aibioOpinion
Desk view by the aibio.space Insmed desk. Updated October 22, 2026.
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Insmed · Opinion
Insmed's launch is working. TPIP is the next test
Brinsupri is on track for more than $1 billion in 2026 sales and losses have nearly closed. The company's $14 billion peak sales claim now rests on a phase 3 program.
The technology
Insmed sells two lung drugs and is testing a third. Brinsupri (brensocatib), approved in the U.S. in August 2025, treats non-cystic fibrosis bronchiectasis, a chronic airway disease. It sold $309.2 million in the second quarter. Arikayce, its older drug for MAC lung disease, sold $116.3 million.
Arikayce has a label expansion in progress. The phase 3b ENCORE trial was positive in March, and Insmed plans a supplemental filing for all patients with MAC lung disease in the second half of 2026. U.S. Arikayce sales grew only 2% in the second quarter, while international sales rose 19%, so the wider label is the product's main route to growth.
The pipeline is led by TPIP, a once-daily dry-powder form of treprostinil for pulmonary arterial hypertension and pulmonary hypertension tied to interstitial lung disease. Twelve-month extension data showed patients walked about 55 meters farther than at baseline and NT-proBNP fell about 60%. Two phase 3 trials, PALM-PAH and PALM-ILD, are enrolling.
The odds
Insmed has already cleared the hardest bar with Brinsupri. The open questions are label growth and TPIP. For TPIP, the right frame is the phase 3 base rate: 57.8% of phase 3 programs reach a filing and 90.6% of filings are approved, according to BIO, Informa and QLS data for 2011 to 2020, which puts the likelihood of approval from phase 3 at 52.4%. TPIP's extension data are open-label, so they say more about durability than about efficacy against placebo.
Brensocatib's record outside bronchiectasis is weak. The phase 2b CEDAR trial in hidradenitis suppurativa failed in April, with both doses doing worse than placebo on abscess and nodule counts, and Insmed ended the program.
The money
Revenue rose 296% to $425.5 million in the second quarter and the net loss fell to $13.2 million. Cash, cash equivalents and marketable securities were about $1.2 billion at June 30. Long-term debt was $543.5 million, and a royalty financing agreement with OrbiMed stood at $159.8 million. Insmed said it has enough money for at least 12 months. Chief executive Will Lewis said the company is positioned to reach cash flow positivity next year.
Guidance is $1.25 billion to $1.40 billion for Brinsupri and $450 million to $470 million for Arikayce in 2026. Insmed projects more than $14 billion in combined peak sales for Brinsupri, TPIP and Arikayce.
The risks
The first risk is concentration in Brinsupri. It is the growth engine, and almost all of its sales are in the U.S. Insmed said international launch timing depends on its evaluation of U.S. policy changes. Four wholesale customers made up 92% of gross product revenue in the first half.
The second is leadership turnover. CFO Sara Bonstein leaves after October 30 and no successor has been named, during the company's push to positive cash flow.
The third is TPIP itself. Its $6 billion peak estimate rests on phase 3 trials that have not read out.
Our read
Insmed's turnaround shows in the numbers. A drug approved 14 months ago is on pace for more than a billion dollars in 2026 sales, and the company is close to breakeven. The next phase is harder to judge. TPIP has good extension data and a large market, but no randomized phase 3 result yet. The October 29 report, the first after the CFO announcement, will show whether Brinsupri's second-quarter jump carried into the third.