Milestone Pharmaceuticals plans 30% expense cut to extend cash runway
September liquidity of US$145.4 million is forecast to last into late 2028, beyond the expected ReVeRA-301 trial readout.
Adrian Kessler
An operating-expense reduction of about 30 per cent is planned as Milestone Pharmaceuticals Inc. NASDAQMIST outlined restructuring measures on Friday to fund its next pivotal heart-rhythm readout. Management expects its Sept. 30, 2026, liquidity of US$145.4 million to last into late 2028.
The Nov. 13 plan carries approximately US$2 million in one-time charges, with the cuts due to finish in the first quarter of 2027. Topline results from the ReVeRA-301 trial in atrial fibrillation with rapid ventricular rate, or AFib-RVR, are expected in the second half of 2028.
Milestone is a small commercial-stage cardiovascular drug developer based in Montreal and Charlotte, North Carolina.
Shares closed at US$0.66 on Nasdaq at 4:00 p.m. EST on Nov. 12, 2026 NASDAQMIST, before Friday's announcement. The revised funding horizon extends more than a year beyond the company's previous guidance.
Launch Costs Outpace Product Sales
CARDAMYST nasal spray generated US$1 million in product revenue for the quarter ended Sept. 30, 2026, against none a year earlier. Net loss widened to US$25.8 million from US$11.9 million.
Selling, general and administrative expense reached US$24.2 million for the quarter ended Sept. 30, 2026, compared with US$7.9 million a year earlier. Research and development expense, net of tax credits, was US$3.5 million, down from US$3.9 million.
Those two expense categories totalled US$27.7 million for the quarter ended Sept. 30, 2026. The release's cost-reduction section gives no dollar baseline for the 30 per cent target, so that total cannot be treated as a promised savings base.
Milestone attributes the increase in selling and administrative spending to personnel, professional services and other CARDAMYST launch costs. The FDA-approved spray converts acute symptomatic episodes of paroxysmal supraventricular tachycardia, or PSVT, to normal sinus rhythm in adults.
In its Nov. 13 update, Milestone reported approximately 3,400 prescriptions written by about 1,600 unique prescribers since launch. Payer coverage had reached approximately two-thirds of commercially covered lives.
The plan retains approximately 45 dedicated sales representatives while converting them from contractors to employees to lower overhead. That follows an August reduction from approximately 60 representatives, concentrating coverage on the strongest-performing territories and prescribers.
Marketing and patient-support spending will focus on the most productive programs, while selected outsourced functions move inside the company. Headquarters staffing is being reduced and certain manufacturing scale-up work deferred, while Milestone says the AFib-RVR trial remains fully funded.
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Cash Forecast Extends Beyond Trial Data
"[W]e expect these measures to extend our cash runway beyond the anticipated Phase 3 readout of ReVeRA-301 in the second half of 2028," Milestone chief executive Joseph Oliveto said in the release.
Milestone also extended the payment-in-kind interest period on its convertible notes to March 2029 from March 31, 2027. Paying interest through additional debt preserves cash while increasing the obligation.
The late-2028 runway remains management's forecast for covering operating expenses and capital expenditure. It depends on the restructuring delivering savings while the commercial launch and trial continue.
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In its Oct. 9 trial update, Milestone described ReVeRA-301 as a randomized, double-blind study targeting approximately 150 treated AFib-RVR events. It compares etripamil with placebo, with reduction in ventricular rate within 30 minutes as the primary endpoint.
In its Nov. 13 update, Milestone estimated a U.S. addressable AFib-RVR population of 3 million to 4 million patients. That is roughly three to four times its estimated PSVT population.
Patients self-administer a 70 mg repeat-dose regimen outside a medically supervised setting. Symptom improvement reported by patients is a key secondary endpoint; the existing PSVT approval does not cover this proposed AFib-RVR use.
Milestone's Nov. 13 financial-results call precedes the first-quarter 2027 restructuring deadline. ReVeRA-301's second-half 2028 readout will test whether etripamil slows ventricular rate against placebo in AFib-RVR.
