Sarepta Therapeutics reported first-quarter 2025 revenue of $744.9 million, surpassing analyst expectations of $693.5 million despite operational challenges that prompted the company to revise its annual guidance. The biotech company's 80.2% year-over-year revenue growth was primarily driven by increased usage of ELEVIDYS, its gene therapy for Duchenne muscular dystrophy, though a recent safety event and administrative hurdles have created near-term headwinds.
Safety Event Impacts Patient Access
Management disclosed that a patient death from acute liver failure related to ELEVIDYS treatment led some families to delay infusions while seeking additional information about the therapy's safety profile. CEO Doug Ingram acknowledged that this safety event, combined with administrative processing delays and site capacity constraints, necessitated a more cautious outlook for the remainder of 2025.
"We are changing our net product revenue guidance driven by three factors," Ingram stated during the earnings call, emphasizing that these issues are expected to impact both the timing and volume of infusions throughout 2025. The company has filed a supplement with the FDA regarding the safety event, with a review expected by year-end.
Operational Bottlenecks Challenge Growth
Beyond the safety concerns, Sarepta faces significant operational challenges in delivering ELEVIDYS to patients. The company reported longer-than-expected timeframes from patient enrollment to infusion, attributed to complex paperwork, insurance agreements, and scheduling bottlenecks at treatment centers. Administrative issues, including delays with Medi-Cal in California, have since been addressed according to management.
Site utilization presents another challenge, with approximately 60% of ELEVIDYS revenue concentrated among a handful of leading treatment sites, many now booked up to a year in advance. This imbalance has created access barriers for patients seeking treatment.
Strategic Response and Pipeline Progress
To address these challenges, Sarepta plans to intensify support for secondary infusion centers to alleviate backlogs at top sites and improve overall patient access. The company has launched comprehensive educational outreach efforts targeting both physicians and patients, including direct-to-consumer campaigns and digital resources to address safety concerns.
Management believes ongoing education of healthcare providers and patient families about safety and efficacy data will be critical to restoring confidence and driving new treatment initiations. When asked by analysts about directing patients to less-utilized centers, CEO Ingram stated the focus would be on expanding engagement and education at existing secondary sites rather than increasing the total number of treatment locations.
Pipeline Developments and Future Outlook
Beyond ELEVIDYS, Sarepta continues advancing its limb-girdle muscular dystrophy (LGMD) and siRNA programs. The company expects to submit a biologics license application for its EMERGENE therapy in the second half of the year and share new data from ongoing studies. Management anticipates these pipeline programs will underpin future revenue and diversify the company's therapeutic base.
Financial Performance and Analyst Perspectives
Despite revenue growth, Sarepta reported a non-GAAP loss of $3.42 per share, significantly below analyst consensus estimates of -$0.65. The company's adjusted EBITDA of -$239.6 million beat analyst estimates of -$371 million, while free cash flow was -$627.1 million compared to -$274.5 million in the same quarter last year.
Analysts questioned various aspects of the revised guidance during the earnings call. When asked which factor most heavily influenced the revision, management cited cycle times as the principal mechanical driver, with site capacity, administrative complexity, and the safety event all contributing. Regarding potential regulatory actions, management emphasized ELEVIDYS' risk-benefit profile and ongoing regulatory support.
Management confirmed the guidance adjustment was entirely ELEVIDYS-related and expects demand to recover in the summer and second half of the year as operational challenges are addressed and educational initiatives take effect.
