BridgeBio bets on four launches by 2027 as Attruby nears blockbuster status

BridgeBio Pharma (BBIO) expects 2027 to mark its transformation from a one-product company into a group with four globally launched therapies, according to Thomas Trimarchi, its president and chief financial officer, speaking at a Bernstein conference.

Trimarchi said the strategy rests on developing medicines for genetic diseases with substantial unmet need, particularly where the underlying mechanism can be targeted directly. He stressed capital allocation discipline and net present value as central to the company's operating model. "We are here in this world to help as many patients living with genetic disease as we possibly can in the shortest amount of time," he said.

The immediate driver is Attruby, BridgeBio's treatment for ATTR cardiomyopathy, which is annualizing at more than $1bn globally about six quarters after launch. Trimarchi said the drug should reach blockbuster status on a full-year basis by the end of this year. The company estimates that 15,000 to 16,000 patients a year are now reaching the "bottom of the funnel" in the market, up from about 8,000 two years ago. Attruby holds roughly 25 per cent of new patient starts, a share that is still rising.

Recent real-world data comparing acoramidis, Attruby's active ingredient, with tafamidis showed a 34 per cent improvement on a composite of diuretic intensification, cardiovascular hospitalizations and all-cause mortality, Trimarchi said. BridgeBio has also published data pointing to a kidney-protective effect, though the mechanism is still under investigation. The company maintains its forecast of more than $4bn in peak-year sales.

Growth is likely to be steady. Trimarchi expects quarterly Attruby revenue to rise by about $25mn to $30mn for the next several quarters, potentially into late 2027, reflecting a normalization in switches from tafamidis and a changing mix between second-line and treatment-naive patients. Lifecycle plans include the ACT-EARLY primary-prevention study in certain asymptomatic variant carriers, a cardiac imaging study, further renal research and a once-daily formulation that could enter the clinic within 12 to 18 months.

The next launches come from rare-disease programs. BBP-418, for limb-girdle muscular dystrophy type 2I/R9, targets a progressive condition with no approved therapy that affects an estimated 2,000 to 2,500 people in the US, about 5,000 in Europe and a further 2,000 or so in Japan with the related Fukuyama muscular dystrophy. Its Phase 3 trial showed statistically significant benefits over placebo on the North Star Ambulatory Assessment, forced vital capacity and a 10-meter walk test. The FDA is due to decide on or before November 27, and BridgeBio has identified about 500 US patients with confirmed genotypes to form the initial launch pool.

Encaleret, for autosomal dominant hypocalcemia type 1, is also under FDA review with a May 8 decision date. In Phase 3, more than 75 per cent of patients stopped conventional calcium and vitamin D therapy and reached normal blood and urine calcium levels after six months. BridgeBio has started a Phase 3 study in postsurgical hypoparathyroidism, with results possible from late 2027 to early 2028.

The fourth product, infigratinib for achondroplasia, is an oral therapy that targets the FGFR3 mutation behind the condition, unlike existing CNP analog treatments. Julie Miller Everett, chief operating officer of BridgeBio's skeletal dysplasias business, said it delivered statistically significant gains in annualized height velocity and proportionality within 52 weeks, along with benefits in ear infections and sleep apnea. Only 20 to 30 per cent of US families have opted for available treatment, against an estimated 70 to 80 per cent outside the country, which BridgeBio sees as room for growth among untreated patients, those wishing to leave injectables and those who previously discontinued therapy.

BridgeBio has deployed medical staff and is building commercial infrastructure in the US, while developing country-specific models abroad. Trimarchi described the next 18 months as the period in which the four-product portfolio could underpin a broader, more durable biopharmaceutical business.