Ada Cockpit | March 2026
Alnylam Pharmaceuticals is an RNAi therapeutics company with four approved rare disease drugs. This analysis evaluates Patient Finder suitability for each approved drug based on underdiagnosis rates, diagnostic delays, addressable markets, and company motivation.
| Drug | Indication | Tier | Fit Score | Addressable Undiagnosed USA | Ada Revenue Opportunity (5% Capture) |
|---|---|---|---|---|---|
| AMVUTTRA | ATTR-CM (Cardiac Amyloidosis) | 1 | 9/10 | 47,430 | $585M per year |
| GIVLAARI | Acute Hepatic Porphyria | 2 | 7/10 | 726 | $14.6M per year |
| OXLUMO | Primary Hyperoxaluria Type 1 | 2 | 7/10 | 1,870 | $18.2M per year |
| AMVUTTRA | hATTR Polyneuropathy | 3 | 6/10 | 1,805 | $7.7M per year |
| ONPATTRO | hATTR Polyneuropathy | 3 | 2/10 | 250 | $1.2M per year |
PRIORITIZE AMVUTTRA (ATTR-CM) - Tier 1 opportunity with massive underdiagnosis (80-90%), perfect timing (March 2025 launch), and company's #1 strategic priority. Bundle with GIVLAARI and OXLUMO for rare disease diagnostic expansion package.
"Alnylam, you're sitting on a $2.3 billion ATTR-CM franchise, but 80-90% of eligible patients remain undiagnosed. Your March 2025 launch beat guidance by $800M, yet only 1.7% of heart failure patients are even tested for ATTR-CM.
Ada Patient Finder can surface the 47,000 undiagnosed US patients waiting in primary care. Our symptom checker identifies heart failure red flags (carpal tunnel history, spinal stenosis, unexplained HF) and navigates patients to cardiology for PYP scans.
At just 1% capture, that's $117M in annual Patient Finder fees and $1.2 billion in new AMVUTTRA revenue. This isn't marketing spend—it's market expansion that pays for itself.
Your 'Alnylam 2030' strategy needs diagnostic expansion to hit that 25% CAGR. We're the fastest path to those 47,000 US patients and 300,000+ globally. Let's talk."
| Metric | USA | DACH | Rest of World |
|---|---|---|---|
| Total ATTR-CM Patients | 91,260-106,860 | 40,222 | 540,000 |
| Undiagnosed (80%) | 73,008-85,488 | 32,178 | 432,000 |
| Drug-Addressable Undiagnosed | 47,430 | 19,259 | 258,552 |
| Net Revenue Per Patient | $238,000 | $380,800 | $380,800 |
| Patient Finder Fee (10%) | $23,800 | $38,080 | $38,080 |
| Characteristic | Details |
|---|---|
| Primary Symptoms | Heart failure with preserved ejection fraction (HFpEF), dyspnea, fatigue, edema |
| Red Flags | Carpal tunnel syndrome, lumbar spinal stenosis, atrial fibrillation |
| Diagnostic Delay | 1.3 years from HF diagnosis; 3-6 years from symptom onset |
| Underdiagnosis Rate | 80-90% (only 1.7% of HF patients tested) |
| Common Misdiagnoses | Unspecified heart failure (32%), hypertrophic cardiomyopathy, aging-related heart disease |
| Ada Surface Ability | 8/10 - High confidence identification |
| Scenario | USA | DACH | ROW | Total |
|---|---|---|---|---|
| At 1% Capture | $11.3M | $7.3M | $98.5M | $117M/year |
| At 5% Capture | $56.4M | $36.7M | $492.4M | $585M/year |
| Score | Rating | Rationale |
|---|---|---|
| Ada Surface Ability | 8/10 | Clear symptom profile (HF, dyspnea, fatigue), identifiable red flags |
| Company Motivation | 10/10 | Fastest-growing product, just launched, #1 strategic priority, aggressive expansion |
| Overall Fit Score | 9/10 | Massive underdiagnosis, severe delays, huge market, perfect timing |
"GIVLAARI patients wait 15 years on average before diagnosis—longer than any other condition in your portfolio. That's 15 years of unnecessary suffering, ER visits, and misdiagnoses as IBS or endometriosis.
Ada can cut that delay by identifying the 726 undiagnosed US patients with the classic triad: severe episodic abdominal pain + neurologic symptoms + dark urine. We surface them from gastroenterology and primary care, where they're lost in the differential.
At $442K net revenue per patient, even 5% capture adds $14.6M in annual Patient Finder fees and $146M in new GIVLAARI revenue. This is a mature asset with 18% growth—patient finding can unlock the next growth phase.
The 15-year delay isn't a medical problem. It's a patient-finding problem. We solve it."
| Metric | USA | DACH | Rest of World |
|---|---|---|---|
| Total Symptomatic AHP Patients | 3,350 | 951 | 25,000 |
| Undiagnosed (60%) | 2,010 | 571 | 15,000 |
| Drug-Addressable Undiagnosed | 726 | 206 | 5,415 |
| Net Revenue Per Patient | $442,000 | $460,000 | $460,000 |
| Primary Symptoms | Severe episodic abdominal pain (90%), neurologic symptoms, psychiatric manifestations |
| Red Flags | Dark/reddish urine during attacks, women of reproductive age |
| Diagnostic Delay | 15 years average |
| Common Misdiagnoses | IBS, IBD, appendicitis, endometriosis, psychiatric disorders |
| Ada Surface Ability | 7/10 - Distinctive symptom constellation |
| Ada Surface Ability | 7/10 | Severe abdominal pain + neuro + psych is unique pattern |
| Company Motivation | 6/10 | Mature product, steady growth, not top priority but open to expansion |
| Overall Fit Score | 7/10 | 15-year delay, high-value patients, clear symptoms |
"Half of adult PH1 patients reach end-stage kidney failure before diagnosis. That's preventable with early detection—but diagnosis takes up to 30 years.
OXLUMO can preserve kidney function if started early. The problem? 1,870 undiagnosed US patients are waiting in nephrology and urology clinics, misdiagnosed as 'idiopathic kidney stones.'
Ada can identify the high-risk cases: recurrent calcium oxalate stones starting in childhood, family history, normal calcium/uric acid. We surface them before ESRD.
At $375K net revenue per patient, even 5% capture adds $18.2M in annual Patient Finder fees and $182M in new OXLUMO revenue. More importantly, it prevents kidney transplants and saves lives.
Nedosiran is competing for the same patients. First to diagnose wins. Let's talk."
| Metric | USA | DACH | Rest of World |
|---|---|---|---|
| Total PH1 Patients | 4,685 | 509 | 11,800 |
| Undiagnosed (70%) | 3,280 | 356 | 8,260 |
| Drug-Addressable Undiagnosed | 1,870 | 203 | 4,708 |
| Net Revenue Per Patient | $375,000 | $600,000 | $600,000 |
| Primary Symptoms | Recurrent kidney stones (79% of adults), nephrocalcinosis, hematuria |
| Red Flags | Childhood onset, family history, calcium oxalate stones with normal calcium/uric acid |
| Diagnostic Delay | 1.2 years (children) to 30 years (adults) |
| Catastrophic Outcome | 52% at ESRD before diagnosis |
| Ada Surface Ability | 6/10 - Recurrent stones identifiable, ultra-rare differential |
| Ada Surface Ability | 6/10 | Recurrent kidney stones, especially pediatric onset with family history |
| Company Motivation | 6/10 | Mature product, competition from nedosiran, some urgency |
| Overall Fit Score | 7/10 | Catastrophic delays (1-30 years), 52% at ESRD, preventable kidney failure |
Position: Natural complement to ATTR-CM. Lead with ATTR-CM (Tier 1), add hATTR-PN as expansion.
Opportunity: 1,805 addressable undiagnosed US patients, $7.7M at 5% capture.
Challenge: Better diagnosed than ATTR-CM (40% vs 80-90% underdiagnosis), less distinctive symptoms (polyneuropathy vs cardiac).
DO NOT PURSUE - Being actively cannibalized by AMVUTTRA. Revenues down 32% in 2025 (Q4: $32M). Alnylam is transitioning patients to AMVUTTRA (subcutaneous vs IV, better dosing).
Company motivation: 1/10 - Zero appetite for ONPATTRO patient finding. Redirect to AMVUTTRA if approached.
| Tier | Drugs | Addressable Undiagnosed USA | Revenue Opportunity (5% capture) |
|---|---|---|---|
| Tier 1 | AMVUTTRA (ATTR-CM) | 47,430 | $585M/year |
| Tier 2 | GIVLAARI + OXLUMO | 2,596 | $32.8M/year |
| Tier 3 | AMVUTTRA (hATTR-PN) | 1,805 | $7.7M/year |
| TOTAL (excluding ONPATTRO) | 51,831 | $625.5M/year | |
No Phase 3+ candidates as of March 2026. Three early-stage programs in Phase 1/2:
Trial Finder opportunity: ALN-HTT02 (Huntington's Phase 1 enrollment)