Alnylam Q2 2026 Product Net Revenue $1.172 Billion, Shares Slump 28% on Guidance Cut

Alnylam reported its second-quarter 2026 financial results, with product net revenue of $1.172 billion, up 74% year-on-year. Core drug Amvuttra surpassed $1 billion in quarterly sales for the first time, reaching $1.012 billion, a 106% increase. Combined TTR pipeline revenue was $1.03 billion, up 89%. However, the company subsequently lowered its full-year TTR pipeline sales guidance from $4.4-4.7 billion to $4.2-4.5 billion, a reduction of about $200 million. Following the earnings release, the stock fell 28% in a single day, reducing its market capitalisation to below $30 billion, roughly half its historical peak.

Chief Commercial Officer Tolga Tanguler said that demand growth for Amvuttra in the US second-line setting is slowing and gradually returning to normalised levels. In the second quarter, approximately 80% of new treatment starts were first-line, with second-line accounting for 20%. The company's goal has historically focused on first-line therapy. Amvuttra is the first US-approved drug for both ATTR-CM and hereditary ATTR-PN, with broad reimbursement access, strong real-world prescription conversion, and compliance rates consistently exceeding 90%. In the second quarter, actual US TTR business demand increased by about $129 million, more than double the Q1 demand increase, but was partially offset by inventory changes and modest price adjustments.

In the ATTR-CM field, Pfizer's tafamidis has maintained a stable market share, while BridgeBio's Attruby is rapidly gaining physician mindshare with differentiated efficacy data. Ionis' TTR antisense oligonucleotide drug Wainua did not demonstrate significant additional clinical benefit in the CARDIO-TTRansform Phase 3 study. Alnylam emphasised that its TRITON-CM trial design differs from that of Wainua, employing a different technology approach, and expressed confidence in nucresiran.

Alnylam's pipeline spans cardiovascular, metabolic, neuroscience, and haematology areas. The Phase 2 trial of mivelsiran for Down syndrome-associated Alzheimer's disease has been initiated. On the commercial front, the company has granted BeiGene exclusive commercial rights for Amvuttra in Greater China, and is collaborating with major US healthcare systems and AI diagnostic platforms to improve early diagnosis of ATTR-CM. In research and development, Alnylam has entered a strategic collaboration with Inceptive to leverage AI technology to transform the RNAi drug discovery process, while also expanding its partnership with Komodo Health to strengthen intelligent decision-making on the commercial side.