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Passionately Committed to Bettering the Lives of Patients with Kidney and Cardiovascular Diseases

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Passionately Committed to Bettering the Lives of Patients with Kidney and Cardiovascular Diseases Passionately committed to bettering the lives of patients with kidney and cardiovascular diseases October 2020 Forward-Looking Statements To the extent that statements contained in this presentation are not descriptions of historical facts regarding Ardelyx, they are forward- looking statements reflecting the current beliefs and expectations of management made pursuant to the safe harbor of the Private Securities Reform Act of 1995, including statements regarding the potential for Ardelyx’s product candidates in treating the diseases and conditions for which they are being developed, the potential for the use of tenapanor as monotherapy and as part of a dual mechanism approach with tenapanor and binders for the control of serum phosphorus in chronic kidney disease (CKD) patients on dialysis, Ardelyx’s expected timing of the acceptance for substantive review by the FDA of the NDA for tenapanor for the control of serum phosphorus in CKD patients on dialysis, and Ardelyx’s expectation regarding the potential approval of such NDA and the expected timing thereof, the commercial potential for Ardelyx’s product candidates, Ardelyx’s expectations regarding the size of the patient populations for its product candidates, Ardelyx’s ability to establish collaborations in the future and Ardelyx’s expectations regarding the exhaustion of its current capital resources. Such forward-looking statements involve substantial risks and uncertainties that could cause the development of Ardelyx’s product candidates or Ardelyx's future results, performance or achievements to differ significantly from those expressed or implied by the forward-looking statements. Such risks and uncertainties include, among others, the uncertainties inherent in research and the clinical development process; the uncertainties associated with the regulatory approval process; and the uncertainties in the drug commercialization process. Ardelyx undertakes no obligation to update or revise any forward-looking statements. For a further description of the risks and uncertainties that could cause actual results to differ from those expressed in these forward-looking statements, as well as risks relating to Ardelyx’s business in general, please refer to Ardelyx’s Quarterly Report on Form 10-Q filed with the Securities and Exchange Commission on August 6, 2020, and its future current and periodic reports to be filed with the Securities and Exchange Commission 2 Translating Scientific Breakthroughs into Promise for Patients We are dedicated to improving the lives of patients by developing and commercializing first-in-class targeted therapies that advance patient care. Our research expertise on biological mechanisms and pathways has enabled us to develop a pipeline of drug candidates designed to address important clinical unmet needs, including better management of complications related to kidney and cardiovascular diseases with the goal of improving outcomes for this large population of underserved patients. Ardelyx Overview • Tenapanor: First-in-class product candidate for the control of serum phosphorus in patients with chronic kidney disease (CKD) on dialysis • Three successful statistically significant Phase 3 studies • NDA Accepted September 2020; PDUFA Goal Date – April 29, 2021 • Large target market • ~2.7M phosphate binder prescriptions written per year in U.S.1 • Accessible with U.S. specialty-focused commercial organization; Ex-US commercialization through select collaborations • IBSRELA® (tenapanor) for IBS-C approved September 2019 • Discovery platform fuels additional pipeline programs • RDX013 is a novel approach for hyperkalemia • Cash of $204.8M2 supports operations into first half of 2022 1. IQVIA 2019 (Retail); Adding estimate for Rxs through dialysis organization specialty pharmacies 4 2. Cash, cash equivalents and short-term investments as of June 30, 2020 Tenapanor for Hyperphosphatemia A first-in-class phosphate absorption inhibitor that provides an innovative and differentiated non-binder approach to phosphorus management - NDA accepted September 2020; PDUFA Goal Date – April 29, 2021 . HYPERPHOSPHATEMIA Phosphate Level is an Independent Predictor of Morbidity and Mortality in Patients on Dialysis1 Serious Potential Consequences From Elevated Phosphorus Increased serum phosphorus RelativeRelative Risk Risk of of Death Death Based on on Serum Serum Phosphorus Phosphorus Level Level levels of 0.5 to 1 mg/dL over 2.5 the reference range resulted Reference range 2.02 in a significant increase in Elevated serum phosphorus level 2 relative risk of death 1.67 1.43 1.5 1.25 1.07 Elevated serum phosphorus also 1 increases the relative risk of hospitalization by up to 38% Relative Risk Deathof 0.5 0 4.0-5.0 5.0-6.0 6.0-7.0 7.0-8.0 8.0-9.0 ≥9.0 Serum Phosphorus Level, mg/dL 1. Block, GA, et al. Mortality, and Morbidity in Maintenance Hemodialysis. J Am Soc Nephrol 15: 2208–2218, 2004 6 2. Increased risk was not diminished by statistical adjustment for coexisting medical conditions, delivered dose of dialysis, nutritional parameters, or markers of noncompliance HYPERPHOSPHATEMIA There is a High Unmet Need for Novel Hyperphosphatemia Treatments Approximately 95% of CKD patients on dialysis need phosphate control1 77% of patients treated with binders Sub-optimal and inconsistent were unable to consistently maintain phosphorus control with phosphorus levels <=5.5 mg/dL phosphate binders over a six-month period2 1. Savica, V Nephrol Dial Transplant 2006 21: 2065-2068 7 2. Spherix RealWorld Dynamix, Dialysis 2019 HYPERPHOSPHATEMIA Inherent Limitations with Phosphate Binder Mechanism of Action BIND DIETARY LIMITED BINDING POOR PHOSPHATE IN THE GUT CAPACITY TOLERABILITY • MOA requires dosing • Number of pills • Constipation with every meal • Size of pills • Bloating • Dosing frequency • Formulation • Nausea • Diarrhea Challenges with Efficacy and Patient Adherence 8 Tenapanor Clinical Development Program HYPERPHOSPHATEMIA Novel Mechanism of Action with Tenapanor Provides a Solution Tenapanor TARGETS BLOCKS DOSED First-in-Class Approach primary pathway of paracellular uptake as one pill twice phosphate absorption of phosphorus* per day† Unlike phosphate binders, tenapanor is a phosphate absorption inhibitor that… * King et al. Inhibition of sodium/hydrogen exchanger 3 in the gastrointestinal tract by tenapanor reduces paracellular phosphate permeability. Sci Transl Med 10, eaam6474. DOI: 10.1126/scitranslmed.aam6467. Accessed on August 29, 2018. 10 † In clinical trials, dosing is 1 pill BID HYPERPHOSPHATEMIA Comprehensive Development Program Supports Tenapanor Opportunity NORMALIZE MONOTHERAPY DUAL MECHANISM MONOTHERAPY targeting normal short-term BENEFIT long-term serum phosphorus Phase 3 BLOCK Phase 3 AMPLIFY Phase 3 PHREEDOM Extension Study NORMALIZE Primary and Secondary Primary and Key Secondary Primary and Key Secondary Initial Analysis Demonstrates Endpoints met Endpoints met Endpoints met Increased % of Patients Achieving Goal Expect FDA approval in Q2 2021 11 HYPERPHOSPHATEMIA BLOCK: Statistically Significant Pivotal Monotherapy Phase 3 Results DESIGN EFFICACY SAFETY 12-week trial to evaluate different Primary endpoint statistically Well tolerated doses of tenapanor, as well as the significant (p<0.01) difference in 8-week open-label treatment period: efficacy, safety and tolerability of least squared mean serum tenapanor monotherapy in patients phosphorus change (0.82 mg/dL) • 39% diarrhea with CKD on dialysis • Only adverse event ≥5% between tenapanor and placebo n=219 • Mostly mild to moderate • Stool form and frequency changes, Secondary analyses: At the end of the 8- Primary Endpoint: Difference in change in on average, remained in normal week open label treatment period, range for healthy individuals serum phosphorus between pooled tenapanor-treated patients in the efficacy • 8% discontinuation due to diarrhea tenapanor-treated patients and placebo- analysis set (n=80) achieved a mean treated patients in the efficacy analysis decrease in serum phosphorus from set from the end of the 8-week treatment baseline of 2.56 mg/dL period to the end of the 4-week randomized withdrawal period 12 Block, GA, et al.. Efficacy and Safety of Tenapanor in Patients with Hyperphosphatemia Receiving Maintenance Hemodialysis: A Randomized Phase 3 Trial. J Am Soc Nephrol 30: 641-652, 2019 HYPERPHOSPHATEMIA AMPLIFY: Statistically Significant Pivotal Phase 3 Results with Tenapanor and Binders DESIGN EFFICACY SAFETY To evaluate tenapanor and Primary endpoint statistically Favorable tolerability phosphate binders (two distinct significant difference in reduction Well tolerated: 4% of patients in MOAs) when used in combination of serum phosphorus levels tenapanor arm discontinued vs. 2% n=235 (p=0.0004) compared to binders in the binder arm Primary Endpoint: Comparison of change alone at week 4 • 43% diarrhea; single adverse from baseline in serum phosphorus at event with a placebo-adjusted week 4 between tenapanor + phosphate ~2 times more patients achieved the rate >3% binder (tenapanor arm) and placebo + serum phosphorus treatment goal of • Mostly mild-to-moderate phosphate binder (binder arm) <5.5 mg/dL with tenapanor and • 3% severe diarrhea phosphate binders vs phosphate • Transient: median resolution binders alone (P≤0.0097) 4 days after onset • Resulted in treatment discontinuations in 3 out of 116 Secondary analyses: Statistically patients significant reduction (p-values≤0.0027) in FGF23 levels 13 HYPERPHOSPHATEMIA PHREEDOM: Statistically Significant Pivotal Long-term Monotherapy
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