Crinetics Pharmaceuticals Q1 Earnings Call Highlights
by Renee Jackson · The Cerbat GemCrinetics Pharmaceuticals (NASDAQ:CRNX) reported first-quarter 2026 results highlighting early commercial traction for its newly launched acromegaly treatment PALSONIFY and continued investment in a broad endocrine-focused pipeline.
PALSONIFY launch builds enrollment and revenue
Founder and CEO Scott Struthers said the company’s first quarter reflected “another strong quarter of executing our plan to make Crinetics the premier endocrine company,” citing steady additions of new patients and positive feedback from healthcare providers and patients. Crinetics reported 232 additional patient enrollment forms in the quarter and $10.3 million in net product revenue from PALSONIFY.
Chief Commercial Officer Isabel Kalofonos said launch momentum is being driven by “strong demand across all patient segments,” including patients switching from existing therapies and an increasing contribution from treatment-naive patients. According to Kalofonos, new enrollments in the first quarter included switch patients coming from “lanreotide, octreotide, cabergoline, oral octreotide, and combination regimes,” with both controlled and uncontrolled patients moving to PALSONIFY.
Kalofonos also said treatment-naive patients represented 15% of first-quarter enrollments, up from 5% in the fourth quarter of 2025. On the company’s Q&A, she clarified the 15% figure was “specific to 1st quarter,” adding that messaging from PATHFNDR-2 is “resonating really well with the community” and helping position PALSONIFY as a first-line option.
In addition, Kalofonos noted that approximately 15% of first-quarter prescriptions came from patients reinitiating therapy after discontinuing prior treatment, which she characterized as an early sign of PALSONIFY’s potential to expand the treated population. Later in the Q&A, she said these discontinued patients generally remained in the healthcare system but had stopped therapy due to the “burden of the treatment” and persistent symptoms, sometimes for more than two years.
Prescriber base expands; access improves
Crinetics emphasized broadening prescriber adoption. Kalofonos said that as of March 31, there were 263 unique prescribers, up from “over 125 at the end of 2025.” She added that enrollments remained “evenly split between academic and community settings.”
During the Q&A, Kalofonos provided additional detail on the mix of prescribing: she said 50% of prescriptions were coming from community practices and 50% from large treatment centers, and that the community channel represented 70% of the total prescriber base. She also estimated the current prescriber base represented “approximately 1,400 patients” under care.
On reimbursement, Kalofonos said about 70% of patients on therapy at the end of the first quarter were reimbursed, an improvement from the prior quarter, with patients continuing to transition from the company’s QuickStart program to paid product. She added that most prior authorizations were being approved for 12 months and aligned with the label. Asked about conversion metrics, Kalofonos declined to provide a specific figure but said the company expects QuickStart patients will eventually convert to reimbursed product.
Kalofonos also discussed payer activity, stating that Crinetics had achieved over 60% coverage and remained on track to exceed a 75% coverage goal by the end of the third quarter of 2026. She said the company was seeing formulary wins “earlier than the typical decision timeframe.”
In remarks on real-world adoption, Struthers pointed to practical barriers rather than physician interest. He said broader adoption at large treatment centers can be limited by “appointment availability,” and later added that “nothing is getting in the way other than a little bit of time and a little bit of finding those darn appointments.”
Pipeline updates: atumelnant, CRN09682, and upcoming data presentations
Chief Endocrinologist Alan Krasner highlighted ongoing pipeline work and upcoming medical meeting presentations. He said atumelnant has shown “unprecedented biomarker and clinical responses in short-term phase II studies,” and that the phase III CALM-CAH adult study and the phase II/III BALANCE-CAH pediatric study are “actively enrolling,” with the company expecting to begin enrollment in the phase II/III EQUILIBRIUM ADCS study “in the near future.” He also said Crinetics plans to report interim data from its phase II CAH open-label extension later in the year.
Struthers addressed a question about a 2026 BALANCE-CAH update, describing it as a cohort-based pediatric study beginning in 12- to 18-year-olds to confirm dose translation from adult data. He said there are two mandated cohorts and a possible third optional cohort, and that if the third cohort is not needed, the company “will have data on the 12 to 18-year-olds as we begin going down the age groups.”
On CRN09682, Struthers said the program remains in dose escalation and that the company did not think it was “prudent to give guidance” on timing of data disclosure. He added that decisions on additional cohorts would be made once the study reaches an effective or tolerated dose, noting the company has “already set out some key cohorts” for the expansion phase.
Krasner also outlined planned communications at the Endocrine Society meeting in June, including three oral presentations:
- Up to two years of long-term safety and efficacy from the phase III PATHFNDR open-label extension studies
- Final results from the phase II TouCAHn study of atumelnant in adult CAH
- New dosing data from an ongoing single-center study evaluating atumelnant in ACTH-dependent Cushing’s syndrome
Asked about safety monitoring for atumelnant in ongoing registrational studies, Struthers said the safety profile remained “very, very favorable,” and Krasner emphasized that phase II/III and phase III trials are closely monitored by medical monitors and data monitoring committees, adding that trial continuation generally signals the risk-benefit profile remains acceptable.
Financial results and 2026 outlook
Chief Financial Officer Tobin Schilke reported $10.7 million in total revenue for the first quarter, including $10.3 million from PALSONIFY and $0.4 million from a licensing agreement with Japanese partner SKK. Cost of product revenue was $0.2 million. Schilke noted that prior to PALSONIFY’s approval, manufacturing costs were expensed through R&D as zero-cost inventory, and that to date the company has only distributed zero-cost inventory and expects to continue doing so “for the near term.”
Research and development expenses were $100.1 million in the first quarter, up from $85.1 million in the fourth quarter, driven primarily by the ramp-up of phase III trials and the initiation of the pediatric atumelnant study in CAH. Selling, general, and administrative expenses were $50.8 million, compared to $53.7 million in the prior quarter, which Schilke attributed to timing variability of commercial investment.
Crinetics ended the quarter with $1.3 billion in cash, cash equivalents, and investments. Schilke said the company is maintaining its 2026 operating expense guidance, expecting GAAP operating expenses of $600 million to $650 million and non-GAAP operating expenses of $480 million to $520 million. Based on current operating plans, Schilke said the company expects its cash and investments to fund operations “into 2030.”
International progress, but revenue expected later
Struthers said PALSONIFY has continued to advance globally, including European Commission approval of the company’s marketing authorization application, a Japanese new drug application submission by SKK, and an MAA submission in Brazil. He said Crinetics is taking a “disciplined market-by-market approach” internationally, prioritizing regions with clearer regulatory and reimbursement pathways and pacing investment amid a “dynamic global pricing and access environment.”
In response to a question about Europe, Struthers said the company is not preparing for international revenue in 2026 but “will be prepared for early launch in 2027.”
About Crinetics Pharmaceuticals (NASDAQ:CRNX)
Crinetics Pharmaceuticals, Inc is a clinical-stage biopharmaceutical company focused on the discovery, development and commercialization of novel therapeutics for rare endocrine diseases. The company’s proprietary platform leverages insights into hormone receptor signaling to design small-molecule candidates that address conditions driven by dysregulated hormone activity. Crinetics’ research efforts center on targeting somatostatin, vasopressin and other GPCR-mediated pathways with orally bioavailable molecules intended to improve patient convenience and adherence.
The company’s lead product candidate, paltusotine (formerly CRN04777), is a selective, non-peptide somatostatin receptor type 2 agonist being evaluated for the treatment of acromegaly and carcinoid syndrome diarrhea.