Executive Summary
Total Ada Revenue Opportunity (5% Patient Capture, All Markets)
~$10.7M / year
Across Isturisa + Enjaymo + Signifor | USA + DACH + ROW
| Drug |
Condition |
Tier |
Fit Score |
Addressable Undiagnosed (USA) |
Ada Revenue Opp. (5% Capture, USA) |
| Isturisa (osilodrostat) |
Cushing's syndrome |
TIER 1 |
9.2 |
~6,000–8,000 |
$4.35M |
| Enjaymo (sutimlimab) |
Cold Agglutinin Disease |
TIER 1 |
7.8 |
~1,000–1,500 |
$1.19M |
| Signifor LAR (pasireotide) |
Acromegaly / Cushing's |
TIER 2 |
6.5 |
N/A (EU only) |
N/A (DACH+ROW: €1.88M) |
| Carbaglu (carglumic acid) |
NAGS deficiency |
NO |
2.0 |
<50 |
— |
| Cystadrops (cysteamine) |
Cystinosis (ocular) |
NO |
2.5 |
~200–300 |
— |
| Qarziba (dinutuximab beta) |
Neuroblastoma |
NO |
1.5 |
N/A (EU only) |
— |
| Combodart (dutasteride) |
BPH |
NO |
1.0 |
N/A (mass market) |
— |
| Seloken (metoprolol) |
Hypertension |
NO |
1.0 |
N/A (mass market) |
— |
| Zanidip (lercanidipine) |
Hypertension |
NO |
1.0 |
N/A (mass market) |
— |
US Active Patients
>1,200
Section A: Market Numbers
| Market | Total Prevalence | Undiagnosed (est.) | Drug-Addressable Undiagnosed | Net Revenue/Patient | Ada Fee (10%) |
|---|
| USA | 37,100 diagnosed; 70-110K true | 37,000–77,000 | ~6,000 | $145,000 | $14,500 |
| DACH | 2,200–11,100 | 1,300–8,300 | ~1,000 | €90,000 | €9,000 |
| ROW | 13,200–30,000 | 7,300–21,000 | ~3,500 | €85,000 | €8,500 |
Drug-Addressable Funnel (USA)
Total Undiagnosed Cushing's (USA): ~37,000–77,000
↓ Adults only (-5%): 35,150–73,150
↓ Need medical therapy (55–65% post-surgery fail/non-surgical): 19,330–47,550
↓ Isturisa market share (~20–25%): 3,870–11,890
↓ No contraindications (90%): ~3,480–10,700
Conservative midpoint: ~6,000 patients
Competitors
| Company | Drug | Mechanism | Revenue / Share |
|---|
| Corcept Therapeutics | Korlym (mifepristone) | GR antagonist | $761M (FY2025); ~55–60% US share |
| Xeris Pharma | Recorlev (levoketoconazole) | Steroidogenesis inhibitor | ~11.3% market share (7MM) |
| Off-label | Ketoconazole, metyrapone | Various | ~5–10% |
Section B: Clinical & Diagnostic Profile
- Symptoms: Weight gain, moon face, fatigue, mood changes, hypertension, purple striae, easy bruising
- Diagnostic delay: 34–56 months (3.2 yrs US, 4.7 yrs Germany, up to 7 yrs some sources)
- Avg. doctors before diagnosis: 4.6 over 3.8 years
- Common misdiagnoses: Metabolic syndrome, T2 diabetes, depression, PCOS, hypertension
- Ada surface ability: 9/10 — IDEAL. Constellation of common symptoms that individually are dismissed but together are diagnostic. This is exactly what Ada's probabilistic engine is built for.
- Treatment: Chronic (lifelong). First-line medical therapy when surgery fails or is not an option.
Section C: Commercial Signals
- Recordati investing €40–50M/year in US market development for Isturisa alone
- Peak sales target doubled to >€1.2B (Nov 2025) after April 2025 label expansion
- Phase IV study planned for 2026 to expand recognized patient pool (mild hypercortisolemia + hypertension)
- >1,200 net active US patients as of 9M 2025 — actively building patient numbers
- This is Recordati's #1 growth asset and entire growth thesis
Section D: Patient Finder Opportunity
| Scenario | Patients Found | Ada Revenue (USA) |
|---|
| 1% of USA addressable | 60 | $870,000 |
| 5% of USA addressable | 300 | $4,350,000 |
| 10% of USA addressable | 600 | $8,700,000 |
Pitch hook: "Cushing's patients see 4.6 doctors over 3.8 years before diagnosis. Ada finds them in 10 minutes. With your €40–50M annual investment in patient finding, we can deliver diagnosed, treatment-eligible patients at a fraction of the cost per acquisition."
Section A: Market Numbers
| Market | Prevalence | Undiagnosed | Drug-Addressable | Net Revenue/Patient | Ada Fee (10%) |
|---|
| USA | 4,760–10,540 | 1,900–6,300 | ~1,250 | $189,000 | $18,900 |
| DACH | 1,020–2,550 | 510–1,660 | ~350 | €120,000 | €12,000 |
| ROW | 6,000–15,000 | 3,000–9,750 | ~2,000 | €110,000 | €11,000 |
Section B: Clinical Profile
- Symptoms: Anemia (fatigue, pallor), acrocyanosis (blue fingers in cold), dark urine, cold sensitivity
- Diagnostic delay: Median 37 months; symptom onset age ~65, diagnosis age ~72
- Common misdiagnoses: Iron deficiency anemia, warm AIHA, Raynaud's phenomenon
- Ada surface ability: 6/10 — Can detect anemia + cold-triggered symptoms, but constellation is less distinctive than Cushing's
- Only approved targeted therapy for CAD globally
Section D: Patient Finder Opportunity
| Scenario | Patients Found | Ada Revenue (USA) |
|---|
| 1% of USA addressable | 13 | $246,000 |
| 5% of USA addressable | 63 | $1,190,000 |
| 10% of USA addressable | 125 | $2,360,000 |
Pitch hook: "CAD patients wait 3+ years for diagnosis while suffering cold-triggered hemolysis. Ada identifies the anemia-plus-cold-sensitivity pattern that PCPs miss, navigating patients to hematologists who can diagnose and treat with Enjaymo."
Diagnostic Delay
4–10+ yrs
Key Notes
- NOT marketed in USA by Recordati (Novartis retains US rights)
- Second-line therapy for acromegaly (after octreotide/lanreotide failure)
- Acromegaly diagnostic delay of 4–10+ years makes it suitable for Ada's symptom assessment (7/10)
- Company motivation is moderate (5/10) — stable franchise, not a growth priority
- Best positioned as add-on to Isturisa pitch: same endocrinology physician targets
Patient Finder Opportunity (DACH + ROW)
| Scenario | Market | Patients Found | Ada Revenue |
|---|
| 5% of addressable | DACH (~1,000) | 50 | €500,000 |
| 5% of addressable | ROW (~2,750) | 138 | €1,380,000 |
Pitch hook: "Bundle with Isturisa: same endocrinology targets, same Ada assessment flow, incremental acromegaly patients in your EU markets."
Drugs Assessed as NOT SUITABLE
| Drug | Condition | Fit Score | Primary Reason for Exclusion |
|---|
| Carbaglu (carglumic acid) |
NAGS deficiency |
2.0 |
Ultra-rare (<100 cases ever worldwide). Acute neonatal emergency presentation. Hospital-diagnosed. Not amenable to symptom-based finding. |
| Cystadrops (cysteamine) |
Cystinosis (ocular) |
2.5 |
Adjunctive ophthalmic therapy for already-diagnosed patients. ~500 total US cystinosis patients. Diagnosis via systemic renal disease, not eye symptoms. |
| Qarziba (dinutuximab beta) |
Neuroblastoma |
1.5 |
Pediatric cancer diagnosed via standard oncology. EU-only (not marketed in US). Orphan exclusivity expired May 2025. |
| Combodart (dutasteride) |
BPH |
1.0 |
Off-patent. Mass market. Generic competition. No diagnostic delay. No patient-finding logic. |
| Seloken (metoprolol) |
Hypertension |
1.0 |
Off-patent commodity drug. Most prescribed drug class globally. Zero patient-finding need. |
| Zanidip (lercanidipine) |
Hypertension |
1.0 |
Patent expired 2009. 16 years of generic competition. Declining revenue. Legacy product. |
Strategic Recommendations
Pitch Strategy
Lead with Isturisa. This is the perfect Patient Finder case study:
- Massive undiagnosed population (37,000+ in US alone)
- Longest diagnostic delay in rare disease (3–7 years, 56 months in Germany)
- Nonspecific symptoms (weight gain, fatigue, mood) that Ada excels at recognizing in combination
- Highest per-patient drug value ($145K+ net/year)
- Company already spending €40–50M/year to find patients
- CEO-level strategic priority (peak sales doubled to >€1.2B)
Bundle Enjaymo as second opportunity. Newly acquired ($1B+), needs patient ramp, strong orphan exclusivity runway.
Mention Signifor as EU add-on with same physician targets.
Target Contacts
| Priority | Name | Title | Angle |
|---|
| 1 | Scott Pescatore | EVP Rare Diseases BU | Direct P&L owner for Isturisa + Enjaymo |
| 2 | Rob Koremans | CEO | Strategic / board-level decision maker |
| 3 | Gabriele Finzi | EVP Corp Dev & Innovation | Innovation / partnership angle |
Total Revenue Opportunity Summary
| Drug | Markets | 1% Capture | 5% Capture | 10% Capture |
|---|
| Isturisa | USA + DACH + ROW | $1.3M | $6.3M | $12.6M |
| Enjaymo | USA + DACH + ROW | $0.4M | $2.5M | $5.0M |
| Signifor | DACH + ROW (EU only) | $0.2M | $1.9M | $3.8M |
| TOTAL | All markets | $1.9M | $10.7M | $21.4M |