Exagen (XGN) Stock: Why It Fell 26% After Earnings

Quick answer

Exagen traded at $5.24 at 1:02pm ET on Nov 10, 2026, down 26.2% from a $7.10 close, after a third-quarter report that missed on the bottom line and a filing to sell more stock. The loss was $0.25 a share against an average estimate of $0.18. Revenue rose 7% to $18.4 million, just above the $18.3 million estimate, but test volume for its main AVISE CTD test grew only about 2% from a year earlier, down from 11% in the second quarter. Two hours after the results, Exagen filed an S-3 to register up to $150 million of securities, including a $50 million at-the-market offering with TD Cowen. At $5.24 that program equals about 37% of the company's market value. The stock touched $4.62 at 11:25am.

Our view: Bearish through December 15, 2026, when Exagen hosts a webcast on its myositis test and pipeline. The case for the stock: revenue still beat, guidance of $72 million to $75 million held, trailing twelve-month selling price per test rose for a 14th straight quarter to $451, nine-month operating cash use fell to $9.0 million from $10.6 million, and the shares trade at 1.8 times sales. The case against carries more weight into December. Volume growth fell from 11% to about 2% in one quarter, which is the number that drives a lab's revenue. The adjusted EBITDA loss widened to $1.9 million from $0.1 million in the second quarter while operating expenses rose 15.7%. And the company already sold 1.01 million shares at $6.58 in the third quarter, so a new $50 million program is likely to be used once the shelf is effective, adding supply at lower prices. We would move off Bearish if Exagen says in a later filing that it has not sold stock under the new program or raises money on better terms, if management reports before or at the Dec 15 webcast that fourth-quarter volume growth is back near the 8% nine-month pace, or if the shares close above the $7.10 Nov 9 close in a later session. This is a view on direction over that window, not a recommendation to trade the stock.

Exagen daily closing price from Sep 28 to Nov 10, 2026, with the Oct 29 high close, the Nov 6 drop and the Nov 10 fall marked

Key takeaways

Exagen traded at $5.24 at 1:02pm ET on Nov 10, 2026, down 26.2% from a $7.10 close, after a third-quarter loss of $0.25 a share against an average estimate of $0.18 and a new at-the-market program to sell up to $50 million of stock.
Revenue rose 7% to $18.4 million, slightly above the $18.3 million estimate, but AVISE CTD test volume grew about 2% from a year earlier, after 11% growth in the second quarter.
The company kept 2026 revenue guidance at $72 million to $75 million, which implies fourth-quarter revenue of $16.3 million to $19.3 million, against $18.4 million in the third quarter and $19.9 million in the second.
The $50 million program equals about 37% of the company's market value at $5.24. Exagen already sold 1.01 million shares at an average $6.58 in the third quarter under its previous program.
Our view is Bearish through December 15, 2026, the date of its myositis webcast: slower volume growth, a wider adjusted EBITDA loss and a share sale program that can be used at any time weigh more than a low sales multiple.

Table of contents

Nov 10, 2026: a narrow beat, slower volume and a new share program
The numbers
The bull case
The risks
What comes next

Exagen released results at 7:30am ET and held its call at 8:00am. Premarket trading started at $6.55, reached $7.25 at 7:39am, then fell to $5.99 by 8:02am, during the call. It was $6.16 just before the open. The stock opened at $6.00, slid to $5.00 by 9:55am and hit its low of $4.62 at 11:25am, 35.0% below the prior close. The S-3 with the share sale program reached the SEC at 9:33am. By 1:02pm the shares had recovered to $5.24 on about 1.3 million shares.

What happened:

A wider loss than expected. The net loss was $6.3 million, or $0.25 a share, against an average estimate of $0.18. That was better than the $0.31 loss a year earlier, but operating expenses rose to $15.2 million from $13.2 million, including a $0.6 million in-process research charge for an AI rheumatology workflow software purchase.
Volume growth slowed. AVISE CTD tests delivered rose about 2% from a year earlier, against about 8% for the first nine months and 11% in the second quarter.
Revenue fell from the second quarter. Third-quarter revenue of $18.4 million compared with a record $19.9 million in the second quarter.
A new share sale program. The $50 million at-the-market agreement with TD Cowen, signed Nov 9, pays a 3.0% commission. Sales can begin once the new shelf registration is declared effective.

The stock was already volatile before the report. It fell 10.7% on Nov 5 and 23.6% on Nov 6 with no company filing on either day, then rose 22.2% on Nov 9. From its $8.51 close on Nov 4 it has lost 38.4%.

Exagen fell far more than other diagnostics labs. From the Nov 9 close to about 1pm ET:

Stock or fund	Nov 9 close	Nov 10, about 1pm	Change
Exagen (XGN)	$7.10	$5.24	-26.2%
Veracyte (VCYT)	$25.92	$24.09	-7.1%
CareDx (CDNA)	$84.42	$80.60	-4.5%
Castle Biosciences (CSTL)	$34.38	$33.83	-1.6%
Quest Diagnostics (DGX)	$259.67	$258.14	-0.6%
Health Care Select Sector fund (XLV)	$188.33	$187.96	-0.2%
Labcorp (LH)	$371.83	$371.36	-0.1%

After the drop, RSI(14) stood at 33, the shares sat 34.0% below their 50-day average and 1.6% above their 200-day average, 49.4% below their 52-week high of $10.27, and volume was already 3.1 times its 20-day average.

The numbers

Bar chart of Exagen quarterly revenue: $17.2 million in Q3 2025, $17.3 million in Q1 2026, $19.9 million in Q2 2026, $18.4 million in Q3 2026 and an implied $17.8 million midpoint for Q4 2026

Revenue. $18.4 million, up 7% from $17.2 million. Pharma services revenue was $0.9 million.
Pricing. Trailing twelve-month ASP for AVISE CTD was $451 per test, up $10 from a year earlier.
Margins. Gross margin was 58.8%, against 58.4% a year earlier and 61.3% in the second quarter.
Losses. Adjusted EBITDA was a loss of $1.9 million, flat with a year earlier but wider than the $0.1 million loss in the second quarter.
Balance sheet. $28.1 million of cash at Sep 30, up from $24.6 million at June 30 because of about $6.4 million of net proceeds from stock sales. The Perceptive term loan was carried at $22.1 million and charged 11.75%.
Guidance. With $55.7 million of revenue through nine months, the $72 million to $75 million range implies $16.3 million to $19.3 million in the fourth quarter. The $17.8 million midpoint would be below the third quarter. Analysts expected $73.9 million for the year, Dow Jones reported.

When a company keeps its guidance after a strong first half, the market reads the unchanged range as a slower second half, and that is what the third-quarter volume figure showed.

The bull case

Exagen still beat on revenue, kept its full-year range and raised its price per test again. Chief executive John Aballi said the quarter "extends what is fast becoming a record year" and that test volume and ASP were "both ahead of the same period last year." The company plans to launch a myositis test early in 2027 and presented nine abstracts at the American College of Rheumatology meeting. Eight analysts rate the shares a buy and none a hold or sell, with a median target of $11.00, Reuters reported. At 1.8 times sales and with management saying cash covers at least twelve months, a steadier fourth quarter could pull the stock back. Our page on why Veracyte fell covers another diagnostics company that reset expectations this month.

The risks

Dilution. At $5.24, $50 million buys about 9.5 million shares, against 25.5 million outstanding on Nov 3. Our explainer on dilution shows how a larger share count lowers each holder's claim.
Volume. A 2% quarter after 11% raises the question of whether sales force expansion and new biomarkers are still adding tests.
Cash and debt. Operating cash use was $9.0 million in nine months, and the term loan costs 11.75%. Our guide on estimating cash runway walks through the math.
Reimbursement. Medicare coverage for AVISE Lupus under its own billing code is not settled, and the company keeps submitting claims and appealing denials, the 10-Q says.

What comes next

The S-3 needs to become effective before any shares are sold under the new program. Exagen hosts its myositis webcast on Dec 15, 2026 at 12:00pm ET, and fourth-quarter results will show whether volume growth recovered. For the rest of the session's movers, see today's biggest stock moves.

Frequently asked questions

Why did Exagen stock fall today?

Exagen traded at $5.24 at 1:02pm ET on Nov 10, 2026, down 26.2% from a $7.10 close. Its third-quarter loss of $0.25 a share was wider than the $0.18 analysts expected, test volume grew only about 2% from a year earlier, and an S-3 filed at 9:33am ET registered up to $150 million of securities, including a $50 million at-the-market stock sale program with TD Cowen.

Did Exagen beat revenue estimates?

Narrowly. Revenue was $18.4 million, up 7% from $17.2 million a year earlier, against an average estimate of $18.3 million. It was down from $19.9 million in the second quarter.

What is Exagen's 2026 revenue guidance?

Exagen kept its 2026 revenue guidance at $72 million to $75 million, the range it set in August when it raised it from $70 million to $73 million. Analysts expected $73.9 million, Dow Jones reported. With $55.7 million booked through Sep 30, the range implies fourth-quarter revenue of $16.3 million to $19.3 million.

What is Exagen's at-the-market offering?

On Nov 9, 2026 Exagen signed a sales agreement with TD Cowen to sell up to $50 million of common stock from time to time at market prices, for a 3.0% commission. It cannot sell under the program until the new S-3 registration statement becomes effective. The S-3 covers up to $150 million of securities in total.

How much cash does Exagen have?

Exagen had $28.1 million of cash and cash equivalents at Sep 30, 2026, after about $6.4 million of net proceeds from stock sales in the quarter. It owed a term loan carried at $22.1 million that charged 11.75% interest at Sep 30 and matures in April 2030. Management says its cash and expected revenue will fund operations for at least twelve months.

What is Exagen's next catalyst?

Exagen will host a webcast on its myositis test and pipeline on Dec 15, 2026 at 12:00pm ET, and it plans to launch the myositis offering early in 2027. Fourth-quarter results would follow after year-end.

Sources

Article details

By James Whitfield, Head of Equity Research, Dombey Capital

Published November 10, 2026 · 6 min read · Event-Driven Investing