Executive Summary / Key Takeaways

• Neumora Therapeutics is pioneering a precision neuroscience approach to address the global brain disease crisis with a pipeline of seven novel mechanism programs, including two in clinical development.
• Despite a setback in the KOASTAL-1 study for its lead candidate, navacaprant in MDD, the company has implemented significant operational modifications to the ongoing KOASTAL-2 and KOASTAL-3 trials, aiming to optimize patient enrollment and study execution.
• Upcoming clinical catalysts include topline data from the modified KOASTAL-3 study in Q1 2026, KOASTAL-2 in Q2 2026, and data from the NMRA-511 Phase 1b signal-seeking study in AD agitation around the end of 2025, alongside advancing an M4 PAM candidate into the clinic by mid-2025.
• A recently secured $125 million debt facility, with $20 million funded at close, significantly strengthens the company's financial position, extending the cash runway into 2027, well beyond these anticipated clinical milestones.
• The company's competitive positioning hinges on its differentiated technology and targeted approach in underserved neuropsychiatric and neurodegenerative niches, contrasting with larger competitors' broader scale and established product portfolios.

A New Chapter in Neuroscience: Neumora's Quest for Precision

Neumora Therapeutics, founded in November 2019, embarked on a mission to fundamentally change how treatments for brain diseases are developed. The company aims to confront the global brain disease crisis, a challenge affecting over 1.5 billion people and representing a significant area of unmet medical need despite substantial R&D investment in the field. Neumora's strategy centers on building an industry-leading pipeline targeting novel mechanisms of action across a range of neuropsychiatric and neurodegenerative disorders, underpinned by a precision neuroscience approach.

The competitive landscape in neuroscience is intense, populated by large biopharmaceutical companies like Biogen (BIIB) and Eli Lilly (LLY) with vast resources and established market presence, as well as more focused players like Acadia Pharmaceuticals (ACAD) and Alkermes (ALKS). These competitors bring scale, manufacturing capabilities, and existing product portfolios to the market. Neumora differentiates itself by focusing on novel targets and leveraging its technological platform to identify specific patient populations, aiming for potentially more effective and better-tolerated therapies compared to existing standards of care or competitors' approaches. While larger rivals may have superior financial health and broader market reach, Neumora seeks to carve out value in specific, underserved niches through targeted innovation and potentially faster development cycles for its early-stage assets.

At the core of Neumora's strategy is its precision neuroscience approach. This involves an integrated suite of translational, clinical, and computational tools designed to generate insights for drug target identification, patient stratification, and objective clinical trial endpoints. The platform interrogates diverse datasets, including genetic, imaging, electroencephalogram (EEG), digital, and clinical data. The stated goal is to reduce the time and increase the likelihood of success in drug discovery and development compared to traditional paradigms. While specific quantifiable performance metrics for this platform's impact on R&D efficiency or success rates were not detailed, the company highlights its importance in identifying biomarker-target relationships and enriching patient populations in clinical trials. The success of this approach is dependent on access to additional multimodal patient datasets, advancements in machine learning capabilities, and computational infrastructure.

Pipeline Evolution and Clinical Catalysts

Neumora's pipeline currently comprises seven neuroscience programs. The most advanced is navacaprant (NMRA-140), a novel once-daily oral kappa opioid receptor (KOR) antagonist being developed as a monotherapy for moderate to severe major depressive disorder (MDD). The rationale for targeting the KOR pathway is supported by independent clinical studies suggesting its potential benefit in MDD and anhedonia. Neumora's own Phase 2 study of navacaprant demonstrated statistically significant and clinically meaningful reductions in symptoms of depression and anhedonia in patients with moderate to severe MDD, with a favorable tolerability profile lacking side effects common to standard treatments like weight gain or sexual dysfunction. The 80mg dose was selected based on a PET study showing approximately 90% receptor occupancy throughout the dosing period.

The pivotal Phase 3 KOASTAL program for navacaprant consists of three replicate randomized, placebo-controlled, double-blind studies. However, the initial KOASTAL-1 study did not meet its primary or key secondary endpoints. Following this setback, Neumora conducted extensive analysis, concluding that the KOASTAL-1 population was not fully representative of a typical MDD population, citing factors such as a high percentage of antidepressant-naive patients and variability in site performance, particularly impacting male patients who showed a high placebo response. In response, the company paused enrollment in KOASTAL-2 and KOASTAL-3 and implemented significant operational modifications. These changes include enhanced medical monitoring with the independent MGH SAFER approach to verify diagnoses, utilizing the Verified Clinical Trial screening database to exclude patients in multiple trials, and refining site selection to focus on experienced centers. Enrollment in the modified studies resumed in March 2025. Management anticipates topline data from KOASTAL-3 in the first quarter of 2026 and from KOASTAL-2 in the second quarter of 2026. As part of a strategic prioritization, the Phase 2 study of navacaprant in bipolar depression was discontinued to focus resources on the KOASTAL program and other clinical assets.

Beyond navacaprant, Neumora is advancing NMRA-511, a highly selective vasopressin 1a receptor (V1aR) antagonist, in a Phase 1b signal-seeking study for agitation associated with dementia due to Alzheimer's disease (AD). Preclinical data for NMRA-511 showed reductions in measures of anxiety, agitation, and aggression and it was well tolerated in Phase 1 studies in healthy volunteers. The V1aR target is a proven pathway implicated in aggression and anxiety. This program addresses a significant unmet need, as the only currently approved agent for AD agitation carries a black box warning. The Phase 1b study is designed to evaluate safety, efficacy, tolerability, and PK, with the primary endpoint being the change from baseline on the Cohen-Mansfield Agitation Inventory (CMAI) at week eight. Data from this signal-seeking study are expected around the end of 2025 and will inform the design of future trials.

Neumora is also progressing its M4 positive allosteric modulator (PAM) franchise, with plans to move a candidate into the clinic by mid-2025. The company believes the M4 receptor is the primary driver of antipsychotic activity seen with muscarinic drugs and is engineering its compounds for high blood-brain barrier penetration to potentially offer improved safety, tolerability, and once-daily dosing compared to other muscarinic approaches. While NMRA-266, an earlier M4 candidate, is on clinical hold, the company has confidence in its follow-on compounds within this franchise.

The preclinical pipeline includes four programs targeting novel mechanisms for conditions such as Parkinson's disease, Alzheimer's disease, and ALS. The NLRP3 program, focused on targeting the NLRP3 inflammasome for neurodegenerative conditions, recently triggered a second tranche of funding from Parkinson's Research Ventures upon successful drug candidate nomination. Updates on these earlier-stage programs are expected in the future.

Financial Position and Outlook

Neumora has incurred significant net losses and negative cash flows from operations since its inception, reflecting its status as a clinical-stage biopharmaceutical company focused on R&D. For the three months ended March 31, 2025, the net loss was $68.0 million, compared to $53.7 million for the same period in 2024. This increase was primarily driven by higher operating expenses, which rose to $70.9 million from $60.1 million year-over-year. Research and development expenses increased by 14% to $52.2 million, largely due to the final costs incurred under the Amgen (AMGN) Collaboration Agreement ($6.3 million) and increased personnel costs ($1.5 million), partially offset by a decrease in direct external program expenses for preclinical research. General and administrative expenses increased by 31% to $18.8 million, mainly due to higher personnel-related costs, including severance and bonus payments, and increased stock-based compensation. Interest income decreased to $3.1 million from $6.4 million due to lower cash and marketable securities balances.

As of March 31, 2025, Neumora held $249.4 million in cash, cash equivalents, and marketable securities. Net cash used in operating activities for the first quarter of 2025 was $59.4 million, primarily driven by the net loss and changes in working capital. Investing activities provided $44.2 million, mainly from maturities of marketable securities offsetting purchases. Recognizing the need for additional capital to fund its extensive pipeline and potential commercialization efforts, Neumora entered into a loan and security agreement with K2 HealthVentures on May 9, 2025. This facility provides up to $125.0 million in term loans across four tranches, with $20.0 million funded at closing and an option for an additional $20.0 million by the end of 2025. The term loan matures in May 2029 and bears a variable interest rate. This non-dilutive financing, combined with existing cash resources, is expected to extend the company's cash runway into 2027, providing financial flexibility to reach key clinical milestones. The company will require further funding to fully execute its long-term business plan.

Risks and Challenges

Investing in Neumora involves significant risks inherent in clinical-stage biopharmaceutical companies. The most immediate risk is the outcome of the modified Phase 3 KOASTAL-2 and KOASTAL-3 studies for navacaprant, particularly given the unexpected results from KOASTAL-1. While the company has implemented changes to address potential factors contributing to the KOASTAL-1 outcome, there is no guarantee these modifications will ensure success in the subsequent trials. Clinical trials are inherently unpredictable, and delays, failures, or unexpected safety findings can occur.

Regulatory approval processes are lengthy, costly, and uncertain, and there is no assurance that any of Neumora's product candidates will receive marketing approval. The company relies heavily on third parties for manufacturing, preclinical studies, and clinical trial execution, introducing risks related to quality control, timelines, and compliance. Protecting intellectual property is critical, and the company faces risks related to obtaining and maintaining patent protection, potential infringement claims, and reliance on licensed intellectual property from third parties. The competitive landscape is intense, and larger competitors may have advantages in resources and market access. Unstable market and economic conditions could also impact the company's ability to raise future capital on favorable terms.

Conclusion

Neumora Therapeutics is pursuing a bold strategy to address the significant unmet needs in brain diseases through a pipeline of novel therapeutic candidates and a precision neuroscience approach. While the KOASTAL-1 setback for its lead program, navacaprant, highlights the inherent risks in drug development, the company has demonstrated a commitment to data-driven decision-making by implementing operational changes to the ongoing Phase 3 studies. Upcoming clinical data readouts for navacaprant and NMRA-511, along with the advancement of the M4 PAM franchise, represent critical catalysts for the company. The recent debt financing significantly bolsters Neumora's financial position, providing a longer runway to achieve these milestones. The investment thesis for Neumora hinges on the successful execution of its modified clinical trials, the validation of its precision neuroscience approach, and the potential of its novel mechanisms to offer differentiated treatment options in competitive markets. Investors will be closely watching the results from the KOASTAL-2 and KOASTAL-3 studies and the NMRA-511 data as key indicators of the company's ability to translate its innovative approach into clinical success and ultimately deliver value.