TENX · Tenax Therapeutics
Conviction · Low · more likely to lag the S&P 500 over the next three months
Wrong if: a daily close above $2.32
Note written ·
Price against the kill line
30.2% clear of its kill line on the 13 November 2026 close.
How to read this
This note expects the shares to lag the market, so its kill line sits above the price: a close above the red mark would prove the view wrong. Prices run from low on the left to high on the right. The dot is where the stock closed on 13 November 2026, left of the mark while it is below the line; a dot right of the mark has closed through it.
The scale is stretched near the line, so close calls are easy to see. More than 8% from the line, the stock reads well clear, with a hollow dot to show the figure is off the drawn scale.
The kill line is the research note's own test. The portfolio sells on business facts, not on a price. How the portfolio decides
Three months against the kill line
Daily closes, to . Red: the kill line, a daily close above $2.32, on record since 11 November 2026. The shares are down 5.3% since the close; the S&P 500 is down 2.1% over the same sessions. Figures in the note can cover a different window.
Kill line
A daily close above $2.32, the highest close of the last 63 sessions (25 August 2026), which would show the shares leading the S&P 500. An FDA agreement on the enriched LEVEL-2 population would also point the same way.
Research onlyNot in the portfolio.
Catalyst
Key figures from the filings · Health Care
Quarter to 30 September 2026, filed 5 November 2026
- Revenue, latest quarter ($M)
- 0.0
- Net cash, cash less debt ($M)
- 114
All filed numbers
What Tenax Therapeutics reports to the SEC in its quarterly and annual filings. Each group states its period and filing date once; a figure dated otherwise says so. Built from the filings known on .
| Quarter to | Revenue ($M) | On a year (%) |
|---|---|---|
| first filed | 0.0 | — |
| first filed | 0.0 | — |
| first filed | 0.0 | — |
| first filed | 0.0 | — |
| first filed | 0.0 | — |
| first filed | 0.0 | — |
| Pre-tax income ($M) | Not reported |
| Net income ($M) four quarters: −65.8 | −16.7 |
| Diluted shares, change on a year (%) against the quarter to 30 September 2025 | +34.5 |
| Operating cash flow ($M) | −49.4 |
| Capital spending ($M) | Not reported |
| Free cash flow ($M) | Not available |
| Cash and short-term investments ($M) | 114 |
| Debt ($M) | None reported |
| Net cash, cash less debt ($M) no debt reported | 114 |
| Deferred revenue ($M) | Not reported |
| Backlog, orders not yet delivered ($M) | Not reported |
| Receivables ($M) | Not reported |
| Inventory ($M) | Not reported |
| Shareholders' equity ($M) | 109 |
| Market value ($M) | 73.8 |
| Enterprise value, market value plus net debt ($M) no debt reported | −39.9 |
| Enterprise value to sales (×) | Not available |
| Enterprise value to operating income (×) | Not meaningful |
| Price to earnings (×) | Not meaningful |
| Price to book value (×) | 0.7 |
| Free-cash-flow yield (%) | Not available |
Short interest (FINRA, settled 15 October 2026, published 26 October 2026): 15.9% of shares outstanding sold short, 3.2 days of average trading to cover, +0.7% since the previous report.
| Window | Bought | Sold |
|---|---|---|
| 90 daysfrom | $6.4M | $0 |
| 12 monthsfrom | $6.6M | $0 |
The thesis
Tenax Therapeutics is more likely to lag the S&P 500 over the next three months. Its recovery case needs the US Food and Drug Administration (FDA) to accept a narrower, enriched LEVEL-2 trial of TNX-103 (oral levosimendan) after the first LEVEL trial failed, and the FDA's response at the Type C meeting it has granted settles the case. The company has given no date for that meeting. Its next guided disclosure is a development update in the first quarter of 2027.
The shares closed at $1.61 on 12 November 2026, down from $1.78 on 9 November 2026 and $1.69 on 11 November 2026 (adjusted daily closes). The three-month price change is −10.6%. The price already reflects the failed primary result: the 52-week intraday high is $19.40, set on 9 July 2026, and the last close is 91.7% below it.
LEVEL showed a 3.5-metre placebo-adjusted difference in six-minute walk distance, p=0.63 (Tenax, 10 August 2026). The 26.3-metre gain in the below-median subgroup carries a nominal p-value of 0.0112 and was chosen after the primary result failed.
Tenax reported a third-quarter net loss of $0.31 per share on 5 November 2026. News reports put the analyst estimate at a $0.40 loss. Cash was $113.7 million at 30 September 2026, which Tenax says funds operations through fiscal 2028, subject to the meeting outcome.
Bullish and bearish views on Tenax Therapeutics, Inc.
The bull case on Tenax Therapeutics, Inc. (TENX), in brief: the FDA meeting is granted. The bear case: the full trial failed.
Bull case
- The FDA meeting is granted. Tenax's 5 November 2026 release says it was granted a Type C meeting, a formal FDA discussion, on the overall development of levosimendan. Tenax says the FDA previously agreed that one Phase 3 trial with a p-value of 0.01 could support a marketing application. Agreement on the enriched population, if disclosed, would support the LEVEL-2 design.
- The enrichment is specific. The revised LEVEL-2 population is patients with a baseline six-minute walk distance of 100 to 300 metres, or 301 to 400 metres with a right atrial volume index of at least 25 mL/m² (Tenax, 5 November 2026). Tenax reports a 34-metre improvement in the 301–400 metre, high-volume subgroup, nominal p=0.001, chosen after the primary result failed.
- Cash covers the plan. Cash and equivalents were $113.7 million at 30 September 2026, up from $97.6 million at 31 December 2025 (Tenax third-quarter release). Third-quarter cash use was $4.3 million.
- Insiders and a large holder bought after the failure. Director Declan Doogan bought 53,000 shares at $1.92 on 16 September 2026, and the chief executive and chief financial officer also made open-market purchases on 11 September to 15 September 2026 (SEC Form 4 filings). ADAR1 Capital Management, a 10% owner, bought 922,849 shares at an average of $1.59 on 19 October to 21 October 2026 (SEC Form 4).
- Biomarkers moved the same way. Tenax reports that NT-proBNP, a heart-strain blood marker, fell 49% more than placebo in LEVEL. These were exploratory measures.
Bear case
- The full trial failed. LEVEL missed its primary and key secondary objectives (Tenax, 10 August 2026). The subgroup result does not offset the overall result.
- The enrichment rests on a post-hoc subgroup. The original cut-off was a baseline walk distance below 333 metres, and the new criteria differ from it. Whether the FDA accepts that population is undisclosed.
- The pause delays the trial. Enrollment is paused while sites adopt the amendment, and Tenax says its operating plan is subject to change pending the meeting outcome. The next update is guided for the first quarter of 2027.
- Spending is rising. Third-quarter research and development was $12.1 million, up from $10.3 million a year earlier. Nine-month research and development was $36.5 million, up from $22.1 million.
- A securities lawsuit is pending. Katz v. Tenax Therapeutics, filed 26 October 2026 in the Middle District of North Carolina, covers purchasers from 13 November 2023 to 7 August 2026 (Open Class Actions). The allegations are unproven.
- Analyst targets are stale. Canaccord Genuity's $35 target (28 July 2026) and Evercore ISI's $39 target (22 July 2026) predate the 10 August 2026 result. No later revisions appear in company news.
Price setup
The shares closed at $1.61 on 12 November 2026. That is below the 50-day average of $1.80 and far below the 200-day average of $9.46, which still carries the pre-failure prices of July. Both averages are from adjusted daily closes as of 12 November 2026.
The 52-week closing low is $1.36, set on 16 October 2026. Closes since the 5 November 2026 report have run from $1.61 to $1.78. The 3-month reference close of $1.80 was set on 14 August 2026.
Tenax had 45,536,448 shares outstanding at 30 September 2026, against 9,314,130 at 31 December 2025 (company release). The count rose roughly fivefold during 2026.
No earnings date falls in the next 30 days. Form 4 filings through 21 October 2026 show only insider and 10% owner purchases, with no sales.
Catalysts ahead
- Undated (no date announced): FDA Type C meeting on levosimendan development, granted per the 5 November 2026 release. The FDA's view on the enriched LEVEL-2 population decides whether the regulatory case holds.
- 28 December 2026: Lead-plaintiff deadline in the securities class action Katz v. Tenax Therapeutics. It marks a procedural step in the lawsuit, which alleges misleading statements about TNX-103; the allegations are unproven.
- First quarter of 2027 (company guidance): LEVEL-2 protocol design paper and development update. It would give the final enrichment criteria and any enrollment restart date.
What would change the view
A daily close above $2.32, the highest close of the last 63 sessions (25 August 2026), which would show the shares leading the S&P 500. An FDA agreement on the enriched LEVEL-2 population would also point the same way.
What it trades with
Tenax trades on its own regulatory outcome rather than on sector direction. Single-asset, clinical-stage biotech names react to the same funding and risk-appetite conditions, but the FDA's view of TNX-103 is specific to this company. Cash of $113.7 million at 30 September 2026 lowers near-term financing pressure compared with peers that must raise capital after a failed trial.
The evidence, claim by claim (8)
- Cash and equivalents were $113.7 million at 30 September 2026, against $97.6 million at 31 December 2025; Tenax says current funding lasts through fiscal 2028. Tenax third-quarter 2026 results release · as of
- Third-quarter net loss was $16.7 million ($0.31 per share), against $15.8 million a year earlier; research and development was $12.1 million, up from $10.3 million. Tenax third-quarter 2026 results release · as of
- Tenax was granted a Type C meeting with the FDA on levosimendan development in pulmonary hypertension with preserved ejection fraction heart failure; no date or outcome was given. Tenax third-quarter 2026 results release · as of
- The revised LEVEL-2 population is patients with baseline six-minute walk distance of 100 to 300 metres, or 301 to 400 metres with a right atrial volume index of at least 25 mL/m². Enrollment is paused while sites adopt the amendment. Tenax third-quarter 2026 results release · as of
- LEVEL's placebo-adjusted six-minute walk difference was 3.5 metres, p=0.63, missing the primary endpoint. Tenax Phase 3 LEVEL topline release · as of
- ADAR1 Capital Management, a 10% owner, bought 922,849 shares at an average of $1.59 on 19 October to 21 October 2026. SEC Form 4 filed 21 October 2026 · as of
- Katz v. Tenax Therapeutics (No. 1:26-cv-01264, Middle District of North Carolina) covers purchasers from 13 November 2023 to 7 August 2026; the lead-plaintiff deadline is 28 December 2026. Open Class Actions case summary · as of
- TENX closed at $1.61, 91.7% below its $19.40 intraday 52-week high of 9 July 2026; the 52-week closing low is $1.36 (16 October 2026). Adjusted daily closes · as of
Sources
- Tenax Therapeutics Reports Third Quarter 2026 Financial Results and Provides Corporate Update · investors.tenaxthera.com
- Tenax Therapeutics Reports Third Quarter 2026 Financial Results and Provides Corporate Update · globenewswire.com ·
- Securities · Lawsuit Filed · openclassactions.com
- One To Watch · thepharmaletter.com
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