ITRM
Iterum Therapeutics plc
Biotechnology
Market Cap$2M
5Y Perf.-100.0%
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Stock Comparison
ITRM vs VNDA vs NKTR vs ACAD
Revenue, margins, valuation, and 5-year total return — side by side.
VNDA
Vanda Pharmaceuticals Inc.
Biotechnology
Market Cap$378M
5Y Perf.-41.0%
NKTR
Nektar Therapeutics
Biotechnology
Market Cap$1.69B
5Y Perf.-77.9%
ACAD
ACADIA Pharmaceuticals Inc.
Biotechnology
Market Cap$3.86B
5Y Perf.-55.2%
ITRM vs VNDA vs NKTR vs ACAD — Key Financials
Market cap, revenue, margins, and valuation side-by-side.
| Company Snapshot | ITRM | VNDA | NKTR | ACAD |
|---|---|---|---|---|
| Industry | Biotechnology | Biotechnology | Biotechnology | Biotechnology |
| Market Cap | $2M | $378M | $1.69B | $3.86B |
| Revenue (TTM) | $390K | $218M | $55M | $1.10B |
| Net Income (TTM) | $-27M | $-240M | $-164M | $376M |
| Gross Margin | -171.3% | 71.1% | 99.6% | 91.5% |
| Operating Margin | -52.0% | -73.6% | -237.9% | 7.4% |
| Forward P/E | — | — | — | 50.9x |
| Total Debt | $46M | $13M | $149M | $52M |
| Cash & Equiv. | $24M | $85M | $15M | $178M |
ITRM vs VNDA vs NKTR vs ACAD — Long-Term Stock Performance
Price return indexed to 100 at period start. Dividends excluded.
ITRM
VNDA
NKTR
ACAD
| Stock | May 20 | Mar 26 | Return |
|---|---|---|---|
| Iterum Therapeutics… (ITRM) | 100 | 0.0 | -100.0% |
| Vanda Pharmaceutica… (VNDA) | 100 | 59.0 | -41.0% |
| Nektar Therapeutics (NKTR) | 100 | 22.1 | -77.9% |
| ACADIA Pharmaceutic… (ACAD) | 100 | 44.8 | -55.2% |
Price return only. Dividends and distributions are not included.
Quick Verdict: ITRM vs VNDA vs NKTR vs ACAD
Each card shows where this stock fits in a portfolio — not just who wins on paper.
Bottom line: ACAD leads in 2 of 6 categories, making it the strongest pick for profitability and margin quality and operational efficiency and capital deployment. Iterum Therapeutics plc is the stronger pick specifically for growth and revenue expansion. VNDA and NKTR also each lead in at least one category. As sector peers, any of these can serve as alternatives in the same allocation.
ITRM
Iterum Therapeutics plc
The Growth Leader
ITRM is the #2 pick in this set and the best alternative if growth is your priority.
- 14.8% revenue growth vs NKTR's -43.9%
Best for: growth
VNDA
Vanda Pharmaceuticals Inc.
The Income Pick
VNDA is the clearest fit if your priority is income & stability and sleep-well-at-night.
- beta 1.04
- Lower volatility, beta 1.04, Low D/E 3.9%, current ratio 2.39x
- Beta 1.04, current ratio 2.39x
- Beta 1.04 vs NKTR's 1.85, lower leverage
Best for: income & stability and sleep-well-at-night
NKTR
Nektar Therapeutics
The Momentum Pick
NKTR is the clearest fit if your priority is momentum.
- +8.2% vs ITRM's -96.6%
Best for: momentum
ACAD
ACADIA Pharmaceuticals Inc.
The Growth Play
ACAD carries the broadest edge in this set and is the clearest fit for growth exposure and long-term compounding.
- Rev growth 11.9%, EPS growth 68.4%, 3Y rev CAGR 27.5%
- -22.9% 10Y total return vs VNDA's -26.8%
- 34.3% margin vs ITRM's -69.1%
- 26.2% ROA vs ITRM's -74.8%, ROIC 10.0% vs -117.8%
Best for: growth exposure and long-term compounding
See the full category breakdown
| Category | Winner | Why |
|---|---|---|
| Growth | ITRM | 14.8% revenue growth vs NKTR's -43.9% |
| Quality / Margins | ACAD | 34.3% margin vs ITRM's -69.1% |
| Stability / Safety | VNDA | Beta 1.04 vs NKTR's 1.85, lower leverage |
| Dividends | Tie | None of these 4 stocks pay a meaningful dividend |
| Momentum (1Y) | NKTR | +8.2% vs ITRM's -96.6% |
| Efficiency (ROA) | ACAD | 26.2% ROA vs ITRM's -74.8%, ROIC 10.0% vs -117.8% |
ITRM vs VNDA vs NKTR vs ACAD — Revenue Breakdown by Segment
How each company's revenue is distributed across its business units
Segment breakdown not available.
FY 2025
FY 2025
FY 2018
ITRM vs VNDA vs NKTR vs ACAD — Financial Metrics
Side-by-side numbers across 4 stocks — who leads on profitability, valuation, growth, and risk.
BEST OVERALLACADLAGGINGITRM
Who Leads Where
ACAD leads in 2 of 6 categories
VNDA leads 1 • NKTR leads 1 • ITRM leads 0 • 1 tied
Explore the data ↓ITRMIterum Therapeutics p…
0leads
NKTRNektar Therapeutics
1leads
VNDAVanda Pharmaceuticals…
1leads
ACADACADIA Pharmaceutical…
2leads
6 Total Categories
CATEGORYLEADERvs VNDAvs NKTRMETRICS WON
Income & Cash FlowRevenue, margins, and cash flow strength
ACAD4/6
Valuation MetricsMultiples, price ratios, and targets
VNDA2/3
Profitability & EfficiencyROE, ROIC, leverage, and quality scores
ACAD6/9
Total Returns1Y, 3Y, 5Y total returns with dividends
NKTR4/6
Risk & VolatilityBeta, volatility, and downside exposure
Tied
—
Analyst OutlookRatings, price targets, and dividends
—
—
Income & Cash Flow (Last 12 Months)
ACAD leads this category, winning 4 of 6 comparable metrics.
Income & Cash Flow (Last 12 Months)
ACAD is the larger business by revenue, generating $1.1B annually — 2808.3x ITRM's $390,000. ACAD is the more profitable business, keeping 34.3% of every revenue dollar as net income compared to ITRM's -69.1%. On growth, ACAD holds the edge at +9.7% YoY revenue growth, suggesting stronger near-term business momentum.
| Metric | ITRMIterum Therapeuti… | VNDAVanda Pharmaceuti… | NKTRNektar Therapeuti… | ACADACADIA Pharmaceut… |
|---|---|---|---|---|
| RevenueTrailing 12 months | $390,000 | $218M | $55M | $1.1B |
| EBITDAEarnings before interest/tax | -$19M | -$150M | -$130M | $96M |
| Net IncomeAfter-tax profit | -$27M | -$240M | -$164M | $376M |
| Free Cash FlowCash after capex | -$20M | -$127M | -$209M | $212M |
| Gross MarginGross profit ÷ Revenue | -171.3% | +71.1% | +99.6% | +91.5% |
| Operating MarginEBIT ÷ Revenue | -52.0% | -73.6% | -2.4% | +7.4% |
| Net MarginNet income ÷ Revenue | -69.1% | -110.0% | -3.0% | +34.3% |
| FCF MarginFCF ÷ Revenue | -51.1% | -58.5% | -3.8% | +19.4% |
| Rev. Growth (YoY)Latest quarter vs prior year | — | +3.4% | -25.3% | +9.7% |
| EPS Growth (YoY)Latest quarter vs prior year | +33.3% | -64.0% | -4.5% | -81.8% |
ACAD leads this category, winning 4 of 6 comparable metrics.
Valuation Metrics
VNDA leads this category, winning 2 of 3 comparable metrics.
Valuation Metrics
| Metric | ITRMIterum Therapeuti… | VNDAVanda Pharmaceuti… | NKTRNektar Therapeuti… | ACADACADIA Pharmaceut… |
|---|---|---|---|---|
| Market CapShares × price | $2M | $378M | $1.7B | $3.9B |
| Enterprise ValueMkt cap + debt − cash | $23M | $305M | $1.8B | $3.7B |
| Trailing P/EPrice ÷ TTM EPS | -0.02x | -1.71x | -8.57x | 9.85x |
| Forward P/EPrice ÷ next-FY EPS est. | — | — | — | 50.91x |
| PEG RatioP/E ÷ EPS growth rate | — | — | — | — |
| EV / EBITDAEnterprise value multiple | — | — | — | 26.91x |
| Price / SalesMarket cap ÷ Revenue | — | 1.75x | 30.64x | 3.61x |
| Price / BookPrice ÷ Book value/share | — | 1.15x | 15.66x | 3.15x |
| Price / FCFMarket cap ÷ FCF | — | — | — | 36.74x |
VNDA leads this category, winning 2 of 3 comparable metrics.
Profitability & Efficiency
ACAD leads this category, winning 6 of 9 comparable metrics.
Profitability & Efficiency
ACAD delivers a 35.6% return on equity — every $100 of shareholder capital generates $36 in annual profit, vs $-4 for NKTR. VNDA carries lower financial leverage with a 0.04x debt-to-equity ratio, signaling a more conservative balance sheet compared to NKTR's 1.66x. On the Piotroski fundamental quality scale (0–9), ACAD scores 6/9 vs ITRM's 1/9, reflecting solid financial health.
| Metric | ITRMIterum Therapeuti… | VNDAVanda Pharmaceuti… | NKTRNektar Therapeuti… | ACADACADIA Pharmaceut… |
|---|---|---|---|---|
| ROE (TTM)Return on equity | — | -61.4% | -4.0% | +35.6% |
| ROA (TTM)Return on assets | -74.8% | -44.6% | -62.8% | +26.2% |
| ROICReturn on invested capital | -117.8% | -32.2% | -57.2% | +10.0% |
| ROCEReturn on capital employed | -94.1% | -33.6% | -55.7% | +10.1% |
| Piotroski ScoreFundamental quality 0–9 | 1 | 2 | 2 | 6 |
| Debt / EquityFinancial leverage | — | 0.04x | 1.66x | 0.04x |
| Net DebtTotal debt minus cash | $21M | -$72M | $134M | -$126M |
| Cash & Equiv.Liquid assets | $24M | $85M | $15M | $178M |
| Total DebtShort + long-term debt | $46M | $13M | $149M | $52M |
| Interest CoverageEBIT ÷ Interest expense | -10.61x | — | -4.74x | — |
ACAD leads this category, winning 6 of 9 comparable metrics.
Total Returns (Dividends Reinvested)
NKTR leads this category, winning 4 of 6 comparable metrics.
Total Returns (Dividends Reinvested)
A $10,000 investment in ACAD five years ago would be worth $10,710 today (with dividends reinvested), compared to $19 for ITRM. Over the past 12 months, NKTR leads with a +818.2% total return vs ITRM's -96.6%. The 3-year compound annual growth rate (CAGR) favors NKTR at 93.3% vs ITRM's -69.7% — a key indicator of consistent wealth creation.
| Metric | ITRMIterum Therapeuti… | VNDAVanda Pharmaceuti… | NKTRNektar Therapeuti… | ACADACADIA Pharmaceut… |
|---|---|---|---|---|
| YTD ReturnYear-to-date | -90.2% | -22.5% | +92.0% | -13.7% |
| 1-Year ReturnPast 12 months | -96.6% | +45.9% | +818.2% | +52.4% |
| 3-Year ReturnCumulative with dividends | -97.2% | -7.8% | +621.8% | +4.7% |
| 5-Year ReturnCumulative with dividends | -99.8% | -64.2% | -72.3% | +7.1% |
| 10-Year ReturnCumulative with dividends | -100.0% | -26.8% | -59.1% | -22.9% |
| CAGR (3Y)Annualised 3-year return | -69.7% | -2.7% | +93.3% | +1.5% |
NKTR leads this category, winning 4 of 6 comparable metrics.
Risk & Volatility
Evenly matched — VNDA and ACAD each lead in 1 of 2 comparable metrics.
Risk & Volatility
VNDA is the less volatile stock with a 1.04 beta — it tends to amplify market swings less than NKTR's 1.85 beta. A beta below 1.0 means the stock typically moves less than the S&P 500. ACAD currently trades 81.1% from its 52-week high vs ITRM's 2.4% drawdown — a narrower gap to the peak suggests stronger recent price momentum.
| Metric | ITRMIterum Therapeuti… | VNDAVanda Pharmaceuti… | NKTRNektar Therapeuti… | ACADACADIA Pharmaceut… |
|---|---|---|---|---|
| Beta (5Y)Sensitivity to S&P 500 | 1.49x | 1.04x | 1.85x | 1.26x |
| 52-Week HighHighest price in past year | $1.28 | $9.94 | $109.00 | $27.81 |
| 52-Week LowLowest price in past year | $0.03 | $3.81 | $7.99 | $14.45 |
| % of 52W HighCurrent price vs 52-week peak | +2.4% | +64.3% | +76.5% | +81.1% |
| RSI (14)Momentum oscillator 0–100 | 29.6 | 54.9 | 53.4 | 44.2 |
| Avg Volume (50D)Average daily shares traded | 36.8M | 1.6M | 991K | 1.8M |
Evenly matched — VNDA and ACAD each lead in 1 of 2 comparable metrics.
Analyst Outlook
Insufficient data to determine a leader in this category.
Analyst Outlook
Analyst consensus: VNDA as "Buy", NKTR as "Buy", ACAD as "Buy". Consensus price targets imply 121.8% upside for VNDA (target: $14) vs 54.1% for ACAD (target: $35).
| Metric | ITRMIterum Therapeuti… | VNDAVanda Pharmaceuti… | NKTRNektar Therapeuti… | ACADACADIA Pharmaceut… |
|---|---|---|---|---|
| Analyst RatingConsensus buy/hold/sell | — | Buy | Buy | Buy |
| Price TargetConsensus 12-month target | — | $14.17 | $132.83 | $34.78 |
| # AnalystsCovering analysts | — | 19 | 33 | 37 |
| Dividend YieldAnnual dividend ÷ price | — | — | — | — |
| Dividend StreakConsecutive years of raises | — | — | — | — |
| Dividend / ShareAnnual DPS | — | — | — | — |
| Buyback YieldShare repurchases ÷ mkt cap | 0.0% | 0.0% | 0.0% | 0.0% |
Insufficient data to determine a leader in this category.
Key Takeaway
ACAD leads in 2 of 6 categories (Income & Cash Flow, Profitability & Efficiency). VNDA leads in 1 (Valuation Metrics). 1 tied.
Best OverallACADIA Pharmaceuticals Inc. (ACAD)Leads 2 of 6 categories
Loading custom metrics...
ITRM vs VNDA vs NKTR vs ACAD: Key Questions Answered
9 questions · data-driven answers · updated daily
01Is ITRM or VNDA or NKTR or ACAD a better buy right now?
For growth investors, ACADIA Pharmaceuticals Inc.
(ACAD) is the stronger pick with 11. 9% revenue growth year-over-year, versus -43. 9% for Nektar Therapeutics (NKTR). ACADIA Pharmaceuticals Inc. (ACAD) offers the better valuation at 9. 9x trailing P/E (50. 9x forward), making it the more compelling value choice. Analysts rate Vanda Pharmaceuticals Inc. (VNDA) a "Buy" — based on 19 analyst ratings — the highest consensus in this comparison. The "better buy" depends entirely on your goals: growth investors should weight revenue trajectory, value investors should weight P/E and PEG, and income investors should weight dividend yield and streak.
02Which is the better long-term investment — ITRM or VNDA or NKTR or ACAD?
Over the past 5 years, ACADIA Pharmaceuticals Inc.
(ACAD) delivered a total return of +7. 1%, compared to -99. 8% for Iterum Therapeutics plc (ITRM). Over 10 years, the gap is even starker: ACAD returned -22. 9% versus ITRM's -100. 0%. Past returns do not guarantee future results, and the stock with the higher historical return may already have its best growth priced in.
03Which is safer — ITRM or VNDA or NKTR or ACAD?
By beta (market sensitivity over 5 years), Vanda Pharmaceuticals Inc.
(VNDA) is the lower-risk stock at 1. 04β versus Nektar Therapeutics's 1. 85β — meaning NKTR is approximately 78% more volatile than VNDA relative to the S&P 500. On balance sheet safety, Vanda Pharmaceuticals Inc. (VNDA) carries a lower debt/equity ratio of 4% versus 166% for Nektar Therapeutics — giving it more financial flexibility in a downturn.
04Which is growing faster — ITRM or VNDA or NKTR or ACAD?
By revenue growth (latest reported year), ACADIA Pharmaceuticals Inc.
(ACAD) is pulling ahead at 11. 9% versus -43. 9% for Nektar Therapeutics (NKTR). On earnings-per-share growth, the picture is similar: ACADIA Pharmaceuticals Inc. grew EPS 68. 4% year-over-year, compared to -1068. 8% for Vanda Pharmaceuticals Inc.. Over a 3-year CAGR, ACAD leads at 27. 5% annualised revenue growth. Higher growth typically commands a higher valuation multiple — check whether the premium P/E or P/S is justified by the growth rate using the PEG ratio.
05Which has better profit margins — ITRM or VNDA or NKTR or ACAD?
ACADIA Pharmaceuticals Inc.
(ACAD) is the more profitable company, earning 36. 5% net margin versus -69. 1% for Iterum Therapeutics plc — meaning it keeps 36. 5% of every revenue dollar as bottom-line profit. Operating margin tells a similar story: ACAD leads at 9. 8% versus -52. 0% for ITRM. At the gross margin level — before operating expenses — NKTR leads at 100. 0%, reflecting greater pricing power or product mix advantage. Stronger margins indicate durable pricing power, lower cost of revenue, or higher mix of software/services. They are one of the clearest signs of business quality.
06Is ITRM or VNDA or NKTR or ACAD more undervalued right now?
Analyst consensus price targets imply the most upside for VNDA: 121.
8% to $14. 17.
07Which pays a better dividend — ITRM or VNDA or NKTR or ACAD?
None of the stocks in this comparison currently pay a material dividend.
All are effectively zero-yield and should be held for capital appreciation rather than income.
08Is ITRM or VNDA or NKTR or ACAD better for a retirement portfolio?
For long-horizon retirement investors, Vanda Pharmaceuticals Inc.
(VNDA) is the stronger choice — it scores higher on the combination of lower volatility, dividend reliability, and long-term compounding (low volatility (β 1. 04)). Nektar Therapeutics (NKTR) carries a higher beta of 1. 85 — meaning larger drawdowns in market downturns, which matters significantly when you cannot wait years for a recovery. Both have compounded well over 10 years (VNDA: -26. 8%, NKTR: -59. 1%), confirming both are viable long-term holds — but the lower-volatility option typically results in less emotional selling during corrections. Retirement portfolios generally favour predictability over maximum returns. Consult a financial advisor before making allocation decisions.
09What are the main differences between ITRM and VNDA and NKTR and ACAD?
Both stocks operate in the Healthcare sector, making this a peer-level intra-sector comparison — the same macro tailwinds and headwinds will affect both.
In terms of investment character: ITRM is a small-cap quality compounder stock; VNDA is a small-cap quality compounder stock; NKTR is a small-cap quality compounder stock; ACAD is a small-cap deep-value stock. These fundamental differences mean investors should not choose between them on a single metric — the "better stock" depends entirely on which of these characteristics aligns with your investment strategy.
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