Alnylam’s third quarter was a beat that traded like a miss. Total revenue rose 17 percent to $1.458 billion, ahead of a consensus of about $1.43 billion in the reporting read, and global net product revenue rose 52 percent to $1.292 billion. The transthyretin franchise generated $1.150 billion, up 59 percent, with Amvuttra sales up 65 percent to $1.130 billion on demand from patients with ATTR cardiomyopathy in the United States, and up 10 percent on the second quarter. Amvuttra reached about 24 percent of total transthyretin category prescriptions by the end of the quarter, 18 months into the cardiomyopathy launch.
The profit line needs its explanation. GAAP net income was $2.167 billion, but that figure includes a discrete income tax benefit of about $1.9 billion from releasing valuation allowances on deferred tax assets, against GAAP operating income of $345.8 million. The tax release is a non cash accounting recognition that the company now expects to use those assets, not a quarter of operating performance.
Guidance was reiterated in form and softened in substance. Full year total net product revenue guidance stayed at $4.7 billion to $5.1 billion and transthyretin guidance at $4.2 billion to $4.5 billion, but management said transthyretin revenue will likely land near the low end of that range, and collaboration and royalty guidance stands at $575 million to $625 million. On the call, management acknowledged that underlying Amvuttra demand growth had not met expectations, that the expanded sales force has not yet translated into additional patient starts, and that a UnitedHealth policy change effective October 1, making first line access through Medicare Advantage more restrictive, is a headwind, alongside possible fourth quarter ordering volatility around the pending 340B rule.
The company also pushed out its forward visibility: it will not give 2027 product revenue guidance at the January JPMorgan conference as in prior years, and will instead provide it with fourth quarter results in mid February. In the pipeline, the TRITON-CM Phase 3 enrollment target for nucresiran was expanded from 1,750 to 2,250 patients to preserve statistical power at lower than expected event rates, with the 2030 launch timeline maintained. Shares fell sharply on the day, by about a fifth, which prices the launch slope question directly: Amvuttra is growing at 65 percent, and the dispute is only about whether the next increments arrive as fast as the valuation assumed.