Syndax Pharmaceuticals (NASDAQ:SNDX) just posted a quarter that nearly doubled revenue, yet shares slipped 2.41% anyway. On its August 4 earnings call, management reported combined sales of $115 million across its two approved drugs, both now annualizing above $200 million a year. So why didn’t the market cheer? The answer sits inside the details investors are still sorting through.
Bull Case: Two Drugs Doing The Heavy Lifting
The growth is genuine. Revuforj net revenue reached $55 million in the second quarter, up 91% year-over-year and 12% from the prior quarter, while Niktimvo revenue climbed to $60 million, up 67% year-over-year. Total Revuforj prescriptions hit roughly 1,500, up 15% quarter-over-quarter, and the drug now sits on formularies covering 98% of insured lives, with preferential access on plans representing 17% of covered lives versus less than 2% for its rival menin inhibitor.
The more durable driver may be how long patients stay on therapy. About 50% of KMT2A patients who pause Revuforj for a stem cell transplant have resumed treatment afterward, up from roughly 45% the prior quarter, and management expects that figure to eventually reach 70% to 80%. Patients on therapy after transplant are already averaging at least nine months of treatment. Niktimvo shows similar staying power, with 60% to 70% of patients remaining on it for at least a year. Syndax also added two new pipeline candidates, an EGFR inhibitor for lung cancer and a next-generation menin inhibitor for myelofibrosis, backed by a $575 million cash balance that includes $244 million raised in June through 2.25% convertible notes.
Bear Case: The Fine Print Behind The Growth
The quarter also exposed some cracks. Revuforj added 250 new patients in the second quarter, but management acknowledged a fluctuation in new patient starts compared with prior quarters, tied to physicians now having more than one menin inhibitor to weigh depending on a patient’s mutation profile. That is an early sign that competition, not just the size of the addressable market, will shape how fast the drug grows from here.
Profitability also remains distant. Syndax guided to roughly $400 million in R&D and SG&A spending for 2026, excluding $50 million of stock compensation, against combined product revenue of just $115 million for the quarter. Niktimvo’s economics add another wrinkle: Syndax only records 25% to 30% of partner Incyte’s reported Niktimvo sales as collaboration revenue, so the headline growth understates how much the drug still needs to scale before it meaningfully helps the bottom line. Much of the next leg of the bull case also depends on data not yet reported. Axatilimab results in IPF and frontline chronic graft-versus-host disease, along with new NUP98 leukemia data, are still pending for the fourth quarter.
What The Smart Money Is Betting
Hedge fund ownership rose to 57 funds in the most recent quarter from 53 previously, suggesting institutional interest is building rather than fading. Short interest, however, sits at a heavy 25.82% of the float, pointing to a sizable bear camp still positioned against the stock. That combination, rising fund ownership against elevated short interest, is the tension investors are weighing after the post-earnings pullback.
The Quarter That Wasn’t Enough
Syndax enters the second half of 2026 with two growing drugs, a strengthened balance sheet, and a stacked catalyst calendar. The open question is whether the patient-start fluctuation in Revuforj was a one-quarter blip or the start of real competitive pressure. Fourth quarter data on axatilimab and NUP98 leukemia will do more to answer that than anything reported this quarter.
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