The company announced a $350 million public offering on Monday shortly after revealing positive Phase II results for its investigational congenital adrenal hyperplasia drug, with hopes to one day compete with Neurocrine’s Crenessity.
Crinetics Pharmaceuticals’ congenital adrenal hyperplasia drug atumelnant beat Neurocrine’s approved therapy Crenessity in a mid-stage trial, setting the stage for a market battle between the two biotechs.
Striking while the iron is hot, Crinetics moved to raise $350 million in a public offering on the strength of the new Phase II results that were revealed Monday.
Patients with congenital adrenal hyperplasia (CAH), a rare genetic condition of the adrenal glands, produce too many androgens and not enough cortisol. These patients therefore require high doses of glucocorticoid (GC) steroids to replace lost cortisol and reduce androgens. A successful treatment would bring patient steroid needs down to physiological replacement levels.
Crinetics appeared to beat out Crenessity in that metric trial, with 88% of patients who received atumelnant achieving physiologic dose levels after 12 weeks of treatment with atumelnant, an adrenocorticotropic hormone (ACTH) receptor antagonist. Analysts at Truist compared that to 63% of patients in a Phase III trial for Crenessity—but there were caveats.
Participants in Crinetics’ trial were taking a lower dose of steroids than those in Crenessity’s Phase III trial (24 mg versus 32 mg), according to the analysts, “making it inherently easier to reach physiologic thresholds over a 12 week period.”
Crinetics reported that seven out of eight patients (88%) reached reduced steroid usage, but that didn’t include two patients who dropped out of the trial. Including those patients reduces the overall rate to 70%, more in line with Crenessity’s 63% figure. That 20% dropout rate is an “overhang” for Crinetics, according to Truist, compared to the 4% dropout rate in the Crenessity trial.
Nevertheless, Crinetics pounced on the moment, announcing the public offering later on Monday with 7.6 million shares up for grabs, with an option for underwriters to put forward another $52 million for an additional 1.1 million shares.
While Neurocrine has yet to report a full year of sales for Crenessity, the drug earned $14.3 million in the first quarter of 2025, $53 million in the second quarter, and $98 million in the third quarter, totaling $165.3 million. The drug was approved in December 2024.
An October 2025 market research report pegged the size of the CAH market at about $500 million in 2024 and projected that it could grow to north of $1 billion by 2035.
It isn’t yet clear whether Crinetics will be able to dethrone Neurocrine if atumelnant gets to the market, according to Truist.
“Crinetics is several years from potential approval (a 32 wk Ph 3 has only just initiated). We continue to believe [Neurocrine] will have largely penetrated the CAH market by the time atumelnant reaches commercialization, and based on existing evidence, we see little rationale for stable Crenessity patients to switch therapies,” the analysts concluded.
