BridgeBio Pharma

BridgeBio reported $244 million in total revenue in the second quarter, up 120% year over year, of which Attruby contributed $222 million. BridgeBio recorded a net loss of $152 million in the second quarter. Shares were trading flat on Aug. 11.

Why it matters: Alongside Attruby's strong 23% sequential sales growth, BridgeBio now has three late-stage candidates in active regulatory review: BBP-418 (for limb-girdle muscular dystrophy), encaleret (for ADH1, a rare genetic disorder), and infigratinib (for achondroplasia). Management will need to run three concurrent launches across distinct physician specialties while continuing to grow Attruby's share in the competitive ATTR-CM market. We assign a 90% probability of approval to each candidate and expect launches in early to mid-2027. Attruby's growth is increasingly driven by newly diagnosed patients rather than patients switching therapies, suggesting durable share gains. This momentum is further supported by the expansion of the overall ATTR-CM market as diagnosis and treatment rates continue to rise.

The bottom line: We maintain our fair value estimate of $85 per share for no-moat BridgeBio, and shares are trading in 3-star, fairly valued territory. We continue to have a positive outlook and forecast a three-year compound annual revenue growth rate exceeding 66%. We raised our 2026 Attruby sales forecast to just over $1 billion due to strong patient uptake, though elevated expenses associated with the three upcoming launches are offsetting much of this benefit, with operating expenses up 43% year over year in the second quarter. BridgeBio shoulders nearly all commercial execution risk as both BBP-418 and encaleret are wholly owned and the firm controls infigratinib commercialization outside Japan. While this structure maximizes long-term economics if launches succeed, it also leaves BridgeBio fully exposed to any commercial setbacks. We maintain our Very High Uncertainty Rating.

We raise our fair value estimate for no-moat BridgeBio to $85 per share, from $65, driven by our increase in probability of approval for infigratinib to 90% from 75%, and raised our sales forecast for this candidate based on the positive phase 3 trial results. BridgeBio plans to submit regulatory filings in the US and Europe in the second half of 2026, and if approved, we anticipate it could reach the market by the end of 2027.

Our valuation largely rests on the commercial success of Attruby. We estimate that this ATTR-CM drug could generate global sales of approximately $3.8 billion by 2034. Our growth trajectory assumes acoramidis will ramp up to capture around a third of the newly diagnosed patients every year and maintain an adherence rate of 90%. If Attruby achieves strong commercial success, it could become a blockbuster drug, which underscores its role as the centerpiece of the firm’s growth strategy.

Other drugs in BridgeBio’s late-stage pipeline also have strong growth potential. We model encaleret could achieve peak sales of $631 million by 2034, assuming it captures around 20% of the patient market. For BBP-418 and low-dose infigratinib, which we anticipate could launch commercially between 2026 and 2027, we estimate probability-weighted 2034 sales of $409 million and $1.3 billion, respectively. Overall, on a probability-weighted basis, the company’s pipeline could contribute roughly $2.3 billion in revenue by 2034.

We anticipate that product costs will be roughly 10% of total revenue, resulting in a gross margin of about 90%. As the company’s pipeline advances into late-stage trials, we anticipate its R&D costs will continue to grow, and selling, general, and administrative expenses are expected to increase as drug candidates approach commercialization. As revenue grows over our 10-year forecast period, R&D expenses and SG&A expenses will scale as a percentage of sales. We assume a 9% cost of equity for BridgeBio, which is consistent with the other emerging biotech companies.

We don’t believe BridgeBio has an economic moat. While we think the emerging biotechnology company is developing a promising pipeline, its assets remain largely unproved at this stage, and the commercial success and regulatory approval of its therapies are still uncertain. Although BridgeBio’s focus on addressing high unmet medical needs and its recent strategic partnerships are positive indicators, we need to see more concrete evidence of continued long-term cash flow and successful product commercialization before considering a narrow moat rating.

After the merger with subsidiary Eidos Therapeutics in 2021, BridgeBio gained full rights for acoramidis, a potential best-in-class therapy for patients with transthyretin amyloidosis. A recent collaboration grants Bayer rights to the drug in Europe, while AstraZeneca holds the rights in Japan. BridgeBio will focus on Attruby’s commercial potential in the United States. ATTR-CM is a rare heart disease caused by the destabilization of the TTR protein and subsequent accumulation of the misfolded TTR protein in the tissue of the heart muscle tissue, known as the myocardium. Attruby is central to our valuation, accounting for approximately 80% of our revenue forecast in 2033, so any safety issues that emerge with its long-term use or superior data from competitors would significantly impair the firm’s value. This potential threat of substantial value destruction drives our no-moat rating.

BridgeBio's main competitor in ATTR amyloidosis is Pfizer’s Vyndaqel/Vyndamax (tafamidis), which is currently the other approved small molecule for this condition. Both acoramidis and tafamidis act as stabilizers that work by binding and stabilizing the TTR protein to prevent it from forming amyloid deposits, thereby slowing the progression of the disease.

Attruby looks like it has a similar safety profile as tafamidis, but recent phase 3 trial data from BridgeBio suggests that its drug may offer superior efficacy. Data from BridgeBio’s Phase 3 ATTRibute-CM trial shows that participants who switched from tafamidis and placebo to acoramidis experienced a mean increase of 3.0 mg/dL in serum transthyretin at month 1 and a mean increase of 3.4 mg/dL at month 6. Increased serum TTR levels at day 28 were associated with a reduced risk of all-cause mortality, cardiovascular mortality, and cardiovascular-related hospitalization in ATTR-CM patients. Another drug class being studied, silencers, aims to reduce production of the TTR protein, thereby lowering the substrate available for amyloid deposition and potentially decreasing the disease burden over time. Alnylam’s Amvuttra, an approved RNAi therapeutic, and Ionis’ eplontersen, an investigational antisense therapy, represent key entrants in this class. However, given that Acoramidis reached the market first and is positioned as a relatively lower-cost stabilizer with strong efficacy, it may prove challenging for these newer silencers to displace stabilizers in the treatment paradigm. Combination use is a possibility, but the cost might be prohibitive, at least until Vyndaqel’s patent expiration in 2028. Given these dynamics and the increasing population of diagnosed patients (due to heightened disease awareness and increased adoption of noninvasive diagnostic techniques), we believe that acoramidis could capture significant market share if approved and looks to be a promising option for newly diagnosed patients and those inadequately managed by current therapies.

A key concern surrounding Attruby’s potential market share gains is the introduction of generic versions of the ATTR-CM drugs. Pfizer’s patents for Vyndaqel/Vyndamax are set to expire in 2028 in the United States and in 2026 in Europe. This might pave the way for the entry of generic alternatives, potentially disrupting Attruby's market share. BridgeBio appears to be positioning itself to capitalize on the market dynamics before the patent expires and during the interim period between expiration and availability of generics, aiming to retain patient loyalty.

BridgeBio is also actively advancing other drugs in its late-stage pipeline. Encaleret is an investigational small molecule that modulates the calcium-sensing receptor to treat low blood calcium and high urinary calcium. It is being developed as a therapeutic for ADH1 and has shown promising results in phase 2b trials in 2022. While encaleret will compete with the newly approved injectable Yorvipath from Ascendis, its main advantage is its oral administration. Low-dose infigratinib, another small oral molecule in development, targets patients with FGFR-driven conditions, such as achondroplasia and hypochondroplasia. If approved, it will compete with BioMarin’s Voxzogo, which has already captured significant market share as the first drug approved for achondroplasia and is currently in phase 3 trials for hypochondroplasia. In February 2026, BridgeBio presented positive phase 3 top-line results demonstrating an impressive efficacy and safety profile. A main advantage over Voxzogo lies in its oral administration; Voxzogo requires daily injections. BridgeBio is also working on BBP-418, which has the potential to become the first oral therapy for LGMD2I/R9 (a rare genetic disorder that causes progressive muscle degeneration and damage), as it aims to provide elevated levels of the mutant FKRP enzyme. This faces minimal competition, as alternative treatments for this condition are still in very early stages of clinical trials.

A critical factor influencing BridgeBio’s valuation and long-term competitive edge is the firm’s ability to advance its pipeline drugs to market. Nulibry, approved by the FDA in February 2021 for molybdenum cofactor deficiency type A (a rare and genetic disorder that progresses rapidly and results in severe and largely irreversible neurological injury), had its global rights acquired by Sentynl in 2022 for an upfront payment of $10 million. While BridgeBio continues to benefit from tiered royalties and sales milestone payments for Nulibry, the success of its pipeline candidates will be essential for driving growth and enhancing its market position.

We are also concerned about BridgeBio’s heavy dependence on strategic collaborations for the marketing and commercialization of its product candidates, as demonstrated by the issues with Truseltiq. Despite receiving FDA approval in 2021 for bile duct cancer, Truseltiq was discontinued after pharmaceutical company Helsinn terminated its commercialization agreement. The FDA approval was also withdrawn because BridgeBio was unable to fund and complete the required postmarketing studies to verify the clinical benefits of the drug. Similarly, the success of Attruby is closely tied to BridgeBio's collaboration with Bayer, a German pharmaceutical company. According to their recent agreement, Bayer has been granted an exclusive license to commercialize Attruby as a treatment for ATTR-CM in Europe. While this partnership offers BridgeBio a lucrative deal, including up to $310 million in upfront and near-term milestone payments and royalty percentages starting in the low 30s, the ultimate success of Attruby in Europe will be contingent upon Bayer’s ability to effectively market and sell the drug.

Overall, we think the company has several promising candidates that could one day support a moat, but the uncertainty around their development is too high to warrant a narrow moat at this time. We currently give the company's late-stage clinical drug candidates probabilities of approval of 90%, with most of these therapies potentially reaching the market between 2026 and 2027.

The successful commercialization of Attruby could establish BridgeBio as a key player in the ATTR-CM market, significantly improving its path to profitability.

BridgeBio’s pipeline targets high unmet patient needs, positioning the company’s products for strong market adoption upon receiving regulatory approval.

Partnerships with pharmaceutical companies provide milestone payments and economic benefits, offsetting clinical development costs and supporting BridgeBio’s financial stability and market entry.

BridgeBio has historically faced challenges in developing pipeline candidates and bringing them to market.

BridgeBio's valuation relies on the commercialization of Attruby, but the drug's full potential may be undermined by tafamidis’ patent extension, introduction of generic alternatives, and other branded competition from Alnylam, Ionis, and Intellia.

While BridgeBio targets several rare genetic disorders—including amyloidosis, achondroplasia, and ADH1—it faces competition from other companies advancing next-generation therapies in these disease areas.