science cell fueled by a potentially best in class product, broad reimbursement and robust and high quality patient programs. We are very excited to begin building our fourth commercial pillar and creating another multibillion dollar franchise at Vertex. I'll now turn the call over to Charlie to review the financials.

Thanks Duncan. As Reshma noted, Vertex's Q1 2026 results demonstrate our consistent strong performance and attractive growth profile. First quarter 2026 total revenue increased 8% year over year to 2.99 billion. CF global revenue increased 6% year over year and new disease areas also contributed, with Kashgevi delivering $43 million and Journavix $29 million in Q1 sales representing about 25% of total year over year growth for the quarter by region. U.S. revenue growth of 7% year over year was driven by continued steady performance in CF and growing contributions from Kashgevi and journavix. International revenue grew 9% year over year driven by continued CF expansion, an increasing contribution from Kashgevi, and, as anticipated, a benefit from year over year changes in foreign Exchange. First Quarter 2026 Combined Non GAAP R and D acquired IPR and D and SGA expenses were $1.29 billion, an increase of 5% compared to $1.23 billion in the first quarter of 2025. Within total OPEX, non GAAP R&D expenses were down 2% year over year, partly driven by the timing and mix of certain clinical trial expenses. In addition, certain POVI manufacturing expenses were included in R and D in 2025 and are now recorded in cost of sales and following the positive interim analysis data, non GAAP SGA expenses increased 30% year over year driven primarily by commercial investments, with roughly 40% attributable to Journavix and PAIN and approximately 1/3 to renal launch programs. We also recorded 1 million in IPRD expense in the quarter versus 20 million in the first quarter of 2025. First quarter 2026 non GAAP operating income was $1.31 billion compared to 1.18 billion in non GAAP operating income in the first quarter of 2025. 1st quarter 2026 non GAAP effective tax rate was 19.6%. 1st quarter 2026 nonGAAP net income was $1.1 billion, an increase of $93 million compared to the first quarter of 2025, primarily due to increased product revenue partially offset by increased operating and income tax expenses in the first quarter of 2026. First quarter 2026 non GAAP earnings per share were $4.47 compared to $4.06 in the first quarter of 2025. Reflecting our strong revenue growth and disciplined expense management, we ended the quarter with $13 billion in cash and investments after deploying approximately $344 million to repurchase more than 741,000 shares in the first quarter. This activity reflects our ongoing commitment to returning value to shareholders while maintaining the flexibility to act on strategic growth opportunities. Overall, our priorities for cash deployment remain unchanged with a primary focus on investing in innovation. Now switching to guidance we are reiterating our 2026 total revenue guidance of 12.95 to $13.1 billion representing growth of 8 to 9%. This outlook reflects continued solid performance from the CF franchise driven by the elliptrek launch, expansion into younger patient groups, incremental patients from the label expansion and geographic expansion. We continue to have high confidence in our outlook for revenue of $500 million or more than from non CF products driven by growing casgevy infusions where we have good line of sight given the length of the patient journey and a meaningful ramp in Jornavix prescriptions and revenue as gross to net normalizes through the second half of the year. Lastly, our revenue outlook continues to include an expected impact from foreign exchange net of our hedging program. Our outlook for full year gross margin remains at just under 86% reflecting the growing non CF product mix impact and ongoing investments in manufacturing network and process development for various products. We are also reiterating our combined non GAAP operating expense guidance of 5.65 to $5.75 billion reflecting continued investment in our late stage clinical pipeline and commercial infrastructure and activities for new launches and revenue diversification. We also continue to expect our non GAAP effective tax rate to be in the range of 19.5 to 20.5% for the full year 2026. On the subject of tariffs, we do not expect any material impact to the income statement in 2026. We continue to evaluate the details of recent announcements and the potential applicability to vertex. In summary, Q1, 2026 was a very strong start to the year. Financial results are on track, commercial launches and diversification are gaining momentum and we continue with targeted investment both in innovation and commercialization as the pipeline is advancing across our multiple disease areas. Our increasingly diversified commercial portfolio, now spanning three disease areas and soon to be four with the establishment of the Renal franchise, is driving new revenue streams and adding to our near and long term growth profile. Vertex is well positioned to continue expanding its impact for patients, investors and all stakeholders. These and other anticipated milestones of continued progress in multiple disease areas are detailed on Slide 17. We look forward to updating you on our progress on future calls. I'll now ask Susie to begin the Q and A period.

Hey guys, good afternoon. Thanks for taking my question. So you've talked about renal one day rivaling the cystic fibrosis business in size. Can you speak to what needs to play out from here to realize that vision and, and among your renal assets which you see having the greatest long term revenue potential? Thank you. Hi Jess, this is Reshma. I guess as a nephrologist at the company, maybe I can take this. And Duncan, please feel free to add. So Jess, what we're talking about in our emerging renal franchise is 4 assets CoV, 4 diseases, 3 assets POVi for IGAN, POVi for membranous, enaxepline for AMKD and what we call VX407 in ADPKD. The reason I think that this has the potential to be as big, if not larger than CF is that the diseases that these medicines treat are rare diseases. But they are common, rare diseases. And when you add them all up together, they're well into the hundreds of thousands of patients. For example, we talk about 150,000 or so patients with IGAN in North America and Europe, 100,000 patients with membranous in the same geographies for AMKD, that's another 150,000 or so patients with the amplitude population, not including the amplified population, which adds another 100,080 PKD is about 300,000 patients. Of course, the first medicine that we're studying, DX 407 can treat about 10% of that 300,000. So one, while each one is a rare disease, they are common, rare diseases. And when you add it together, we're hundreds of thousands of patients in just the western world. The second is that in renal medicine, unfortunately, the outcome of these diseases is a relentless decline in renal function and a movement then to death. Dialysis and transplantation, obviously those are enormous burns for society. I don't need to say much more about death, but dialysis in particular is exceptionally expensive. And while it allows you to live, it is a very, very difficult life. And life expectancy is like very serious cancers like pancreatic cancer. And then last of that block, when we look at the emerging results for povi, for example, in Igan and Membranous, you can look at the phase two and for Igan, you can certainly look at the phase three in terminals results, as I said on the call, they are sparkling from top to bottom. Safety, efficacy. These are the kind of medicine that can bring transformative value. When I think about AMKD, same thing. You look at the phase two results that we published in the New England Journal. 47.6% reduction in proteinuria is a very big deal. And when we think about adpkd, no human results yet. But when you look at the mechanism of action, this is to say to properly fold the misfolded PC1 and what we see preclinically another one where we think transformative effect. That's why we believe this is another vertical that can rival if not Crest CF best renal asset. That's a tough one, Jess. I'm going to focus my attention for the here now on Tobi. It just looks sparkling. You can call it near term bias because we just looked at the phase three results. Thank you.

Good afternoon. Could you discuss the read through from Maze's recent data to the Enaxiplin program And also could you just speak for that program whether there were enrollment considerations to enrich for patients with larger APOL1 contribution to CKD, especially in the non FSGS patients. Thank you. Yeah. Hey, good afternoon Salvine on the Maze data. You know we don't like commenting on other companies assets and results but I'll simply say at the top line the vertex results were 47.6% reduction in proteinuria as published in the New England and my recollection is the maize data is 35.6% at the top line. Going below that is difficult because we're talking about groups of two and three patients with or without diabetes and such. And I just don't think you can make very much when you're down to two or three patients. What I will say is I'm very happy about the decision we made early on to not mix a heterogeneous group and to focus our program on those with heavy proteinuria, two Apol 1 alleles and reduced kidney function and not study those who have a comorbid condition like diabetes. Instead what we did is study those people in a separate trial called Amplify along with a group of patients with lower proteinuria. That trial is done enrollment and I do expect to have results in the second half of this year.

Duncan, Brian, good afternoon. So, one comment before we dive into your answer. I just made the point that obviously this is a huge market opportunity with about 160,000 patients in the U.S. it's five times bigger than CF for example, and the vast majority, about 75% of those patients are nowhere near the Kidigo guideline goal in terms of proteinuria. So the opportunity is significant. We've been engaging through market research and other mechanisms with many nephrologists and essentially they tell us they're looking for a product that significantly impacts proteinuria. We'll come back to that is well tolerated and is easy for patients to use and we believe that uniquely meets those needs. We think it has the sort of winning trifecta of incredible clinical effects, as you heard in the prepared remarks, things like the rapid, deep and sustained reduction in proteinuria as well as Gdiga1 and Hematuria. It has a supremely favorable tolerability profile and very attractive dosing and administration. So as you know, it's once a month, it's a small volume dose and it's delivered by an auto injector. So we think we have an incredible product as we saw in the clinical data. We also know from our market research that those nephrologists that distinguish between bas April and April alone, the vast majority of them prefer dual inhibition with BAF in April and in our patient market research that the vast majority of patients prefer monthly dosing over weekly dosing. In fact, eight times more patients prefer monthly dosing to weekly dosing. So in terms of the profile of the product matched against the needs of the physicians and patients, we think we have a best in class asset on our hands. And I would also add on the commercial capability side, we know how to execute a high science cell, we know how to secure rapid, deep and broad reimbursement and we know how to build patient support programs which are incredibly important in the biologic space as we have done for the last 12, 13 years or so in cystic fibrosis. So we're feeling really good about the profile of COVID as accept. We are getting ready for launch and we're going to be ready to go the day the FDA give us regulatory approval.

Afternoon guys. Thanks so much for the question. I have two quick ones. So on pain and on 993 in particular, as you guys have got commercial experience with Dranavics, are there settings where an IV modality is perhaps a better fit in the clinical practice? I imagine that's maybe the hospital setting in Cuba wanted to obviously get your perspective. And then on povi, congrats on the quick filing and Igan. But looking beyond PMN and gmg, is it worth it to do a basket study? Are there other autoimmune indications that make, you know, sort of that you could have the most differentiation for POV and then maybe have the highest probability of success? Thank you.

Hey Jeff, this is Reshma on the pain portfolio and whether or not an IV medicine would be helpful. I think it would be helpful to have an IV medicine and what we're really looking to do here is and the reason we have not only Sucetrogine or Genavix but 993 and additional NAV1.8s but very importantly NAV1.7 is to make sure that we have the best medicine whether it's PO or iv. And that formulatability into IV is one of the features that we're looking at and are interested in switching then to POVI and where we see things go. IGAN is already done in terms of the interim analysis and filing. Membranous phase three is already underway. Myasthenia phase two is underway. There are some additional B cell mediated diseases that we are thinking about and I do think a basket study is a very efficient way of evaluating those conditions through phase two development. I won't say much more about exactly which conditions, but suffice it to say there are some B cell mediated conditions. Autoantibodies are important, where we think POVI would fit nicely. And I do think that going about this by way of basket studies and efficient phase 2 3s are the right way to go. You'll be hearing us talk more about POV and our immunology portfolio in the coming months and in the coming time. But I like your idea.

Hey, good afternoon guys. Thanks for taking my question. I wanted to follow up on Salvine's question on Enoxaplin and when you think about the pending data from amplified, looking at AMKD patients with moderate proteinuria or diabetes, what's needed in this population for a clinically meaningful benefit to justify advancement in this patient segment. Corey. I would say that generally speaking in renal medicine, we've been thinking about double digit improvements as being valuable. By that I don't mean 10% or 11%. I would say if we can show 30% improvement, you know, some number between 20 and 40%, 25 and 50%, some substantial double digit improvement in proteinuria on top of standard of care, of course. So on top of ACEs, ARBs, ERVs, et cetera, that would be meaningful and we'll be able to see how we fare shortly. The enrollment's done, it's a 12 week study, so we'll be able to tell you the results in the near term.

and the noise within the assay and the timing of the measurement and why you don't think that would be any issue here for povi. Yeah, start with safety and the question on hypogamma, globulinemia and then we'll go to efficacy on safety. The results are really terrific because POVI and any medicine that works on April or baf. April in essence is modulating B cells. You do need to think about the safety profile. And in the safety profile the domain to think about is infection. So specifically what we focused on and what I was very pleased to see is we can get this level of efficacy on proteinuria, on Hematuria, on Gdiga 1, on getting down to these very low levels, less than 0.5 grams per gram, which is the important clinical threshold, we can get down to those levels with a very favorable Safety profile. So on infection, most of the infections are mild to moderate. So think upper respiratory infection. There's no opportunistic infections, no uncommon infections. The SAEs of infection are low and balanced. It's exactly 0.5% in the placebo group and the same exact number in the pulvi treated group. So that looks really nice with regard to the actual immunoglobulin levels. And let's focus on IgG. The IgG levels of less than 300 or 150 or 200. Some people use 400. These thresholds are important because that's how people set up their trials and that's how the trials may have certain actions taken. You are correct. Each trial defines a different threshold. You measure it a different number of times. Some people measure it monthly, like us. Other people measure it quarterly. Some people require multiple measurements to call it less than that threshold. Others require a simple one level. So it's not very easy at all to cross compare. The important thing though, Michael, if you're asking me, hey, is there anything there that gives you concern? None at all. The important thing to look at is the infections. And the infections look very balanced between these groups on efficacy. You ask about gfr, which is the regulatory enabling endpoint. Right. So the regulators have said proteinuria is acceptable at nine months for accelerated approval, but they are looking for two year GFR for full approval. Note, however, GFR is actually not the hard endpoint in renal medicine. The hard endpoint is death, dialysis or transplantation. That's what we're really trying to avoid. It's just that that endpoint takes a long time. And so the acceptable regulatory enabling endpoint for full approval is gfr. The reason I think that the proteinuria is so important is when you think about that hard endpoint of death, dialysis and transplantation, which takes years to develop. The thing that most proximally reflects that is proteinuria. And what I would do is think about proteinuria, okay, if I got 1 point of proteinuria improvement more than any other medicine, 2 points, 5 points, 10 points. Compound that over years and you start to see why proteinuria is so very important. The agency has said very clearly that we're not allowed to share gfr, but they've equally said that they need to see GFR to provide accelerated approval. So what I would say is any medicine in Igan that gets accelerated approval has the proteinuria that we've already shared and has GFR that the agency finds comforting. Thank you.

Hi, good afternoon. I wanted to ask what your thoughts are Reshma on the read through from this positive IGAN study that you provided the top line for recently onto the PMN study that you're currently running for post. And then secondly on the CF pipeline I just wanted to get a sense of what data you plan on showing in the second half of the year for 8.28 and what would be considered good data there. Thanks. Okay, let's do Igan first. Tazim, I see some data that are from the IGAN as very important and positive for membraness because now we've studied hundreds of patients over a nine month period which is additive information to the phase two results. So things like PK pd, the reduction in proteinuria, I see all of that in terms of efficacy as important. Clearly the autoantibody of interest is different. One is PLA2R. That's what we're looking for in membranous versus gdiga1. So that has to play itself out. But in terms of those other parameters I see that as really positive. The other variable that I see is very positive is on safety. The fact that there is such a favorable safety profile I see as a positive. Of course the IGAN study was in 80 milligrams and in the membranous study we're studying both 80 and 240 to pick one. Lastly, I feel very good about the way the study is being conducted, that is to say low discontinuations in terms of study discontinuations and treatment discontinuations. And I also feel really good about the background therapy. It's very important to look at as you think about doing these studies in contemporary practice on switching now to CF. The 828 results are a CF cohort after we've completed the healthy volunteer study. And so what you should see is data from the single dose that's gone into the patient cohort. And you should expect to see sweat chloride results and safety results as well. It's a small cohort so you shouldn't expect anything on PPF EV1. But the readout, the efficacy readout that we're looking for is sweat chloride. So you should expect us to share that.

Thank you. Yeah. Good afternoon, Evan. On VX522, what I can tell you is that the tolerability issue that we have been monitoring and sharing with you now that the study is being discontinued has to do with lung inflammation, like an inflammatory response, probably in response to the LNP that's being used to deliver it. And I say that because this is not unusual in that regard. So with regard to what are we going to do for our patients, I want to be clear about the fact that our commitment to CF is absolute and steadfast. If there is any more that we can do for our patients in the 95% group, we're going to be the ones who do it. And for our last 5,000 or so patients, we're going to work on that as well. I expect that the challenge is going to continue to be delivery. And in terms of modalities, we're going to have to go back to the drawing board on modalities. These last 5,000 are going to require some nucleic acid therapy. Right. Because they simply don't make any protein. And so the big question is not necessarily what the nucleic acid therapy is. We have some big, there are ideas and they're, I think, obvious. But how do you deliver it without having this lung irritation? And that's what we're going to be working on.

Yes, thanks very much and thanks for all the updates. So my questions are on Journavix. Could you maybe help reconcile the $29 million in revenue in the first quarter with the volume of either prescriptions or pills? And then given that Your Navix has PBM coverage for 240 million lives now, which is over two thirds of the population, does Genavics need to achieve more employer opt ins and more tier 2 formulary positions for the gross to net to normalize? Thanks so much, Duncan.

Sure. Good afternoon, David. So in terms of the first part of your question, I would say overall, by the way, we are extremely pleased with the progress on Genabix. We are fully on track in terms of our prescription numbers and our revenue numbers in terms of reconciling quarter $1 and volume. As I mentioned in the prepared remarks, we did see a small but relatively normal channel inventory destocking in quarter one between quarter four, 25 and quarter one, 2026. It's also true that in that quarter, of course, Medicare Part D plans are resetting, which can lead to higher co pays and more abandonment. And then also we saw the traditional reduction in the number of elective surgeries in January, which were a little bit harder impacted this year because of the sort of fairly strong flu season. So overall, I would say that the quarter one performance was in line with our expectations. We are absolutely on track to more than triple the number of prescriptions that we delivered in 2025. And to answer the second part of your question, we have just achieved our 240 million lives covered. As you know, we're very happy with that. And actually, in an update, since we finalized the script, you know that we've been working on four Medicare Part D plans. And in the script, we communicated that we had secured coverage at one of those four plans, which we've actually secured coverage at two of those four plans and are very close to securing coverage at a third of those plans or the third of those plans. And that coverage starts from between May 1 to July 1. So I don't think we need to be focused on downstream plans and employer plans. As we have said all along, as we secure the final pillars of access, the patient support program will taper down. Our gross to net will normalize by the end of the year, and you will see revenue significantly accelerate and accelerate faster than prescription growth as we go through the balance of the year. Thank you.

Thanks. Just two questions for me. I was just wondering if you can tell us if there's a defined percentage of FSGS patients in the amplitude phase 3 trial for Enaxaplan, if there's a cutoff, or if it's just pretty much all comers. And that mix will be dictated by who's enrolled and then for liftrec. Just curious to know if you're seeing anything different in terms of patient mix this quarter versus prior quarters, in terms of the three different buckets that you guys have focused on. Thank you.

Terrence. I'll take your SSGS question for phase three in Axoplan. I'll turn it over to Duncan. I won't be able to share what the baseline characteristics look like because we haven't looked at those data and we don't know those data. But what I will tell you is that what's common in AMKD is because they tend to be heavily proteinuric, so we're talking about people who are coming in with proteinuria, 0.7 grams or more. They often tend to have a biopsy because that's a lot of proteinuria. And people are trying to figure out whether there's an underlying identified cause. So it wouldn't surprise me at all if many, maybe even the majority of patients in the AMKDALE Phase 3amplitude trial actually were known FSGS patients, because a lot of these patients actually do get a biopsy. Not all of them, but it's not an uncommon act, so that would be my guess, but I don't have a formal answer for you. Fortunately, the IA enrollment is complete. The full study enrollment will complete this year, and we fully expect to have results from the IA in early 2027. So we'll know the answer real soon. Duncan A Lift Track Characteristics Transition New

York Yep, Terence, thank you for the question. So, yeah, I'm assuming the three categories you're talking to at the naive talking about are the naive patients, the discontinued patients, and the transition patients. I would say that we see continued strong progress in all of those once we have both regulatory approval and reimbursement. We see the naive patients coming on first, then we see the discontinuation patients coming on, and then finally the transition patients are moving onto a liftrek, indeed, exactly as we desire. So at this point, essentially, I would tell you that all new patients are going onto a liftrek. No one is going onto trikaftor. They're all going onto a liftrek. We see the discontinued patients largely moving on to aliftrec, and the vast majority, of course, of our patients now are transitions from Trikaftor to Aliftrec, exactly as we would expect. So the three drivers, really, of a Liftrec growth this year are continued uptake in the US, more European countries securing reimbursements, and the expanded labels, for example, the additional 800 patients that were recently included in the most recent labeling updates. So hopefully that answers your question, but we're seeing essentially similar profile to that which we saw before and super happy that we are well over a billion dollars on a lift track at this point.

An efficacy or safety perspective. And I guess as you think about the CF landscape broadly, how are you thinking about sort of the bar set by a lift track versus where you see room for incremental improvement? Thanks, Elliot. We couldn't catch the first part of your question. Would you restart, please? Sure. Sorry about that. Let me know if you can't hear me now. Just another question on ACQ. You can hear me. Okay, good. Just on 828, just to follow up on the earlier question, I guess, what are you seeing as a bar for what you would want to see to bring this forward from an efficacy or safety perspective? And then just as you think about the cystic fibrosis landscape overall, how are you thinking about sort of the bar set by a lift track versus where you see room for improvement? Thank you. Yeah. When we had trikafta and we're working to see what the unmet need was, honestly Ellie was a little bit easier to see. As amazing as trikafta is, we could see that a once daily medicine would be better for patients and we could see that getting more CFTR protein function that's the same, more sweat chloride, more patients below the diagnostic threshold of 60 and the normal level of 30 would be advantageous. Now fast forward to where we are today with the lift track and genuinely there is very little unmet need. And so it's going to take something special for us to advance. And that's why we're looking at VX828, we're looking at VX581 and we're looking at VX272 because we want to really interrogate to see if there's more that we can bring to the table. And what I'm really saying in the event is unclear is this. Today 90% of people, if you start at a young age, which Ali is now approved down to six years old and we're filing for two to five years old, 90% are less than 60. Two thirds of our patients are at sweat chloride. That's below normal. And this is with a once a day medicine. And now when you think about it, everyone, as Duncan described, all our new patients, all our young patients are coming on to ali. There's very little room for improvement here. So if it's possible, we're going to be the ones who do it. But it's getting really, really tough because we're already down to once a day good looking DDIs, excellent sweat chloride function with 2/3 normal. It's tough, so if we see it, we'll certainly let you know. But that's why we're being so particular and bringing these number of medicines forward to see if anything can be better than a liftrek. Great, I think we'll wrap there. Chuck, can you give the replay information?

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