Milestone Pharmaceuticals Reports Third Quarter 2026 Financial Results and Announces Cost-Efficiency Measures Designed to Extend Cash Runway Through AFib-RVR Phase 3 Data
Sentiment and the balance of points
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Rhea-AI Summary
Milestone Pharmaceuticals (Nasdaq: MIST) announced measures expected to cut operating expenses approximately 30% while preserving CARDAMYST sales coverage and clinical development. Completion is expected by the first quarter of 2027, with approximately $2 million in one-time charges. Third-quarter CARDAMYST net revenue was $963,000, up 73% from the second quarter. Net loss widened to $25.8 million from $11.9 million a year earlier.
Cash, cash equivalents and short-term investments totaled $145.4 million at September 30, 2026. Milestone expects funding into late 2028, more than one year beyond prior guidance, covering the anticipated second-half 2028 Phase 3 results for etripamil in atrial fibrillation with rapid ventricular rate. An RTW amendment extends the convertible notes’ payment-in-kind interest period to March 2029. CFO Amit Hasija and CMO David Bharucha departed the leadership team; Bharucha is transitioning to an adviser.
How this balance works
Rhea-AI gives every point it takes from this document a weight. Minor counts 1, Moderate 3 and Major 9, so one Major point outweighs several Minor ones. The bar adds up the weights on each side, and when neither side holds more than 65% of the total the balance reads Mixed.
It reads the document as published, with the same rules for every company, and it does not look at what the market expected or at how the stock traded, so a point can be objectively good on a day the stock falls.
Rhea-AI Sentiment measures something else, the tone of the wording.
Hollow bars mark forward-looking points. How the balance works
Positive
- Moderate pointCARDAMYST third-quarter net revenue reached $963,000, up 73% from the second quarter of 2026.
- Moderate point. Forward-looking: it has not happened yet and may not happen.Cost-efficiency measures are expected to reduce operating expenses approximately 30%, with completion expected by first-quarter 2027.
- Moderate point. Forward-looking: it has not happened yet and may not happen.Milestone expects cash runway into late 2028, more than one year beyond prior guidance.
- Moderate pointRTW amendment extends payment-in-kind interest through March 2029, from March 31, 2027, deferring cash interest payments.
- Minor pointCARDAMYST generated $1.760 million in nine-month net revenue, versus none in the corresponding 2025 period.
7 minor points
- Minor pointCARDAMYST prescriptions since launch reached approximately 3,400, written by approximately 1,600 unique prescribers.
- Minor pointCommercial payer coverage increased to approximately two-thirds of commercially covered lives.
- Minor pointLicense and other revenue totaled $2 million for both the third quarter and nine months, versus none in 2025.
- Minor pointCash, equivalents and short-term investments rose to $145.4 million from $106.0 million at December 31, 2025.
- Minor point. Forward-looking: it has not happened yet and may not happen.ReVeRA-301 remains fully funded and on schedule; Milestone expects Phase 3 topline data in second-half 2028.
- Minor pointThird-quarter research and development expense fell to $3.458 million from $3.940 million a year earlier.
- Minor pointNine-month research and development expense fell to $10.191 million from $12.587 million a year earlier.
Negative
- Major pointLong-term royalty financing obligation reached $82.829 million at September 30, 2026, versus none at December 31, 2025.
- Moderate pointThird-quarter net loss widened to $25.8 million, or $0.18 per share, versus $11.9 million, or $0.12, a year earlier.
- Moderate pointThird-quarter selling, general and administrative expense increased to $24.232 million from $7.889 million a year earlier.
- Moderate pointShareholders’ equity shifted to a $6.217 million deficit from positive $41.769 million at December 31, 2025.
- Moderate pointCommon shares outstanding increased to 124,498,693 from 106,236,344 at December 31, 2025, diluting existing holders.
5 minor points
- Minor pointNine-month net loss widened to $80.5 million from $45.6 million; loss per share narrowed to $0.59 from $0.60.
- Minor pointNine-month selling, general and administrative expense increased to $67.5 million from $32.3 million a year earlier.
- Minor point. Forward-looking: it has not happened yet and may not happen.Restructuring is expected to incur approximately $2 million in one-time severance, conversion and workforce-reduction charges.
- Minor pointSelected non-essential activities, including certain manufacturing scale-up work, have been deferred.
- Minor pointSenior secured convertible notes increased to $60.237 million from $57.191 million at December 31, 2025.
News Explained
ReVeRA-301 remains fully funded, while certain non-essential manufacturing scale-up work has been deferred.
The announced plan calls for retaining about 45 field representatives but moving them from a contracted model to company employees, which Milestone says lowers overhead while maintaining current sales coverage.
Details
Market move: MIST +9.77% vs previous close. 3Q26 earnings report
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Key Figures
- CARDAMYST product revenue
- $1.0 million
- Q3 2026
- Operating expense reduction
- Approximately 30%
- Expected from cost-efficiency measures
- Cash and short-term investments
- $145.4 million
- As of September 30, 2026
- Cash runway
- Into late 2028
- Company expectation; more than one year beyond prior guidance
- One-time charges
- Approximately $2 million
- Expected, primarily severance, conversion fees, and workforce-reduction costs
- Payment-in-kind interest period
- Extended from March 31, 2027 to March 2029
- Amendment to the convertible note purchase agreement
- Net loss
- $25.8 million, or $0.18 per share
- Q3 2026
- ReVeRA-301 topline data
- Expected in the second half of 2028
- Phase 3 AFib-RVR trial; remains on schedule
Historical Context
-
First European participant enrolled in ReVeRA-301, extending enrollment beyond the U.S. and Canada.
24h Move is the share-price change in the day after each event; other market factors may also have contributed.
Key Terms
payment-in-kind financial
convertible notes financial
phase 3 medical
atrial fibrillation with rapid ventricular rate medical
sinus rhythm medical
AI-generated analysis. How Rhea-AI works. Not financial advice.
Launch of CARDAMYST® (etripamil) nasal spray marked by steady prescription growth, new prescriber expansion and improving commercial coverage
Company is reducing operating expenses by approximately
AFib-RVR Phase 3 trial on schedule with data expected in 2H 2028
MONTREAL and CHARLOTTE, N.C., Nov. 13, 2026 (GLOBE NEWSWIRE) -- Milestone Pharmaceuticals Inc. (Nasdaq: MIST) today reported financial results for the quarter ended September 30, 2026, and announced cost-efficiency measures designed to extend cash runway through the topline results from its Phase 3 trial of etripamil in atrial fibrillation with rapid ventricular rate (AFib-RVR), while preserving the sales force and core commercial activities for CARDAMYST® (etripamil) nasal spray. CARDAMYST is FDA-approved for the conversion of acute symptomatic episodes of paroxysmal supraventricular tachycardia (PSVT) to sinus rhythm in adults.
Third Quarter and Recent Updates
- Net product revenue for CARDAMYST of
$1.0 million for Q3 2026, up73% from the second quarter ended June 30, 2026; approximately 3,400 total prescriptions written by approximately 1,600 unique prescribers since launch; current payer coverage has increased to approximately two-thirds of commercially covered lives. - Corporate cost-efficiency measures expected to reduce operating expenses by approximately
30% ; executives, Mr. Amit Hasija (Chief Financial Officer) and Dr. David Bharucha (Chief Medical Officer) have departed from the leadership team, with Dr. Bharucha transitioning to an advisor to the Company. - Amendment to Note Purchase Agreement with RTW Investments LP and certain of its affiliates (“RTW”) extends the payment-in-kind interest period on its convertible notes from March 31, 2027 to March 2029.
- Cash and equivalents of
$145.4 million as of September 30, 2026, expected to provide operating runway into late 2028, more than one year beyond prior guidance. - Ongoing Phase 3 pivotal trial (ReVeRA-301) evaluating etripamil nasal spray in atrial fibrillation with rapid ventricular rate (AFib-RVR) is on schedule; topline data expected in the second half of 2028.
“We are encouraged by the early progress of CARDAMYST, and as we gain experience in the market, we believe we are better able to identify where our investments can have the greatest potential impact,” said Joseph Oliveto, President and Chief Executive Officer of Milestone Pharmaceuticals. “The actions we are announcing today reflect a more efficient approach to capital allocation, which we believe will drive continued prescription growth, expand our prescriber base and improve patient access for CARDAMYST, while reducing operating expenses. Importantly, we expect these measures to extend our cash runway beyond the anticipated Phase 3 readout of ReVeRA-301 in the second half of 2028.”
Key elements of the cost-efficiency measures include:
- Bringing the sales force in-house: the Company plans to retain the existing field sales team of approximately 45 dedicated representatives, transitioning them from a contracted model to company employees at a lower overhead cost while maintaining current sales coverage. This team reflects the territory optimization completed in August, when the field force was reduced from approximately 60 representatives to focus on the strongest-performing representatives and territories, including those covering electrophysiology and highest-prescribing cardiology accounts.
- Operating efficiencies and cost reductions: The Company will also concentrate on its most productive targeted marketing, market access and patient support programs while discontinuing less productive initiatives. The Company is also rightsizing and internalizing selected outsourced activities and reducing its headquarters workforce. These actions are expected to reduce the Company’s operating expenses by approximately
30% and to be complete by the first quarter of 2027. The Company expects to incur approximately$2 million in one-time charges, primarily severance, conversion fees and costs related to the workforce reduction. - Leadership changes: Consistent with the organizational reduction and runway extension, Mr. Amit Hasija (Chief Financial Officer) and Dr. David Bharucha (Chief Medical Officer) have departed from the leadership team. Anthony Krick, the Company’s Vice President of Finance, has been named Principal Financial and Principal Accounting Officer, and will lead the Finance function.
- R&D Commitment Maintained: The AFib-RVR Phase 3 program (ReVeRA-301) remains fully funded; non-essential short-term activities, including certain manufacturing scale-up work, have been deferred. AFib-RVR has an estimated addressable patient population of approximately 3 to 4 million patients in the United States (approximately 3 to 4 times the size of that for PSVT).
Financial Outlook
- As of September 30, 2026, Milestone had cash, cash equivalents, and short-term investments of
$145.4 million . The Company currently expects its cash, cash equivalents and short-term investments to be sufficient to cover operating expenses and capital expenditure into late 2028, more than one year beyond prior guidance.
Third Quarter 2026 Financial Results
As of September 30, 2026, Milestone had cash, cash equivalents, and short-term investments of
Product revenues were
Research and development expense, net of tax credits, for the three months ended September 30, 2026, was
Selling, general and administrative expense for the three months ended September 30, 2026, was
For the three months ended September 30, 2026, net loss was
For further details on the Company’s financials, refer to the Quarterly Report on Form 10-Q for the quarter ended September 30, 2026, filed with the U.S. Securities and Exchange Commission (SEC) today.
Conference Call and Webcast
Milestone will host a conference call and webcast at 8:30 am ET today, Friday, November 13. To access the live conference call, participants may register here.
Conference Call Details:
| Conference Dial-in: | 1-877-407-0792 |
| International Dial-in: | 1-201-689-8263 |
| Conference ID: | 13763324 |
Participants can use Guest dial-in #s above and be answered by an operator OR click the Call Me™ link for instant telephone access to the event. The Call Me™ link will be made active 15 minutes prior to scheduled start time.
A replay of the audio webcast of the call will be available under the News & Events section of Milestone's website, www.milestonepharma.com.
About Milestone Pharmaceuticals
Milestone Pharmaceuticals Inc. (Nasdaq: MIST) is an emerging commercial-stage biopharmaceutical company advancing innovative cardiovascular medicines to benefit people living with certain heart conditions. Milestone’s lead product is CARDAMYST® (etripamil) nasal spray, a novel calcium channel blocker, which is FDA-approved for the conversion of acute symptomatic episodes of paroxysmal supraventricular tachycardia (PSVT) to sinus rhythm in adults. Etripamil is also in Phase 3 development for the control of symptomatic episodic attacks associated with AFib-RVR. https://milestonepharma.com/.
About CARDAMYST
CARDAMYST® (etripamil) nasal spray is approved by the U.S. Food and Drug Administration (FDA) for the conversion of acute symptomatic episodes of paroxysmal supraventricular tachycardia (PSVT) to sinus rhythm in adults. It is a novel calcium channel blocker nasal spray designed as a self-administered rapid response therapy for patients, thereby bypassing the need for immediate medical oversight. The product is intended to provide health care providers with a new treatment option to enable on-demand care and patient self-management. This portable treatment may provide patients with active management and a greater sense of control over their condition. CARDAMYST is well studied with a robust clinical trial program that includes a completed Phase 3 clinical-stage program for the treatment of PSVT. Currently, etripamil is in Phase 2 development for treatment of PSVT in pediatric patients and Phase 3 development for control of acute atrial fibrillation with rapid ventricular rate (AFib-RVR) in adults. For more information, please visit CARDAMYST.com.
Indication
CARDAMYST is indicated for the conversion of acute symptomatic episodes of paroxysmal supraventricular tachycardia (PSVT) to sinus rhythm in adults.
IMPORTANT SAFETY INFORMATION FOR CARDAMYST (etripamil)
What is CARDAMYST?
CARDAMYST is a prescription medicine used to help restore normal sinus heart rhythm in adults who have symptoms of sudden episodes of fast heartbeat called paroxysmal supraventricular tachycardia (PSVT).
It is not known if CARDAMYST is safe and effective in children.
Do not use CARDAMYST if you:
- are allergic to CARDAMYST or any of its ingredients. See the Patient Information for a complete list of ingredients in CARDAMYST.
- have limitations in activities due to heart failure (moderate to severe heart failure).
- have Wolff-Parkinson-White (WPW) syndrome, Lown-Ganong-Levine syndrome, or an abnormal heart rhythm pattern called pre-excitation (delta wave) on an electrocardiogram (ECG).
- have sick sinus syndrome without a permanent pacemaker.
- have second degree or higher atrioventricular (AV) block.
Before using CARDAMYST, tell your healthcare provider about all of your medical conditions, including if you:
- have a history of fainting.
- have low blood pressure.
- are pregnant or plan to become pregnant. It is not known if CARDAMYST will harm your unborn baby.
- are breastfeeding or plan to breastfeed. It is not known if CARDAMYST passes into your breast milk. You should stop breastfeeding for 12 hours after treatment with CARDAMYST. During this time, pump and throw away your breast milk. Talk to your healthcare provider about the best way to feed your baby after using CARDAMYST.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
What are the possible side effects of CARDAMYST?
CARDAMYST may cause serious side effects, including:
- Fainting due to CARDAMYST effects on blood pressure, heart rate, and electrical activity of the heart. CARDAMYST may cause dizziness and fainting, especially in people with a history of fainting and certain heart problems, or people with a history of fainting during an episode of PSVT. Use CARDAMYST while sitting in a safe area where you will not fall if you become dizzy or lightheaded. Lie down if you feel dizzy or lightheaded after using CARDAMYST. If fainting occurs after using CARDAMYST, caregivers should place you on your back and seek medical help.
The most common side effects of CARDAMYST include:
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These are not all of the possible side effects for CARDAMYST. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Please see the full Prescribing Information
https://milestonepharma.com/etripamilprescribinginformation.pdf for CARDAMYST.
Forward-Looking Statements
This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Words such as “believe,” “continue,” “could,” “demonstrate,” “designed,” “develop,” “estimate,” “expect,” “may,” “pending,” “plan,” “potential,” “progress,” “will,” “intend” and similar expressions (as well as other words or expressions referencing future events, conditions, or circumstances) are intended to identify forward-looking statements. These forward-looking statements are based on Milestone’s expectations and assumptions as of the date of this press release. Each of these forward-looking statements involves risks and uncertainties. Actual results may differ materially from these forward-looking statements. Forward-looking statements contained in this press release include statements regarding: the continued commercialization and adoption of CARDAMYST and Milestone’s planned commercial priorities; the implementation, timing and anticipated benefits of Milestone’s cost-efficiency measures and associated one-time charges; the anticipated reduction in operating expenses of approximately
Contacts
Investor Relations
Kevin Gardner, kgardner@lifesciadvisors.com
Media Relations
Rebecca Novak, rnovak@milestonepharma.com
Milestone Pharmaceuticals Inc.
Condensed Consolidated Balance Sheets (Unaudited)
(in thousands of U.S. dollars, except share data)
| September 30, 2026 | December 31, 2025 | |||||||
| Assets | ||||||||
| Current assets | ||||||||
| Cash and cash equivalents | $ | 144,472 | $ | 73,046 | ||||
| Short-term investments | 882 | 32,914 | ||||||
| Accounts receivable, net | 3,929 | — | ||||||
| License receivable | 2,000 | 1,546 | ||||||
| Research and development tax credits receivable | 623 | 316 | ||||||
| Prepaid expenses | 2,513 | 1,805 | ||||||
| Inventory, net | 6,676 | 648 | ||||||
| Other receivables | 509 | 1,646 | ||||||
| Total current assets | 161,604 | 111,921 | ||||||
| Operating lease right-of-use assets | 675 | 1,129 | ||||||
| Property and equipment, net | 416 | 511 | ||||||
| Total assets | $ | 162,695 | $ | 113,561 | ||||
| Liabilities and Shareholders' (Deficit) Equity | ||||||||
| Current liabilities | ||||||||
| Accounts payable | $ | 9,235 | $ | 5,645 | ||||
| Accrued liabilities | 14,496 | 7,644 | ||||||
| Operating lease liabilities | 686 | 647 | ||||||
| Deferred revenue | 1,321 | — | ||||||
| Other current liabilities | 43 | 43 | ||||||
| Total current liabilities | 25,781 | 13,979 | ||||||
| Operating lease liabilities, net of current portion | 14 | 539 | ||||||
| Senior secured convertible notes | 60,237 | 57,191 | ||||||
| Royalty financing obligation, long-term | 82,829 | — | ||||||
| Other long-term liabilities | 51 | 83 | ||||||
| Total liabilities | 168,912 | 71,792 | ||||||
| Shareholders’ (Deficit) Equity | ||||||||
| Common shares, no par value, unlimited shares authorized, 124,498,693 shares issued and outstanding as of September 30, 2026, 106,236,344 shares issued and outstanding as of December 31, 2025 | 384,987 | 352,619 | ||||||
| Pre-funded warrants - 16,412,925 issued and outstanding as of September 30, 2026, and 16,412,925 as of December 31, 2025 | 55,649 | 55,649 | ||||||
| Additional paid-in capital | 64,226 | 64,104 | ||||||
| Accumulated deficit | (511,079 | ) | (430,603 | ) | ||||
| Total shareholders’ (deficit) equity | (6,217 | ) | 41,769 | |||||
| Total liabilities and shareholders’ (deficit) equity | $ | 162,695 | $ | 113,561 | ||||
Milestone Pharmaceuticals Inc.
Condensed Consolidated Statements of Loss (Unaudited)
(in thousands of U.S. dollars, except share and per share data)
| Three months ended September 30, | Nine months ended September 30, | |||||||||||||||
| 2026 | 2025 | 2026 | 2025 | |||||||||||||
| Revenues | ||||||||||||||||
| Product revenue, net | $ | 963 | $ | — | $ | 1,760 | $ | — | ||||||||
| License and other revenue | 2,000 | — | 2,000 | — | ||||||||||||
| Total revenues | 2,963 | — | 3,760 | — | ||||||||||||
| Operating Expenses | ||||||||||||||||
| Cost of product sales | 325 | — | 371 | — | ||||||||||||
| Research and development, net of tax credits | 3,458 | 3,940 | 10,191 | 12,587 | ||||||||||||
| Selling, general and administrative | 24,232 | 7,889 | 67,543 | 32,296 | ||||||||||||
| Total operating expenses | 28,015 | 11,829 | 78,105 | 44,883 | ||||||||||||
| Loss from operations | (25,052 | ) | (11,829 | ) | (74,345 | ) | (44,883 | ) | ||||||||
| Interest income | 1,438 | 874 | 4,911 | 2,087 | ||||||||||||
| Interest expense | (2,182 | ) | (967 | ) | (11,042 | ) | (2,853 | ) | ||||||||
| Net loss and comprehensive loss | $ | (25,796 | ) | $ | (11,922 | ) | $ | (80,476 | ) | $ | (45,649 | ) | ||||
| Weighted average number of shares and pre-funded warrants outstanding, basic and diluted | 140,910,921 | 96,494,588 | 136,668,430 | 76,497,361 | ||||||||||||
| Net loss per share, basic and diluted | $ | (0.18 | ) | $ | (0.12 | ) | $ | (0.59 | ) | $ | (0.60 | ) | ||||
FAQ
AI-generated questions and answers. How Rhea-AI works. Not financial advice.
How long does Milestone Pharmaceuticals expect its cash to last after the cost reductions?
Milestone expects its cash, cash equivalents and short-term investments to cover operating expenses and capital expenditure into late 2028. That is more than one year beyond prior guidance and extends beyond the anticipated second-half 2028 ReVeRA-301 topline results.
How did CARDAMYST sales perform in Milestone Pharmaceuticals’ third quarter of 2026?
CARDAMYST net product revenue was $963,000 in the third quarter of 2026, up 73% from the second quarter. Nine-month net product revenue totaled $1.760 million. There was no product revenue in either corresponding 2025 period.
What operational changes are included in Milestone Pharmaceuticals’ cost-reduction plan?
Milestone plans to bring its existing field sales team of approximately 45 representatives in-house at lower overhead cost while maintaining coverage. The field force was reduced from approximately 60 representatives in August. The plan also reduces headquarters staffing, internalizes selected outsourced activities and discontinues less productive marketing, market-access and patient-support initiatives.
Who will lead Milestone Pharmaceuticals’ finance function after its CFO departure?
Anthony Krick, Vice President of Finance, has been named Principal Financial and Principal Accounting Officer and will lead the finance function following Amit Hasija’s departure from the leadership team.