Ascendis Pharma A/S Q4 2024 Earnings Call Transcript

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Operator

Good day, and thank you for standing by. Welcome to the Fourth Quarter and Full Year twenty twenty four Ascendis Pharma Earnings Conference Call. At this time, all participants are in a listen only mode. After the speakers' presentation, there will be a question and answer To ask a question during the session, you'll need to press 11 on your telephone. You will then hear an automated message advising your hand is raised.

Operator

To withdraw your question, please press 11 again. Please be advised that today's conference is being recorded. I would now like to hand the conference over to Scott Smith, Chief Financial Officer. Please go ahead.

Scott Smith
Scott Smith
Executive Vice President, Chief Financial Officer at Ascendis Pharma

Thank you very much, operator. And thank you, everyone, for joining our full year twenty twenty four financial results conference call. I'm Scott Smith, Chief Financial Officer at Ascendis Pharma. Joining me on the call today are Yan Mickelson, President and Chief Executive Officer Sherry Glass, Chief Business Officer Jay Wu, President, U. S.

Scott Smith
Scott Smith
Executive Vice President, Chief Financial Officer at Ascendis Pharma

Market and Amy Hsu, Chief Medical Officer. Before we begin, I would like to remind you that this conference call will contain forward looking statements that are intended to be covered under the Safe Harbor provided by the Private Securities Litigation Reform Act. Examples of such statements may include, but are not limited to, statements regarding our commercialization and continued development of Skytrosa and Urvapath for The U. S, European and other markets as well as certain financial expectations, our pipeline visits and our expectations with respect to their continued progress in potential commercialization, our strategic plans, partnerships and investments our goals regarding our clinical pipeline, including the timing of clinical trials and results our ongoing and planned regulatory filings and our expectations regarding the timing and the results of regulatory decisions expected market developments and our exploration of market opportunities in therapeutic areas outside of endocrinology rare disease. These statements are based on information that is available to us today.

Scott Smith
Scott Smith
Executive Vice President, Chief Financial Officer at Ascendis Pharma

Actual results may differ materially could differ materially from those in our forward looking statements and you should not place undue reliance on these statements. We assume no obligation to update these statements as circumstances change except as required by law. For additional information concerning the factors that could cause actual results to differ materially, please see our Forward Looking Statements section in today's press release and the Risk Factors section of our most recent annual report on Form 20 F filed with the SEC today, 02/12/2025. TransCon Growth Hormone or TransCon HGH is approved in The U. S.

Scott Smith
Scott Smith
Executive Vice President, Chief Financial Officer at Ascendis Pharma

By FDA and in The EU has received MAA authorization from the European Commission for the treatment of pediatric growth hormone deficiency. TransCon PTH is approved in The U. S. By the FDA for the treatment of hypoparathyroidism in adults and the European Commission and The United Kingdom's Medicine And Healthcare Products Regulatory Agency have granted marketing authorization for TransCon PTH as a replacement therapy indicated for the treatment of adults with chronic hypoparathyroidism. Otherwise, please note that our product candidates are investigational and not approved for commercial use.

Scott Smith
Scott Smith
Executive Vice President, Chief Financial Officer at Ascendis Pharma

As investigational products, the safety and effectiveness of product candidates have not been reviewed or approved by any regulatory agency. None of the statements during this conference call regarding our product candidates shall be viewed as promotional. On the call today, we will discuss our full year 2024 financial results and will provide further business updates. Following some prepared remarks, we will then open up the call for questions. With that, let me turn it over to Ian.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Thanks, Scott, and good afternoon, everyone. 2024 was a pivotal year for Ascendis, as we achieved key milestones that set us up to deliver strong growth and value creation in 2024 and beyond. With Skatofa firmly established as a high value growth hormone brand in 2024. Volume growth sustainable with revenue reaching around EUR 200,000,000 on a 6.5% market share of the total growth hormone market in The U. S.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

And around 45% of the total U. S. Long acting growth hormone market based on third party prescription data. With further penetration in pediatric growth hormone deficiency and our planned commercial launches across multiple indication and countries, We expect sustained value creation for the TransCon growth hormone Francis in the coming year as outlined in our Vision 02/1930. Importantly, EURAPET, the only FDA approved treatment for hypothyroidisme in adults is now launched in The U.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

S. And has already begun to establish ECELL as the new standard of care. Given the long standing need for a treatment option like uopads, we are seeing significant early demand in both the patient and physician communities. And we are pleased with the pace of payer approval so far. The last global population living with a significant hypoparent disease burden underscores the potential for UroPADS to grow into a multi billion dollar product over time.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Rounding out our endocrine rare disease portfolio. TransCon CMP clinical data demonstrated it could be a highly differentiated product with an unique profile that represent a major step forward in the treatment of achondroplasia and other growth disorder. We believe the once weekly transplant CMP data demonstrating superior linear growth and benefits beyond linear growth, supporting our proposed label for treatment of achondroplasia. For this reason, following our pre NDA meeting with FDA, we are on track to submit an NDA to FDA this quarter, followed by MAA submission to the EMEA in the third quarter this year. All three of these endocrine rare disease medicines demonstrate the value of our TransCon technology platform and its potential to address major unmet medical needs with highly differentiated product.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

We are also bringing the TransCon technology platform beyond endocrine rare diseases. In last patient population, through our collaboration with Novo Nordisk in metabolic diseases such as obesity, Type two, diabetes and cardiovascular diseases in ophthalmology to the creation of Iconis. We have also expanded the TransCon technology platform to incorporate protein degraders, a very promising area where we believe that new the new TransCon technology platform will expand our pipeline with additional potential blockbusters. We entered 2025 with a very strong financial position with a cash of EUR $665,000,000 on our balance sheet, including the $100,000,000 upfront payment that we received from Novo Nordisk last month. As a result, we are in a strong position to invest in commercial uptake and new product development to drive continued revenue growth.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Let me review our key programs in rare endocrine disease in more detail. In The U. S, SCARTOVA was launched just over three years ago. Today is the treatment of choice and at the same time, growing the growth hormone market. Importantly, with the pediatric growth hormone deficiency indication alone, we are currently addressing only half of the existing U.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

S. Growth Hormone market. Both are on path to expand Crytopha's addressable market in multiple ways. Near term, we expect U. S.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Approval in adult growth hormone deficiency this year with our PDUFA date on July 27. Longer term, we will investigate SAKATOFA in additional therapeutic areas through a basket trial, including idiopathic statu shock deficiencies, Turner syndrome and SDA. In the third quarter of this year, we plan to submit an IND application for this basket trial to the U. S. FDA.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Planned commercial launches across multiple countries. In 2024, SKITTOFA volume increased 84% in The United States, with premium net pricing of 3x compared to once daily growth hormone. Skytolva achieved revenue of around EUR 200,000,000 in 2024, supporting the potential for it to become a blockbuster product over time. Moving to Europads. Twenty twenty four was a critical year for Europads with commercial availability in Europe starting early in 2024 and then this past December in The U.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

S. With UAPAD also available to name patient programs. Patient in multiple countries living with hypoparatide rizement can begin to assess this long awaited treatment option. Hypoparatirisme represent a large global market of opportunity for Zentis to address a major on-site medicine for an effective and well tolerated treatment option. To create durable long term leadership for EUROPATH, we are building this market by educating physician above the well documented limits on risk of conventional therapy and the clinical benefit seen with our PTH treatment.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

In The U. S, we estimate there is about seventy thousand to ninety thousand patients with chronic hypoparatariism, most of whom are currently using conventional therapy of oral calcium and active vitamin D. Our claims analysis demonstrate that ten thousand to fifteen thousand of these U. S. Patients are uncontrolled and thirty thousand to thirty five thousand are partly controlled.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

We believe UroPath can sustain growth over a long time as the waste majority of patients with hypoparatarisme qualified for PTH treatment per the current international guidelines. Less than two months in The U. S, Europe had launched initial demand is strong with nine zero eight patients with prescription as of 02/07/2025. This includes prescription from five thirty nine unique prescriber in around 44 states. Nearly eighty percent of the enrollments are new to europepts.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

The majority of whom are switching from commensal therapy with the remaining being existing patients from the TransCon PTH clinical trial or expanded access program. Discussion with payers are ongoing. And as expected with a noble specialty product, we estimate the majority of insurance approval will take about four to eight weeks. We are pleased with the initial pace of insurance approval across commercial and government payers and have shipped reimbursed drug to patients in around 35 states. Outside U.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

S, we remain on track for decent commercial launches in what we call Europe Europe countries, where we expect to add five or more countries this year. We also expect launches in multiple international markets in 2025, further expanding our global reach where we have signed eight exclusive distribution agreements covering 50 plus countries so far. EUROPAD is a unique product. Our broad and extensive clinical data include three successful Phase III trials in The U. S, Europe, Japan and China, covering diverse disease groups, including POSS SIRGENT, AUTOIDDUNE, ADH1, idiopathic hyperpathalism.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Last year, we presented three years data from our Phase II PARP FORWARD trial and later this year we plan to present four years data demonstrating excellent patient retention and sustained serum calcium control and bone health, sustained reduction of calcium phosphate product, independent from conventional therapy and normalization of twenty four hour urinary catholic reaching. The data also showed sustained improvement in kidney function. Switching to TransCon CMP. Hair Contopase remained at the seas with high on-site medication, and we believe TransCon CMP has the potential to be a highly differentiated treatment option. In the pivotal APPROSE trial, TransCon CNP demonstrated significant improvements in linear growth and body proportionality compared to placebo, as well as benefit beyond linear growth.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

As one example of benefits beyond linear growth, we have shown data demonstrate significant improvement with Tricon CMP treatment on leg bone and common and debasing complication in achondroplasia that can result in pain, impaired physical function, need for corrected surgery and a negative impact on quality of life. Triscon P CMP has shown a safety and tolerability profile comparable to placebo with low frequency of injection site reaction, all of which were mild and no evidence of hypertension effect, so reporting TransCon CMP potential as a best in class treatment for achondroplasia. Following our productive pre NDA, we plan to submit an NDA for the treatment of achondrokase during the first quarter of twenty twenty five and submit an MAA for treatment at children with achondrokase to the EMEA during the third quarter of twenty twenty five. We believe TransCon CV will be setting a new bar for treatment of achondroplasia. To further raise this bar for linear growth and other clinical benefit, We are also working on a combination treatment of TransCon CMP and TransCon Growth Hormone in achondroplasia.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Zendesk is uniquely positioned to bring these two once weekly medicines together in a combination treatment, providing two different modes of action to potentially improve outcome in acrotoraphasia and other growth disorders. We look forward to sharing top line week twenty six results from Phase II cohort trial of TransCon CMP in combination with TransCon Growth on Mode, which we expect in the second quarter of twenty twenty five. Additionally, during the fourth quarter of twenty twenty five, we plan to submit an IND or similar to investigate TransCon CMP alone or and in combination with TransCon Grosomonal for the treatment of hypochondriplasia. Looking to how we are expanding our pipeline in endocrine rare disease. We are expanding into additional product candidates beyond our first three successful indices, as we disclosed at the JPMorgan conference.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

In addition, we continue to broaden the reach of our platform outside endocrine rare disease and true collaboration in therapeutic area affecting much greater patient number. For oncology, our internal development continues to focus on TransCon IL-two beta gamma aiming for accelerated approval in one or more indication. In early twenty twenty four, we announced the formation of our colleagues to explore the development of TransCon based therapies in ophthalmology. In November, we announced a multiproduct collaboration in Novo Nordisk, growing metabolic and cardiovascular diseases with a lead program to develop once monthly TransCon similutide. This entitled us to escalating tiered mid single digit royalties on global net sale of approved products.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Finally, as I mentioned earlier, we have expanded TransCon to incorporate protein degraders. As technology, we bear promising potential within as well as outside rare endocrine diseases. As said is today, with approved commercial product, a strong pipeline and guided by our values of patient, science and passion is positioned to continue driving rapid and sustained growth in the years ahead. I will now turn it over to Scott. Schmidt?

Scott Smith
Scott Smith
Executive Vice President, Chief Financial Officer at Ascendis Pharma

Thanks, Jan Mickelson. The progress we made in 2024 enables us to head into 2025 with the financial and organizational strength to execute on our strategic priorities, which are to successfully launch YorbaPAP on a global basis, to build on Skycrosa's leadership position in pediatric GHD by expanding The U. S. Label to adults while maintaining its premium net pricing of 3x compared to daily growth hormone and to submit TransCon CNP for approval to treat achondroplasia in children in The U. S.

Scott Smith
Scott Smith
Executive Vice President, Chief Financial Officer at Ascendis Pharma

And The EU. I will touch on some key points surrounding our fourth quarter and full year financial results, but for further details please refer to our 20 F filed today. Skytrova volume increased 37% in the fourth quarter of twenty twenty four compared to the fourth quarter last year, while reported revenue was EUR58.5 million compared to EUR64.2 million reported in the fourth quarter of twenty twenty three. In the fourth quarter this year, Skytrafa revenue benefited from volume growth and a favorable sales adjustment of EUR 4,600,000.0 attributable to periods prior to 01/01/2024, which was offset by higher sales deductions compared to the same period the prior year. Backing out this favorable sales adjustment, Skytropha revenue was approximately EUR 54,000,000 for the quarter.

Scott Smith
Scott Smith
Executive Vice President, Chief Financial Officer at Ascendis Pharma

Sequentially, Skytropha volume increased 16% in Q4 compared to Q3, while pricing was stable. We expect revenue growth to continue to track closer to script growth unless payer mix changes substantially as there have been no major contracting changes compared to Q4 last year. Shifting to YORVA Path. As previously reported, fourth quarter YORVA Path revenue increased to €13,600,000 bringing total 2024 revenue to €28,700,000 As Jan noted, the launch of Yoreba path in Germany and Austria in 2024 together with the initial demand and progress with reimbursement in The U. S.

Scott Smith
Scott Smith
Executive Vice President, Chief Financial Officer at Ascendis Pharma

So far in 2025 has been very encouraging. We expect that YORVA path will have a significant impact on our financial profile in 2025. While it is early in the launch, we look forward to sharing data on parameters like enrollments, prescribing HCPs, time to reimbursement, etcetera, to to provide more detail on launch dynamics. More importantly, everything we are seeing in the early launch phase supports our view that over time, we expect OrbiPath to be the standard of care for patients with hypoparathyroidism and to become a multibillion dollar product. Closing out the top line, total revenue for the fourth quarter was €173,900,000 including revenue recognition of the $100,000,000 upfront fee related to our collaboration with Novo Nordisk as well as other revenue from partners.

Scott Smith
Scott Smith
Executive Vice President, Chief Financial Officer at Ascendis Pharma

To be clear, although we recognize the $100,000,000 from Novo in 2024 for accounting purposes, The cash was received after year end in January. Total revenue for the full year 2024 was EUR 363,600,000.0. Turning to expenses. For the fourth quarter, R and D costs totaled million compared to million during the fourth quarter of twenty twenty three. The 13% decline was largely due to lower external development costs for TransCon Growth Hormone and TransCon PTH as well as the Iconis spin off.

Scott Smith
Scott Smith
Executive Vice President, Chief Financial Officer at Ascendis Pharma

SG and A expenses in the fourth quarter of twenty twenty four totaled EUR 80,200,000.0 compared to EUR 64,000,000 during the fourth quarter of twenty twenty three. The million increase was due to higher employee costs including the impact of additional headcount supporting global commercial expansion, most of which came toward the end of the year. Similarly, we spent more on external commercial costs to support launch activities and plan to continue to do so in 2025 with the global launches of YORU Pass. Total operating Yauruh Pass. Total operating expenses were EUR159.5 million for the fourth quarter of twenty twenty four, a 3% increase compared to EUR154.9 million during the fourth quarter of twenty twenty three.

Scott Smith
Scott Smith
Executive Vice President, Chief Financial Officer at Ascendis Pharma

Total operating expenses for the full year 2024 were EUR $598,000,000. Net cash financial expenses for the full year 2024 were less than EUR 1,000,000, while net finance expenses for the full year were EUR 74,400,000.0, driven primarily by non cash items. We ended 2024 with cash, cash equivalents and marketable securities totaling EUR560 million compared to EUR 399 million as of 12/31/2023. Including the 100,000,000 upfront payment from Novo Nordisk that was received in January 2025, cash at the end of twenty twenty four would have totaled EUR $655,000,000. Finally, as separately announced, we expect to use approximately $25,000,000 in the first quarter of twenty twenty five to preserve approximately 200,000 ADS that is held as treasury shares.

Scott Smith
Scott Smith
Executive Vice President, Chief Financial Officer at Ascendis Pharma

With that operator, we are now ready to take questions.

Operator

Our first question comes from Jessica Fye with JPMorgan.

Jessica Fye
Jessica Fye
Managing Director & Equity Research Analyst - Biotechnology at JP Morgan

Congrats on the strong Repast script number and breadth of prescribers. I have one question with a few parts, mostly just confirming some stuff. First, can you confirm that the $9.00 8 figure is unique patients and not like cumulative scripts including refills, for example? Second, can you just confirm how many of the EAP and OLE rollover patients are now included in that 908 number? I want to make sure I heard you.

Jessica Fye
Jessica Fye
Managing Director & Equity Research Analyst - Biotechnology at JP Morgan

I think you said it was eighty four percent new to YorkiePath, sixteen percent from the EAP and OLE. Lastly, I think you reiterated that you continue to expect the majority of insurance approvals will take four to eight weeks. Can you just confirm that's actually what you're seeing now that you've been in The U. S. Market for coming up on eight weeks?

Jessica Fye
Jessica Fye
Managing Director & Equity Research Analyst - Biotechnology at JP Morgan

Thank you.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Thanks, Jess, a lot for the questions. I think we can confirm nearly all the answers. So Jay and Sherry, will you confirm all the numbers, so be sure?

Jay Donovan Wu
Jay Donovan Wu
President at Ascendis Pharma

Happy to. Jessica, thank you for the question. The first part of your question from an enrollment standpoint, we can confirm that is unique patient enrollments, so not cumulative repeat. I think the second question you asked was the percentage of patients that are coming over from either the EAP or clinical trials versus those that are new to ORVELL PATH. So about twenty percent of the nine zero eight is existing patients from TransCon, PTH, EAP or clinical trials and then eighty percent of OrpPath.

Jay Donovan Wu
Jay Donovan Wu
President at Ascendis Pharma

And then the third question that I think we heard you ask Jessica is more around the four to eight weeks. That is our estimate of what we think it should take. But keep in mind too that based on the timeframe for which the drug has been on market, it is still a very nascent period of time where for many of the patients enrolled that time period hasn't actually occurred yet, right. So we'll need more time to get a better sense of that, but that is our initial estimate today.

Jessica Fye
Jessica Fye
Managing Director & Equity Research Analyst - Biotechnology at JP Morgan

Thank you. For my follow-up, can you provide the Jorvik PATH patient number outside The U. S?

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

We have not proven that, not put down. It's still increasing as we expected to do. We are still only in Europe direct countries, full commercial in Germany and Austria. We have our AP2 program in France, the non promotional program that also is enrolling reimbursed patients. And then we have our international market in this way.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

And the patient number are increasing to exactly as we have expected, but we have not broken down the numbers.

Operator

Our next question comes from Tazeen Ahmad with Bank of America.

Tazeen Ahmad
Tazeen Ahmad
MD - US Equity Research at Bank of America

Hi, guys. Good afternoon and thanks for taking my questions. Yan, could you provide any color on how many of the nine zero eight scripts that have been written have now been converted to patients on actual therapy? And can you give us also any color that you might have on what proportion of these patients may have had previous experience with Natpara? And then I have a follow-up.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Yes. The question you are addressing is a question where we still lack all the information to give you and quote, really the concrete answer that you want to have. What we have done in our market research, we have looked a lot on claim data and we have defined patient group, which we call the 10,000 to 15,000 patients, which we will call not controlled on standard therapy or conventional therapy. And this patient group is basically seeing the physician at least four times a year. And they also will have one thing more in common, they have at least one hospitalization related to the disease.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

And we also know the limitation in really that is in seeing an endo. So often that perspective, just by the random process when you can see an endo, we actually believe that many of the patients that we see of nine zero eight actually are coming from the group, which we define as more uncontrolled in this. We don't have a positive definition if that is true or not, but that is our expectation in this. The second question you raised about how many patients we have on therapy now is a number we are waiting to some way to come out with, answer the feeling we have sufficient good enough data to give you a solid number because we are now in the initial part of our, you can say, journey of getting them 100% reimbursed. We were extremely positive on the broadness of having reimbursed patient, both from the commercial setup, but also for the government side.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

And we basically are getting reimbursed patient every place from and when you see the broadness on the state we're covering with about 35 different states, we're really coming out in all different states. We also feeling that we are in a very, very strong position. The waste majority of the patients are on label and basic they are also fulfilling exactly the criteria that justifies for them to be on a PTH treatment. So we are really highly positive on the development we have seen in the reimbursement spectrum.

Tazeen Ahmad
Tazeen Ahmad
MD - US Equity Research at Bank of America

Okay. Thanks, Jan. And then I just wanted to clarify, I think you had said that you were considering providing sales guidance for Euroview Pass for the full year sometime in the middle of the year. Is that still the plan?

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

I think it's still Cessin, I think we will like to give you guidance when we believe in the numbers. And I think that is the criteria we take up. So dependent on how we see the longs going and how we see different regions, we will come up with what we call revenue guidance exactly when we're feeling that we feel the confident. Scott always like to give up a lot of numbers. So you can hear in his list and what he said in his prepared remarks that he will come up with a lot of elements that can give you the best possible fundament to build up a solid model in your own way.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Comment on you, Scott?

Scott Smith
Scott Smith
Executive Vice President, Chief Financial Officer at Ascendis Pharma

Yes, we will. As we said, we're excited to continue to share with you the underlying parameters driving the launch and we plan to do that in the quarters ahead.

Operator

Our next question comes from Gavin Clark Gartner with Evercore ISI.

Gavin Clark-Gartner
Director - Biotechnology Equity Research at Evercore ISI

Hey guys, congrats on the very strong progress so far. Just had one question on Orvipath and one on CNP. For Orvipath, how have your discussions with payers gone so far? And what are your assumptions for how some of the prior authorization criteria may read? Specifically wondering if you think it's going to be different than the label.

Gavin Clark-Gartner
Director - Biotechnology Equity Research at Evercore ISI

And kind of on that same line, maybe you could just remind us your contracting or gross to net assumptions. That's the first one. On the CNP side, for the CNP plus growth hormone combo data coming in the second quarter, Can you just remind us your expectations specifically on AGV? Thank you.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Yes. I think Jay will come with some flavor about the contracting situation, but also as I said before, I've been lucky to see most of the peers and I have been really pleased how they are aligning to the labeling, but I believe Jay will come up with further comments related to the commercial contracting landscape.

Jay Donovan Wu
Jay Donovan Wu
President at Ascendis Pharma

Yes. So thank you for the question. As you can expect for any new launch, we are still in the early stages of establishing policy with payers. So just as an example, most medical policies right now for our large national players haven't yet even published a policy yet, right? So our conversations have all been productive today, really focusing on the clinical value proposition of the drug.

Jay Donovan Wu
Jay Donovan Wu
President at Ascendis Pharma

As you can see and based on our data from our array of clinical studies, we feel really positive about the benefit that we can convey to the patient community and we're having great conversation around that. Specifically, your question around prior auths and what that might look like, we're expecting and again as part of those negotiations and discussions wanting to ensure that the standard PA is consistent to label, both in terms of reauthorization timelines, tests that may need to be conducted to ensure that again it is consistent with label. So while many of those plans and policies still need to take some time to come into fruition, we're feeling encouraged by those conversations.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

So the CMP question is always looking in the crystal ball, because you asked me, Jens, what is your expectation to a data you have not really seen? And it's first time, to my knowledge, everyone have done a combination trial in achondroplasia, a Phase II trial, which seems TransCon, CMP and growth hormone. And why I think it's really, really interesting because it's two different compounds become very different physiological mode of action. And if I ever believe in science, which I always do a lot, it should be a great combination because it's synergistic pathway. And when I look on what you can do when you address the hyperactive tyrosine kinase systems that you have in accretorplasia, You can do that with either the tyrosine kinase inhibitors.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

You can do it by CMP as short acting or you can say continuous exposure. I think it's easier to saturate the analyzed high velocity in this part of the integrated effect you expect to give as a treatment option in the accondylacia. One of them that easiest to hit is basic the analyzed high velocity. And when I look on all the data, it's likely are going around 5.5 to six point zero on analyzed high velocity, which basic are affecting little bit what the science also will say, you are removing a break and you restore normal growth. So, up from that perspective.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

And this is why I love the growth hormone, because what is growth hormone? This is like sitting in a car and then you suddenly get rid of the speeder, some may take a little bit on the speeder, get the break off and then you really can move. And this is why I feel this combination will give a good result. And I look forward to the results as much. I can ask you, what would a good result be?

Gavin Clark-Gartner
Director - Biotechnology Equity Research at Evercore ISI

That's helpful. Thanks guys. We'll leave

Gavin Clark-Gartner
Director - Biotechnology Equity Research at Evercore ISI

it there for now.

Operator

Our next question comes from the line of Lee Wasik with Cantor Fitzgerald.

Li Watsek
Director at Cantor Fitzgerald

Hey guys, wanted to add my congrats on the strong your Repath launch as well. Just curious for these 900 plus prescriptions, what proportion of these patients have more severe versus more moderate diseases? And if you can share any early trends of compliance and initial titration, whether it's consistent with your clinical trial?

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Yes. It's a question we tried to address with before. But I think, Sherry, you're also sitting with a lot of data potential you can some way describe the limitation that we have in our data set, really to answer that question today.

Sherrie Glass
Sherrie Glass
Chief Business Officer at Ascendis Pharma

Sure. And thanks for the question, Lee. So what we don't actually have data in terms of the enrollments on patient severity. What we do know though is a couple of important things. One is that as Dan said earlier, the most severe patients are going most frequently to the endocrinologist.

Sherrie Glass
Sherrie Glass
Chief Business Officer at Ascendis Pharma

So by that practical matter of them getting into the office to get the prescription, it's likely that we have severe patients initially getting some of the first prescriptions. And as Anne also mentioned, there are a number of those uncontrolled patients in The U. S. There is ten thousand to fifteen thousand of them and then a number more people who are partially controlled. So to the extent that we are starting to see some of the first patients being the more uncontrolled and severe patients, we know there's still a tremendous amount of room for expansion beyond that.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Thanks, Jay.

Operator

Our next question comes from Derek Archila with Wells Fargo.

Eva Fortea-Verdejo
Eva Fortea-Verdejo
Equities Analyst at Wells Fargo

Hi, this is Yvonne for Derek. Thanks for taking our questions and congrats on the progress. A quick one from us on your BPAT. So can you provide some color on what type of docs are prescribing your BPAT? Are these like high volume docs?

Eva Fortea-Verdejo
Eva Fortea-Verdejo
Equities Analyst at Wells Fargo

Or are you starting to get some docs from the community? And as a follow-up, how long do you expect patients will take to convert from drug in the EIP over to pay drug since?

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Yes. Let me take the last question before I turn it over to Jay or Sherry. What is happening in our EIP program, the last package I got was a three pack of basic three months and some of them got them in December to in January. So the 100 plus patient that we are converting from our ERP clinical trial over, we'd likely come into commercial drug starting in February and then the majority in March. So that was the second question.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

And I think Shari or Jay, who will take with,

Jay Donovan Wu
Jay Donovan Wu
President at Ascendis Pharma

will you start? Sure. Happy to start. I think the question around prescriber breadth, I think as we mentioned before, five thirty nine across 44 states, we're seeing that pretty broadly across all different types of physicians across all deciles. Naturally, you would expect directionally physicians that are treating perhaps a greater number of patients, right?

Jay Donovan Wu
Jay Donovan Wu
President at Ascendis Pharma

We're naturally also focusing on them quite heavily. So from a field standpoint, we're actually over 50% reach for a lot of our priority physician. So I think naturally you're going to see some directional lean in that direction. But more importantly, what you're seeing is a broad outreach and broad interest across the provider community agnostic of DESA.

Sherrie Glass
Sherrie Glass
Chief Business Officer at Ascendis Pharma

And maybe I'll just add that, to that, that what is really exciting is that we see that we're broadening a lot beyond the nat pair of prescribers. So of the five thirty nine physicians, only about two hundred, a little less than two hundred had prescribed Natpara. So we see that we're really broadening our reach.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Next.

Operator

Our next question comes from Yaron Werber with TD Cowen.

Yaron Werber
Yaron Werber
Analyst at Cowen

Great. So thanks so much. I got maybe a couple of questions, Scott, for you and then I don't know, Jan, if you want to take the next one. I think Scott, you said that towards the end of the year, you could be you could reach profitability on a cash basis. Does that still sort of hold?

Yaron Werber
Yaron Werber
Analyst at Cowen

What would drive that? How do we is it going to be Yorbi Pass is the biggest driver? And then secondly, as you think about reimbursement for Yorbi Pass, are you expecting with time prior authorizations or are you expecting not to have any prior auths? Thank you.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Okay. I think Scott will like to say something.

Scott Smith
Scott Smith
Executive Vice President, Chief Financial Officer at Ascendis Pharma

Yes, I think you're exactly right. Your overpass will be a big driver of the ability to cash breakeven. It's a strong launch in Europe for us. Obviously, we're off to the races here in The U. S.

Scott Smith
Scott Smith
Executive Vice President, Chief Financial Officer at Ascendis Pharma

And it's a very profitable product. So I think we agree that that will be a strong driver of breakeven potential this year.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Yes, but I also believe you need to look that U. S. Is the numbers we're giving you today. But we basically have a global effort. And we also some way seeing that end of this year, we're starting to take into a much, much higher gear in our Europe direct countries.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

We will also see the international market is starting to really, really getting engaged. I accept that it will be a major event for 2026, where all the countries will come in, mainly with full year launches in for many of them. But the '25 will be where we start in both the Europe direct in at least five countries more, but basic also our international market. So The U. S.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Sure is a fast market, is a fast penetration we can get because it's so large single market. So sure, it will dominate in the beginning of the year. But just remember the number of patients outside U. S. With hypo para is so much, much, much larger past four, five fold than what you have in The U.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

S. The second one, Wilbur, you take that.

Jay Donovan Wu
Jay Donovan Wu
President at Ascendis Pharma

Yes, sure. I mean, from a prior auth standpoint, I think the question was what do we expect for Urofelpab. It is a specialty product and I anticipate there to be some basic questions even if it's simple as who's prescribing it, right? I think whether it's endocrinologist, whether it's a nephrologist, etcetera. And I think secondly, what you're going to see and should expect is there's going to be wide heterogeneity across what you'll see across both national and regional plans.

Jay Donovan Wu
Jay Donovan Wu
President at Ascendis Pharma

I think as we alluded to before, we are seeing approvals across commercial payers, public payers and even absent of there being a formalized policy at some of the large national payers, we still submit generic prior auths to seek exception through that policy. So again, some of this will take time to evolve and some of that we would expect to change, but we will see probably a wide range across the various plans.

Operator

Our next question comes from the line of Joseph Schwartz with Leerink.

Joori Park
VP - Equity Research at Leerink Partners

Hi. I'm Julie Park dialing in for Joe. Thank you for taking our questions. I believe in the last earnings conference call, you mentioned that in Germany, Physicians are prescribing ORBIPAST-two, but one to two of their patients, whereas in The U. S, you are expecting physicians to prescribe the drug to the three of their patients.

Joori Park
VP - Equity Research at Leerink Partners

And based on the metrics that you provided today, it seems like on average, each physician is prescribing the drug to a little over 1.5 of their patients. So I was just wondering if you're still expecting each physician in The U. S. To prescribe ORAPAP to about two to three of their patients and where does it go from there?

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Yes, I think in some way, I accept what I said and I stand by what I said before. And I think the pattern we see now is an early launch. I have seen and follow some of the physician that was part of our ERP and clinical trial. And one of some of these physician have been already make prescription up to 20 patients. So no doubt the boldness of that will come, but in some way, this is an early launch, one to two months in the launch.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

So I will expect that to see and come in the future.

Joori Park
VP - Equity Research at Leerink Partners

Okay, great. That's helpful. And then a clarifying question. Are there any are any of the nine zero eight prescriptions included in the urbepat sales from 2024, considering the drug was available mid to late December? Thank you so much.

Scott Smith
Scott Smith
Executive Vice President, Chief Financial Officer at Ascendis Pharma

Got it. I mean, strictly speaking, so we did ship a very small amount in December. It was basically immaterial to the total.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Yes. So in practical, no.

Operator

Our next question comes from the line of Kelly Shi with Jefferies.

Kelly Shi
Kelly Shi
Senior Vice President at Jefferies

Congrats on the greater quarter. On manufacturing front, how should we think about the capacity to meet increasing demand of your BPF throughout the year? Thank you.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Yes. I think one of the things we have been very proud of at Ascend is really our robust supply chains. We have seen how we have managed to go up in high demand on the shortage of the daily growth mode and could fulfill all requirements for all wishes for having, for example, the SKYTOFA brand. And when I look on the euro pads, we're using the same solid supply chains, the same infrastructure. We follow it the same way.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

I personally get a weekly report on every compound in every region, in every place where we are selling product, how many months that is on storage. And we some way are taking that as a really serious thing, because we will never be in position that we will go short. And that is our vision and I hope we never come to this positioning.

Kelly Shi
Kelly Shi
Senior Vice President at Jefferies

Thank you.

Operator

Our next question comes from the line of Ellie Merle with UBS.

Ellie Merle
Ellie Merle
ED - Biotech Equity Research at UBS Group

Hey guys, thanks so much for taking the question and congrats on the launch progress. Just in terms of how we should think about The U. S. Yorba path script cadence, I guess, sort of what's the latest that you're seeing in terms of the cadence of new starts? Are you sort of seeing a steady number of adds each week?

Ellie Merle
Ellie Merle
ED - Biotech Equity Research at UBS Group

Was there a bolus upfront? How should we think about this going forward? And second, just a follow-up on reimbursement. I know you said you're seeing approval across a number of plans, but could you characterize maybe sort of the number of scripts that have been covered so far and sort of any trends that you're seeing in terms of ease of reimbursement, say, between the moderate patients versus the severe patients and your expectations there? Thanks.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

I think the question related to what we call lung control to CAR TAE controlled and patient we have some way answered this to our best of knowledge. We have no clear data of the patients that is already have received a prescription. We have a gut feeling, and the gut feeling is that we believe many of them belongs to the uncontrolled part because they see the endo in a much higher frequency than anyone else. Related to the pattern on prescription, we are not breaking it down in weeks or anything. This is something we are following where we are tight, and we would like to see a pattern being developed.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

We don't believe that's really a huge bolus coming in because there is not a huge availability of the diabetic ENDO really to come in and say, oh, I just want to have an appointment run into an ENDO and now I have a prescription. It's not like life it is that. Like Amy sitting here, if you want to see Amy, our CMO at Stanford, it takes how many weeks now, Amy?

Aimee Shu
Aimee Shu
EVP & Chief Medical Officer at Ascendis Pharma

Twelve.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Twelve weeks to see her. So it takes a little bit time to get an appointment. So we don't believe that it's a lot of build up demand. It's basic is patient that come in and have the need to be in a treatment. And I think it's pretty obvious for me when I see the benefit that all the patient get, yes, everyone should have a treatment option and come on PTAs like everyone on Type one diabetes should have insulin.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

This is a hormone replacement therapy in this perspective. Related to the reimbursement system, I do not know, Jay, if you have further comments compared to that.

Jay Donovan Wu
Jay Donovan Wu
President at Ascendis Pharma

Yes. As we mentioned before, because this is such early days, I don't think we would be able to draw a meaningful pattern or trend based on just a few weeks that we've been in here. I think I go back to the statement we made before. We are seeing approvals across all both commercial and public payers, but fully recognizing too that because many policies aren't in place, a lot of these cases are exception by exception basis. And we believe that after at least a few more months, we'll have a better sense of how these policies shake out and what that more stable trend should be.

Ellie Merle
Ellie Merle
ED - Biotech Equity Research at UBS Group

Great. Thanks.

Operator

Our next question comes from the line of David Lebowitz with Citi.

David Lebowitz
David Lebowitz
Analyst at Citigroup

Thank you for taking my question. First on SKYTROFA, you had the PDUFA date coming up this summer for the adult growth hormone deficiency. I'm just curious, how should we be thinking about that in terms of what that market opportunity actually presents?

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Yes. I think Amy can explain on the unmet medical need that really exists in adult growth hormone deficiency. From my perspective, there's two key things I really some way are reflecting over a lot. First of all, it's air with extremely low penetration to our best knowledge is under five percent, six percent, seven percent. So you can say there is a huge opportunity for growth.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

And the other thing is that has been a huge burden basic to be in the treatment with daily growth hormone. But Amy, you can explain and tell about what is really the unmet kidney burden of having adult growth hormone deficiency?

Aimee Shu
Aimee Shu
EVP & Chief Medical Officer at Ascendis Pharma

Sure. Happy to do so. So many people arrive at growth hormone deficiency in adulthood following something involving organically the brain, right? So a brain tumor or a brain cancer or its treatment, either surgery or radiation, that's at least fifty percent or more. So many of them because they are missing function of the pituitary gland are taking many hormone replacements and growth hormone is just one on that list.

Aimee Shu
Aimee Shu
EVP & Chief Medical Officer at Ascendis Pharma

So they have oftentimes said if I if it's something we can make simpler, right, that the community could provide more simply to them, they would it is something they would consider, knowing that it adds to their metabolic health and overall endocrine health, right. But of course, their first priority always are the two life saving hormones from the brain that is from the adrenal gland and the thyroid gland. So those you can't forget and those are pills. So after that, they are willing to think about injectable less frequent therapies, knowing it is good for their overall health. We could admit that growth hormone deficiency is not immediately life threatening the way that if you don't take thyroid or adrenal replacement is.

Aimee Shu
Aimee Shu
EVP & Chief Medical Officer at Ascendis Pharma

So we think we're in a nice sweet spot here. It's a hormone that should be replaced and if it meets patients' expectations, we think there would be a tick.

David Lebowitz
David Lebowitz
Analyst at Citigroup

Thank you for that. And just jumping over to your Vipass, I'm just curious as to thoughts on potential competing pivotal data coming out this year and how you think the OEM market ultimately might evolve?

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Yes. If you reflect on people's data, I don't think there is anyone else than one compound, the amyloid compound. And to our best knowledge, when we talk with Zetas, the last patient in was in November. So I'm still waiting to see the results of the pivotal trial. It's a small trial with little bit more than 100 patients.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

So it shouldn't take too long time to clean the data and come up with a top line data, but I have not seen anything else. When I go back to the science at one of our key values, this is not an hormone replacement therapy. This is a substitution of the long acting effect, where you basic are placing part of the receptor system into a fixed position and therefore have a long acting effect. It's not even reflecting the normal biology where you are basic activating both the PTF1 receptor and the PTF2 receptor. And by doing the different mode of action, you already are from the data can see that it can now substitute as an hormone replacement therapy element where you see is not restored normal function, for example, in the kidney, both with, for example, related to phosphate excretion.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

See, for example, it cannot lower a key element like calcium phosphate complex. You also see the unnatural activation to the activating system in the bone and other organs. And then I'm not talking about the hemogenic potential that is in the compound. So we are looking forward to see the data. We would like to see the data, and we hope one day they will come out there should be out there now because it's so long time since the last patient came into the visit.

Operator

Our next question comes from Paul Choi with Goldman Sachs.

Paul Choi
Paul Choi
Analyst at Goldman Sachs

Hi, thanks. Good afternoon and congrats on the early launch success with UroPath in The U. S. My first question is on UrovaPath. And as we look at consensus numbers, the Street is modeling less than 900 patients in The U.

Paul Choi
Paul Choi
Analyst at Goldman Sachs

S. For this year and you've already exceeded that in terms of scripts. So I was just wondering recognizing that you're not giving guidance and not and the reimbursement is a work in progress, just your level of comfort with The Street revenue number for the full year possibly or any color around that would be great. And my second question is regarding CMP and the hypochondriplegia program that you plan to file an IND for later this year. Are you planning to do any run-in activities ahead of that possibly at some of the centers just to potentially help accelerate the timing of that study and enrollment?

Paul Choi
Paul Choi
Analyst at Goldman Sachs

Any color there would be helpful. Thank you very much.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Yes. Let me take the first part together with Amy, because we are really dedicated to be the leader in growth to solve. And when we see the two cornerstone we have TransCon Rotomo and TransCon CMP. We really will do the best for the patient in eight case. How can we design an optimal treatment in this way?

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

And what we're doing now in hypercontemplation is defining what is really the pathway forward for us, is then just a TransCon CMP treatment or will it be a combination treatment between TransCon CMP and TransCon prokrom? And we are now in a position that we are starting the discussion with regulatory agencies. But I think Amy can give you a little bit of background why we some way think that when we moving into hypercontemplation, it's one of many growth disorders we actually would like to focus on. And the actual design can also be a different state process.

Aimee Shu
Aimee Shu
EVP & Chief Medical Officer at Ascendis Pharma

So exactly, we are taking the time to give hypochondriplasia the opportunity it deserves. While some of hypochondriplasia overlaps highly with achondriplasia and the genetic variant arises on the same FGFR3 receptor, the gene changes are very different along that whole receptor and we are understanding that hypochondriplasia has a unique phenotype. It's a broader phenotype and very unique. So along those lines, we are still figuring out, it's an active process, what's the population of interest to us, where we can benefit from them and therefore the different ways to find a regulatory path forward, which I think gets to your question about how much time do we put in into the run-in. So I couldn't tell you now as we are still figuring a lot of this out.

Aimee Shu
Aimee Shu
EVP & Chief Medical Officer at Ascendis Pharma

But I think the condition and other conditions of short stature, especially on the skeletal dysplasia genetic side, right, deserve a very good thorough understanding to find the best way to accomplish.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

We are in this position that potentially we will start both trials at the same time and CMP and then combination trial. And then we will basic evaluate the data and find out that potentially we will go for an approval for both, and then they can choose the optimal treatment from the physician, how best can serve the patient needs in this way. If they really want to have a much more extensive linear growth, likely the combination therapy will be the preferred option. Related to your last first question, I think we said in Scott's prepared remarks that we are not giving any guidance as you correctly said. We would like to give you as much as possible what we can call elements we are using in our own modeling and giving that as fast as we can give it with all the different calls to ensuring that you have the best possible modeling that you can do.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

And I think Scott is always open for discussion. He's extremely extroverted, like to talk with people. So I think if there is any element of model discussion, I think he likely will engage in it.

Operator

Our next question comes from the line of Alex Thompson with Stifel.

Alex Thompson
Managing Director at Stifel Institutional

Hey, great. Thanks for taking my questions. I guess on GobiPath, I wonder if you could talk a little about how titration is working in the real world with patients, whether that requires additional visits with their HCP, etcetera, if this is done at home. And then maybe could you talk a little about your expectations around growth to net stability in 2025 for SKYTROFA? Thanks.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

Amy, would you take the first question?

Aimee Shu
Aimee Shu
EVP & Chief Medical Officer at Ascendis Pharma

Sure. The first question was about titrations with your VPATH. From what we've

Aimee Shu
Aimee Shu
EVP & Chief Medical Officer at Ascendis Pharma

heard so

Aimee Shu
Aimee Shu
EVP & Chief Medical Officer at Ascendis Pharma

far, right, this is in the domain, this is the sweet spot for endocrinologists. They know how to titrate medicine. So we are but that being said, I'm not sitting on the shoulder of each prescriber and I can't see what they're doing week to week. I think so far they have found it straightforward to follow. They have gotten the guidance that they wanted.

Aimee Shu
Aimee Shu
EVP & Chief Medical Officer at Ascendis Pharma

And the only times we may have touch points with them will be as we go further along and one switches from the medium dose pen to a high dose pen or a low dose pen. But we don't have that insight yet. But from what we're hearing just anecdotally, it's what endocrinologists know how to do.

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

At least what we have seen now, but being in market in Germany for one year now, we are not seeing any issues to the titration and patient physician feel that is not complicated and easy element to do it and they're getting up on conventional therapy exactly at the same speed that we saw in our clinical trials, which surprised me a little that they were doing in the same speed as we do when we have much more rigid framework for a patient to come into and talk with the physician. It's same thing happening in real life. They're out of commensal therapy extremely fast.

Operator

Our next question comes from the line of Yoon Jong with Wedbush Securities.

Yun Zhong
SVP - Equity Research at Wedbush Securities

Good afternoon. Thank you very much for taking the questions. The first one on YooriPath. So when you report first quarter earnings, are you going to break down sales to tell us how much is coming from Europe, how much is from U. S, please?

Jan Mikkelsen
Jan Mikkelsen
President and Chief Executive Officer at Ascendis Pharma

That's a good question. We will decide when we come to that state exactly how we report the data.

Yun Zhong
SVP - Equity Research at Wedbush Securities

Okay. Then follow-up question on SKYTROLFA. I believe what I heard was that the adjustment has largely been over for 2024, but you haven't really given any guidance unlike in January, you put out the guidance for 2024. And are there any uncertainties surrounding the schedule or is that related to the adult launch or more related to the pediatric market, please?

Scott Smith
Scott Smith
Executive Vice President, Chief Financial Officer at Ascendis Pharma

Yes. Thanks for the question. So, we expect revenue growth to continue to track closer to script growth going forward unless of course there's payer mix changes, substantial payer mix changes. And this is primarily because there's been no major contracting changes compared to last year, Q4 last year.

Operator

That's all the time we have for questions today. This concludes today's conference call. Thank you for participating. You may now disconnect.

Scott Smith
Scott Smith
Executive Vice President, Chief Financial Officer at Ascendis Pharma

Thank you. Bye bye.

Analysts
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