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Mirum Pharmaceuticals’s LIVMARLI (maralixibat) oral solution is now available in the US for cholestatic pruritus in patients with PFIC. Credit: Mirum Pharmaceuticals / Business Wire. The US Food and Drug Administration (FDA) has approved Mirum Pharmaceuticals ’s LIVMARLI (maralixibat) oral solution to treat cholestatic pruritus. The medication is intended for patients aged five years and above with progressive familial intrahepatic cholestasis (PFIC). A once-daily, orally administered ileal bile acid transporter inhibitor, LIVMARLI is the sole FDA-approved treatment for PFIC. The approval is based on findings from the Phase III MARCH clinical trial in 93 PFIC patients. The randomised trial enrolled people with PFIC genetic types PFIC1, PFIC2, PFIC3, PFIC4 and PFIC6, along with people with unidentified mutational status. See Also: Terns scores FDA orphan designation for CML therapy FDA issues CRL to Mapi Pharma for GA Depot to treat RMS The FDA, the European Commission and Health Canada have also granted approval for LIVMARLI for the treatment of cholestatic pruritus in patients with Alagille syndrome in their respective regions. In addition to its current approvals, Mirum has filed a supplemental new drug application to the FDA. The aim is to introduce a higher concentration formulation of LIVMARLI, which was utilised in the Phase III MARCH study. This could expand the treatment’s label for younger PFIC patients later in 2024. A rare genetic disorder, PFIC results in progressive liver disease that can go on to cause liver failure. Mirum Pharmaceuticals CEO Chris Peetz stated: “LIVMARLI has the potential to have a transformational impact for patients with cholestatic pruritus associated with PFIC, and importantly, offers an option for those patients with the rarest of subtypes. “Thank you to the patients, families and clinicians whose study participation made this approval possible.” In September 2023, the company concluded the acquisition of the bile acid product portfolio of Travere Therapeutics . Mirum gained the rights and assets related to Cholbam (cholic acid) and Chenodal (chenodiol). Travere secured $210m from Mirum, with the potential to receive $235m in sales-based milestone payments.

- FDA approval based on MARCH Phase 3 study with highly statistically significant (p<0.0001) reduction in pruritus severity between LIVMARLI vs. placebo - Label covers broad range of PFIC subtypes - Immediate launch and availability for eligible patients in the U.S. FOSTER CITY, Calif.--(BUSINESS WIRE)-- Mirum Pharmaceuticals Inc. (NASDAQ: MIRM) today announced that the U.S. Food and Drug Administration (FDA) has approved LIVMARLI® (maralixibat) oral solution for the treatment of cholestatic pruritus in patients five years of age and older with progressive familial intrahepatic cholestasis (PFIC). Mirum has also submitted an additional supplemental new drug application (sNDA) to introduce a higher concentration formulation of LIVMARLI, used during the MARCH study, to enable label expansion for younger patients with PFIC, later this year. This press release features multimedia. View the full release here: LIVMARLI® (maralixibat) oral solution is now available for prescribing in the US for cholestatic pruritus in patients with PFIC. (Photo: Business Wire) LIVMARLI is also approved for the treatment of cholestatic pruritus in patients with Alagille syndrome (ALGS) in the U.S. (three months and older), Europe (two months and older), in Canada and other regions globally. “LIVMARLI has the potential to have a transformational impact for patients with cholestatic pruritus associated with PFIC, and importantly, offers an option for those patients with the rarest of subtypes,” said Chris Peetz, chief executive officer at Mirum. “Thank you to the patients, families, and clinicians whose study participation made this approval possible.” The approval is based on data from the Phase 3 MARCH study, the largest randomized trial conducted in PFIC, with 93 patients across a range of genetic PFIC types, including PFIC1, PFIC2, PFIC3, PFIC4, PFIC6, and unidentified mutational status. “LIVMARLI’s approval in cholestatic pruritus for patients with PFIC is a result of years of investigation and a collection of a strong body of clinical evidence showing meaningful improvements across a number of important parameters, including pruritus, affecting children with PFIC,” said Richard Thompson, professor of molecular hepatology at King’s College London and an investigator in the MARCH study. “I am pleased that we will have a well-studied and efficacious option to offer patients whose life has been disrupted by itch.” “PFIC is a difficult disease for both the patient and family and significantly impedes the quality of life for all,” said Emily Ventura, executive director of the PFIC Network and mom to a daughter with PFIC. “These young and fragile patients endure an itch so severe that they experience deficits in their sleep, nutrition, growth, and, in the past, some have turned to transplant to resolve their itch. We are hopeful that LIVMARLI will have a measurable impact for patients, potentially offering a new normal and relief from the sleepless nights and disruption to their lives caused by cholestatic pruritus.” About PFIC Progressive familial intrahepatic cholestasis (PFIC) is a rare genetic disorder that causes progressive liver disease typically leading to liver failure. In people with PFIC, liver cells are less able to secrete bile. The resulting buildup of bile causes liver disease in affected individuals. Signs and symptoms of PFIC typically begin in infancy. Patients experience severe itching, jaundice, failure to grow at the expected rate (failure to thrive), and an increasing inability of the liver to function (liver failure). The disease is estimated to affect one in every 50,000 to 100,000 births in the United States and Europe. More than six types of PFIC have been genetically identified, all of which are similarly characterized by impaired bile flow and progressive liver disease. About LIVMARLI® (maralixibat) oral solution LIVMARLI® (maralixibat) oral solution is an orally administered, once-daily, ileal bile acid transporter (IBAT) inhibitor and the only approved medication by the U.S. Food and Drug Administration for the treatment of cholestatic pruritus in patients with Alagille syndrome (ALGS) three months of age and older and progressive familial intrahepatic cholestasis (PFIC) five years of age and older. LIVMARLI is also the only approved IBAT inhibitor approved by the European Commission for the treatment of cholestatic pruritus in patients with ALGS two months and older, and by Health Canada for the treatment of cholestatic pruritus in ALGS. For more information for U.S. residents, please visit LIVMARLI.com. Mirum has also submitted LIVMARLI for approval in Europe in PFIC for patients two months of age and older. LIVMARLI has received Breakthrough Therapy designation for ALGS and PFIC type 2 and orphan designation for ALGS and PFIC. To learn more about ongoing clinical trials with LIVMARLI, please visit Mirum’s clinical trials section on the company’s website. IMPORTANT SAFETY INFORMATION Limitation of Use: LIVMARLI is not for use in PFIC type 2 patients who have a severe defect in the bile salt export pump (BSEP) protein. LIVMARLI can cause side effects, including: Liver injury. Changes in certain liver tests are common in patients with Alagille syndrome and PFIC but can worsen during treatment. These changes may be a sign of liver injury. In PFIC, this can be serious or may lead to liver transplant or death. Your healthcare provider should do blood tests and physical exams before starting and during treatment to check your liver function. Tell your healthcare provider right away if you get any signs or symptoms of liver problems, including nausea or vomiting, skin or the white part of the eye turns yellow, dark or brown urine, pain on the right side of the stomach (abdomen), bloating in your stomach area, loss of appetite or bleeding or bruising more easily than normal. Stomach and intestinal (gastrointestinal) problems. LIVMARLI can cause stomach and intestinal problems, including diarrhea and stomach pain. Your healthcare provider may advise you to monitor for new or worsening stomach problems including stomach pain, diarrhea, blood in your stool or vomiting. Tell your healthcare provider right away if you have any of these symptoms more often or more severely than normal for you. A condition called Fat Soluble Vitamin (FSV) Deficiency caused by low levels of certain vitamins (vitamin A, D, E, and K) stored in body fat is common in patients with Alagille syndrome and PFIC but may worsen during treatment. Your healthcare provider should do blood tests before starting and during treatment and may monitor for bone fractures and bleeding which have been reported as common side effects. US Prescribing Information EU SmPC Canadian Product Monograph About Mirum Pharmaceuticals, Inc. Mirum Pharmaceuticals, Inc. is a biopharmaceutical company dedicated to transforming the treatment of rare diseases affecting children and adults. Mirum has three approved medications: LIVMARLI® (maralixibat) oral solution, CHOLBAM® (cholic acid) capsules, and CHENODAL® (chenodiol) tablets. LIVMARLI, an IBAT inhibitor, is approved for the treatment of two rare liver diseases affecting children and adults. It is approved for the treatment of cholestatic pruritus in patients with Alagille syndrome in the U.S. (three months and older), in Europe (two months and older), and in other regions globally. It is also approved in the U.S. in cholestatic pruritus in PFIC patients five years of age and older. Mirum has submitted for approval in Europe for the treatment of PFIC in patients two months of age and older. CHOLBAM is FDA-approved for the treatment of bile acid synthesis disorders due to single enzyme deficiencies and adjunctive treatment of peroxisomal disorders in patients who show signs or symptoms or liver disease. CHENODAL has received medical necessity recognition by the FDA to treat patients with cerebrotendinous xanthomatosis (CTX). Mirum’s late-stage pipeline includes two investigational treatments for debilitating liver diseases. Volixibat, an IBAT inhibitor, is being evaluated in two potentially registrational studies including the Phase 2b VISTAS study for primary sclerosing cholangitis and Phase 2b VANTAGE study for primary biliary cholangitis. Lastly, CHENODAL, has been evaluated in a Phase 3 clinical study, RESTORE, to treat patients with CTX, with positive topline results reported in 2023. To learn more about Mirum, visit mirumpharma.com and follow Mirum on Facebook, LinkedIn, Instagram and Twitter. Forward-Looking Statements Statements contained in this press release regarding matters that are not historical facts are “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995. Such forward-looking statements include statements regarding, among other things, the potential impacts of LIVMARLI in PFIC and for any future label expansion, the additional improvements in disease beyond pruritus, and the ability of LIVMARLI to modify PFIC patient disease experience and the continued commercial success of LIVMARLI across ALGS and PFIC. Because such statements are subject to risks and uncertainties, actual results may differ materially from those expressed or implied by such forward-looking statements. Words such as “will,” “intended,” “potential” and similar expressions are intended to identify forward-looking statements. These forward-looking statements are based upon Mirum’s current expectations and involve assumptions that may never materialize or may prove to be incorrect. Actual results could differ materially from those anticipated in such forward-looking statements as a result of various risks and uncertainties, which include, without limitation, risks and uncertainties associated with Mirum’s business in general, the impact of geopolitical and macroeconomic events , and the other risks described in Mirum’s filings with the Securities and Exchange Commission, including its most recent Annual Report on Form 10-K, as updated by any subsequent Quarter Reports on Form 10-Q. All forward-looking statements contained in this press release speak only as of the date on which they were made and are based on management’s assumptions and estimates as of such date. Mirum undertakes no obligation to update such statements to reflect events that occur or circumstances that exist after the date on which they were made, except as required by law.

Late-breaking poster presentation features LIVMARLI® data showing long-term maintenance of response in patients with PFIC Four poster presentations highlight LIVMARLI PFIC data as well as a poster with proof-of-concept trial data from volixibat study in intrahepatic cholestasis of pregnancy FOSTER CITY, Calif.--(BUSINESS WIRE)-- Mirum Pharmaceuticals, Inc. (NASDAQ: MIRM) today announced new data from its LIVMARLI and volixibat programs presented at The Liver Meeting®, the American Association for the Study of Liver Diseases (AASLD) annual meeting in Boston, Massachusetts. Data were presented from the Phase 3 MARCH study and MARCH-ON extension evaluating the efficacy and safety of LIVMARLI in patients with progressive familial intrahepatic cholestasis (PFIC) as well as the Phase 2 OHANA study evaluating the efficacy and safety of volixibat in patients with intrahepatic cholestasis of pregnancy (ICP). MARCH was the largest and most genetically diverse trial of PFIC to date, enrolling patients with deficiencies of BSEP, FIC1, MDR3, TJP2, AND MYO5B, as well as those clinically diagnosed with PFIC but without a known genetic variant. “PFIC is a chronic, debilitating cholestatic liver disease characterized by elevated bile acids and pruritus so severe that patients can be listed for liver transplant even in the absence of disease progression. We are excited to share the long-term benefits observed across multiple measures including reductions in pruritus, serum bile acids, improved liver health and growth for patients with PFIC treated with maralixibat in multiple genetic types which have not previously been reported,” said Pam Vig, PhD, head of research and development at Mirum. “We are also pleased to share the findings from the OHANA study of volixibat in patients with ICP, showing a clear impact of volixibat on serum bile acids and pruritus in this cholestatic setting.” A summary of these data presented is featured below. Full presentations can be found within the Publications and Presentations section of Mirum’s website. Late-breaker Poster Presentation Poster 5048-C: Long-term maintenance of response and improved liver health with maralixibat in patients with progressive familial intrahepatic cholestasis (PFIC): 2-year data from the MARCH-ON study The MARCH-ON extension study evaluated the long-term efficacy and safety of maralixibat in patients with PFIC who received maralixibat in the original MARCH study for 26 weeks and continued for up to two years and those who were on placebo who went on to receive maralixibat for up to one year. Significant and sustained improvements in pruritus severity, serum bile acid (sBA) levels, total bilirubin, and growth were observed with up to two years of maralixibat treatment across the broadest range of genetic PFIC types studied to date. The placebo-maralixibat group demonstrated rapid (as early as three weeks) and significant improvements in pruritus severity and sBA levels similar to those observed in the original MARCH maralixibat group. No new safety signals were observed. The most common treatment emergent adverse events were GI, occurred early in treatment, and were mild and transient in nature. These data suggest overall improved liver health with maralixibat treatment in patients with PFIC that can be maintained long-term. Other Poster Presentations Poster 4602-C: Improvements in pruritus with maralixibat are associated with improved quality of life for patients with progressive familial intrahepatic cholestasis: Data from the MARCH-PFIC trial Pruritus is known to be one of the most burdensome symptoms of PFIC, occurring in the majority of patients and leading to sleep disturbance, self-mutilation, and decreased school performance, further contributing to impaired quality of life. An exploratory endpoint in the MARCH study was to evaluate if a clinically significant reduction in pruritus following treatment with maralixibat was associated with an improvement in quality of life. These data demonstrated that clinically significant reductions in pruritus were associated with meaningful improvements in quality of life, as evaluated across several domains. The maralixibat group demonstrated significant differences between pruritus responders and non-responders for PedsQL, PedsQL-SF, PedsQL-PF, and a trend toward significance with FI-T. Clinically meaningful improvements (MCID >4-5 points) across all HRQoL scales were experienced by maralixibat responders. The placebo group showed no significant differences between pruritus responders and non-responders in any of the assessments. These data suggest that benefits of maralixibat may extend beyond pruritus and yield meaningful improvements in quality of life as well. Poster 4604-C: Maralixibat leads to significant improvement in cholestatic pruritus for children with progressive familial intrahepatic cholestasis due to TJP2 or MYO5B deficiency: Data from the MARCH-PFIC trial The MARCH study assessed the broadest set of genetic types associated with PFIC. The most common causes of PFIC are deficiencies in BSEP (PFIC2), FIC 1, MDR3, TJP2, and MYO5B. Patients with TJP2 deficiency have a predisposition to developing hepatocellular carcinoma. The goal of this analysis was to understand maralixibat’s potential to provide improvement across key markers of the disease in patients with these two rare genetic variants (TJP2, n=7, MYO5B, n=4). The results demonstrated that all patients with either a TJP2 or MYO5B deficiency receiving maralixibat achieved substantial improvements in pruritus and reductions in sBA while patients who received placebo experienced little benefit. Bilirubin levels were normalized in one participant with MYO5B deficiency who received maralixibat. MARCH is the first trial demonstrating benefit of IBAT inhibition for TJP2 and MYO5B deficiencies and these data support the use of maralixibat in patients with these genetic types. Poster 4605-C: Maralixibat leads to significant improvements in cholestatic pruritus for children with progressive familial intrahepatic cholestasis without a genetic diagnosis: Data from the MARCH-PFIC trial The MARCH study evaluated patients (n=8) with a PFIC clinical diagnosis without an identified genetic variant. The objective of this analysis was to understand the efficacy and safety of maralixibat treatment for patients clinically diagnosed with PFIC but without a known genetic variant. Data demonstrated that maralixibat was associated with improvements in pruritus, sBA levels, total bilirubin, and direct bilirubin, as compared to placebo. No new safety signals were observed. These data demonstrate the utility of treating patients with PFIC but without a known genetic variant with maralixibat. Poster 4547-C: Efficacy, safety and tolerability of volixibat in patients with intrahepatic cholestasis of pregnancy: A case series of 4 patients Intrahepatic cholestasis of pregnancy (ICP) is a cholestatic liver disease impacting pregnant woman. ICP is characterized by elevated sBA and cholestatic pruritus, often impairing sleep and quality of life. Elevated sBAs pose significant risk to the unborn fetus. A Phase 2 open-label study, OHANA, was conducted with volixibat, a minimally absorbed IBAT inhibitor, to evaluate the efficacy and safety in four patients with ICP. Volixibat demonstrated improvements in pruritus and sBA levels, signaling proof of concept for volixibat in cholestatic disease. No clinically meaningful changes in liver enzyme levels or hematology parameters were observed after volixibat treatment. The most common TEAEs were GI in nature, transient and moderate in severity. About LIVMARLI® (maralixibat) oral solution LIVMARLI® (maralixibat) oral solution is an orally administered, once-daily, ileal bile acid transporter (IBAT) inhibitor and the only approved medication by the U.S. Food and Drug Administration for the treatment of cholestatic pruritus in patients with Alagille syndrome (ALGS) three months of age and older. LIVMARLI is also the only approved IBAT inhibitor approved by the European Commission for the treatment of cholestatic pruritus in patients with ALGS two months and older, and by Health Canada for the treatment of cholestatic pruritus in ALGS. For more information for U.S. residents, please visit LIVMARLI.com. Mirum has also submitted LIVMARLI for approval in the U.S. in cholestatic pruritus in PFIC patients three months of age and older, and in Europe, in PFIC for patients two months of age and older. LIVMARLI is currently being evaluated in late-stage clinical studies in other rare cholestatic liver diseases including biliary atresia. LIVMARLI has received Breakthrough Therapy designation for ALGS and PFIC type 2 and orphan designation for ALGS, PFIC and biliary atresia. To learn more about ongoing clinical trials with LIVMARLI, please visit Mirum’s clinical trials section on the company’s website. IMPORTANT SAFETY INFORMATION LIVMARLI can cause side effects, including: Changes in liver tests. Changes in certain liver tests are common in patients with Alagille syndrome and can worsen during treatment with LIVMARLI. These changes may be a sign of liver injury and can be serious. Your healthcare provider should do blood tests before starting and during treatment to check your liver function. Tell your healthcare provider right away if you get any signs or symptoms of liver problems, including nausea or vomiting, skin or the white part of the eye turns yellow, dark or brown urine, pain on the right side of the stomach (abdomen) or loss of appetite. Stomach and intestinal (gastrointestinal) problems. LIVMARLI can cause stomach and intestinal problems, including diarrhea, stomach pain, and vomiting during treatment. Tell your healthcare provider right away if you have any of these symptoms more often or more severely than normal for you. A condition called Fat Soluble Vitamin (FSV) Deficiency is caused by low levels of certain vitamins (vitamin A, D, E, and K) stored in body fat. FSV deficiency is common in patients with Alagille syndrome but may worsen during treatment. Your healthcare provider should do blood tests before starting and during treatment. Other common side effects reported during treatment were gastrointestinal bleeding and bone fractures. US Prescribing Information EU SmPC Canadian Product Monograph About Mirum Pharmaceuticals, Inc. Mirum Pharmaceuticals, Inc. is a biopharmaceutical company dedicated to transforming the treatment of rare diseases affecting children and adults. Mirum has three approved medications: LIVMARLI® (maralixibat) oral solution, Cholbam® (cholic acid) capsules, and Chenodal® (chenodiol) tablets. LIVMARLI, an IBAT inhibitor, is approved for the treatment of cholestatic pruritus in patients with Alagille syndrome in the U.S. (three months and older), in Europe (two months and older), and in Canada. Mirum has also submitted LIVMARLI for approval in the U.S. in cholestatic pruritus in PFIC patients three months of age and older and in Europe in PFIC for patients two months of age and older. Cholbam is FDA-approved for the treatment of bile acid synthesis disorders due to single enzyme defects and adjunctive treatment of peroxisomal disorders in patients who show signs or symptoms or liver disease. Chenodal has received medical necessity recognition by the FDA to treat patients with cerebrotendinous xanthomatosis (CTX). Mirum’s late-stage pipeline includes three investigational treatments for debilitating liver diseases. The LIVMARLI development program includes the Phase 2b EMBARK study for biliary atresia. Mirum’s second investigational IBAT inhibitor is volixibat, which is being evaluated in two potentially registrational studies including the Phase 2b VISTAS study for primary sclerosing cholangitis and Phase 2b VANTAGE study for primary biliary cholangitis. Lastly, Chenodal, has been evaluated in a Phase 3 clinical study, RESTORE, to treat patients with CTX. To learn more about Mirum, visit mirumpharma.com and follow Mirum on Facebook, LinkedIn, Instagram and Twitter. Forward-Looking Statements This press release includes forward-looking statements pertaining to the Company’s planned participation at a scientific conference, including data presentation title and synopsis, which may include discussion of the Company’s clinical and research data, including the therapeutic potential and/or commercial viability of our products and product candidates in various liver disease indications. Because such statements are subject to risks and uncertainties, actual results may differ materially from those expressed or implied by such forward-looking statements. Words such as “will,” “goal,” “potential” and similar expressions are intended to identify forward-looking statements. The accuracy of such statements is subject to a number of risks, uncertainties and assumptions including, but are not limited to, the following factors: the uncertainties inherent in research and development; the uncertainties inherent in business and financial planning, including, without limitation, risks related to Mirum’s business and prospects, adverse developments in our focused markets, or adverse developments in the U.S. or global regulatory environment or economies generally; the continued impact of COVID-19 on our business, operations and financial results; and competitive developments. Other factors that might cause such a difference include those discussed in the Company’s filings with the SEC. All forward-looking statements contained in this press release speak only as of the date on which they were made and are based on management’s assumptions and estimates as of such date. Mirum undertakes no obligation to update such statements to reflect events that occur or circumstances that exist after the date on which they were made, except as required by law. Abbreviations: PedsQL-SF – Social functioning PedsQL-PF – Physical functioning FI-T – Family Impact Total Scale HRQoL – Health Related Quality of Life View source version on businesswire.com: Contacts Media: Erin Murphy 510-508-6521 media@mirumpharma.com Investors: Andrew McKibben ir@mirumpharma.com Sam Martin Argot Partners ir@mirumpharma.com Source: Mirum Pharmaceuticals, Inc. View this news release online at: