Royalty Pharma struck a major royalty acquisition tied to Neurimmune’s cliramitug, paying $125 million upfront plus $125 million due in Q1 2027 and up to $175 million in milestone cash depending on clinical and regulatory outcomes. The deal gives Royalty Pharma a royalty of 3% to 4% on worldwide net sales of cliramitug. Cliramitug is a first-in-class TTR-fibril-depleting antibody intended to clear amyloid deposits already present in the heart in patients with transthyretin amyloidosis with cardiomyopathy (ATTR-CM). It is designed to differ from approved therapies that primarily slow new ATTR accumulation. The antibody is in Phase III DepleTTR-CM (NCT06183931), with results expected in 2028. AstraZeneca has previously outlined peak sales expectations of $3 billion to $5 billion at an investor day, underscoring the commercial stakes for the asset. The transaction also signals continuing institutional appetite for late-stage royalties in fast-expanding specialty indications, including ATTR-CM’s reported market growth of more than 40% in 2025 to past $7 billion.