SRPT Q1 2026 Financial Results

Let’s start with the positive notes:

1. The quarter was profitable (GAAP operating income of $358 million, non-GAAP $398 million);

2. Elevidys net product revenue totaled $102 million whereas PMO revenue was more than twice this at $229 million. They earned a significant amount of revenue from “collaboration.”

3. Submitted sNDA for Amondys 45 and Vyondys 53 to FDA seeking traditional approval;

4. siRNA pipeline shows great promise.

Let’s dig a little deeper. Elevidys revenue was actually 46% less this quarter than Q1 2025. The CEO noted several times that the data supporting the efficacy of the drug is increasingly compelling. The muscle MRI data “shows you cannot wait,” he said. Add to that the EMBARK data. So why are revenues down? There is apparently a “massive information gap” about Elevidys. In a nutshell, the negative headlines from 2025–acute liver injury (ALI) in some non-amb patients and, tragically, three deaths—linger. Plus the black box warning.

To counter this, they’ve doubled their sales force and developed new educational materials. According to one of the speakers on the call, these efforts are starting to bear fruit. Sites that had paused infusions are now enrolling patients again. But he reiterated a point they made last quarter—it takes six months from enrollment to dosing. This is why they’re not upping guidance, I think. Even with all their efforts, it will take a while to see more revenue from Elevidys.

The team seemed very upbeat about Cohort 8–dosing non-amb patients with sirolimus in an attempt to minimize ALI events. Apparently numerous doctors have been dosing amb patients with sirolimus prophylactically with zero adverse effects. While their stated goal is a 50% reduction in ALI episodes, the CEO said they were hopeful there would be none.

Look, the other news is all good. The PMO franchise is going strong. The siRNA therapies are very promising. The director of research was asked how Sarepta’s treatment of Huntington’s would differ from competitors’. She said that siRNA has the potential to be much safer.

I’m sure the market will pull back tonight/tomorrow since they left guidance unchanged—$1.2-$1.4 billion for the year. And yet, if anything, the story may be even more compelling. The regulatory overhang is far less of a risk now (in part because of Prasad’s departure). By the end of the year, we’ll have better data on sirolimus for the non-amb population. We’ll see the educational initiatives translating into higher revenues. Finally, the siRNA data may prove to be a game changer.

I’m playing the long game. This is biotech, after all.