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Exagen Patient Focused . Discovery Driven . Accelerating personalized medicine in autoimmune disease Q2 2026 UPDATE | AUGUST 4 , 2026
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Disclaimer 2
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Identifying autoimmune disease is a challenge…Ambiguous symptomsManifestations overlap Tests lack specificity, sensitivityOutdated tech, testing delays High rate of misdiagnosis 3 Graphics are not to scale. 1. lupus.org | 2. rheumatoidarthritis.org | 3. Extrapolotion from Dinse GE, Parks CG, Weinberg CR, et al. Increasing Prevalence of Antinuclear Antibodies in the United States. Arthritis Rheumatol. 2022;74(12):2032-2041. doi:10.1002/art.42330. With rheumatoid arthritis2 ~1MAmericans diagnosed with lupus1 ~2M >41MAMERICANS ANA+ ANA+: antinuclear antibody positive, first-line screen for autoimmune disease 3
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4 INCLUDING: Lupus diagnosis can take1558Doctor visits1 Lab procedures1 ~6 years1 Diagnosis is prolonged despite the need for timely intervention… 1. Bruce IN, O’Keeffe AG, Farewell V, et al. Ann RheumDis 2015;74:1706–1713. |2. https://ard.bmj.com/content/74/3/e12 | 3. https://pmc.ncbi.nlm.nih.gov/articles/PMC8281185/# THE PATIENT CHALLENGE Rheumatoid arthritis diagnosis can take~2 years4Different physicians consulted32
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5 Earlier intervention improves outcomes *Early diagnosis is within 6 months of symptoms onset | 1. Lupus Foundation of America UNVEIL Survey 2014 2. Oglesby et aL Appl Health Econ Health Policy 2014 DOI 10.1007/s40258-014-0085-x | 3. https://pmc.ncbi.nlm.nih.gov/articles/PMC3766928/ THE PATIENT CHALLENGE RHEUMATOID ARTHRITIS 25%Reduction in lupus-related hospitalization with earlier treatment1 Reduction in lupus mortality risk related to irreversible organ damage2 1.5xLUPUS Inflammation will lead to articular damage & bone erosion without treatment3 Disease progresses to more severe forms requiring more aggressive therapy3 within first 2 years
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Specific autoantibodies have multiple clinical associations Source: Didier et al. Frontiers in Immunology. 2018. doi:10.3389/fimmu.2018.00541 Conventional biomarkers are not specific to one disease THE CLINICAL CHALLENGE centromereDNA-topoisomerase IRNA-topoisomerase IIITh/To Pm/SclKuSSaRNP nucleosomehistoneACPAdsDNASmC1q ribosomal P SSb ɑ-fodrin NOR90Fc of IgG Systemic sclerosisRheumatoid arthritis Systemic lupus erythematosus Sjogren’s syndromeMyositisSAEMi2NXP2MDA5TIF1-𝛶 DMSRPHMGCRNM Jo1ZOKSHAPL12PL7EJ OJASS CN1aIBM 6 CONVENTIONAL AUTOIMMUNE BIOMARKERS
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OUR PROPRIETARY SOLUTION 7 AVISE Testing: the simple, clear choice for rheumatologists Simple | Proven | Trusted>1.2MAVISE CTD tests completed Rheumatologist 2 tubes of patient’s blood Exagen lab AVISE CTD report•Comprehensive panel aids autoimmune disease diagnosis•Proprietary markers•Algorithmic interpretation with straightforward result
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OUR PROPRIETARY SOLUTION 8 AVISE testing outperforms conventional biomarkers1 14%33%44%66%80% 0% 20% 40% 60% 80% 100% anti-Smithanti-dsDNAC3/C4CB-CAPsMAP Conventional markers Better diagnostic accuracy for the >41M Americans with ANA+2 TEST SENSITIVITY FOR LUPUS 1. Source: Putterman, et al., Lupus Science and Medicine 2014 | 2. Extrapolotion from Dinse GE, Parks CG, Weinberg CR, et al. Increasing Prevalence of Antinuclear Antibodies in the United States. Arthritis Rheumatol. 2022;74(12):2032-2041. doi:10.1002/art.42330. . ®
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Demonstrated clinical benefits at scale ~50,000patient tests analyzed 5.1×more likely to receive SLE DxAVISE+ vs. tANA+ (OR 5.11) 2.8×treatment-effect oddsNew patients started on therapy $985avg. annual lab-cost reductionAVISE-negative vs. tANA-negative WHAT THIS MEANS CLINICALLYDecisive diagnostic actionAVISE-positive results were associated with significantly higher rates of SLE diagnosis and SLE-medication initiation, consistent with shorter time-to-diagnosis. 2Stronger negative predictive valueAVISE-negative patients had a substantially greater decrease in downstream lab testing — supporting confident rule-out and reducing unnecessary work-up. 3Largest comparative dataset in SLE diagnosticsMulti-source design (EHR + Medicare + commercial claims) makes CAPSTONE uniquely robust for payer and academic-center engagement. Peer-reviewed Capstone Publication highlights improvements to patient care 9O’Malley T, Xie F, Su Y, et al.Complement Activation Products vs. Standard ANA Testing: Treatment Outcomes, Diagnosis & Economic Impact (CAPSTONE) in Systemic Lupus Erythematosus.Journal of Managed Care & Specialty Pharmacy. 2022. Published online. Doi: 10.18553/jmcp.2022.22039and PMID: 35775579 9
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Experienced LeadershipTrack records of success in diagnostics Prashanti Reddy, MD Board adds deep industry expertiseTina S. Nova PhD Bruce Robertson, PhD Frank Stokes Hammock Pharmaceuticals Paul Kim Scott Kahn, PhD Chas McKhann Michael Mahler, PhDChief Scientific Officer John AballiChief Executive Officer Jeff BlackChief Financial Officer Medical & Lab Director Prashanti Reddy, MD 10
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Prioritizing objectives to deliver long-term, profitable growth 1ADVANCE ADOPTION•Upgrade & expandsales force•Support science with evidence 2EXPAND ASP 3INNOVATE•Improve RCM & market access•Engage with payers•Invest in high-potential projects•Create new product cadence•Evaluate inorganic opportunities FINANCIAL UPDATE Q2 2026 11
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115 120 125 130 135 140 2022202320242025 VOLUME (IN 000’S) STRATEGIC EMPHASIS ON ASP TOTAL VOLUME•Earning market share with demonstrated clinical differentiation in autoimmune disease testing*•Emphasizing & generating clinical support•Upgrading talent following 2025 territory expansion•Improving team productivity & focus GROWTH DRIVERS ADVANCE ADOPTION1Volume growth has resumed 12. | *Data on file
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13 Singular commitment to autoimmune diagnostic clarity is driving adoptionDIFFERENTIATEDBringing better science, more timely results and unmatched service to the clinicians serving some of medicine’s toughest-to-diagnose patients~3%Estimated $ share*>$2B* ADDRESSING A GROWING OPPORTUNITY ~5%CAGR 2026E to 2033E* *Management estimates, BioSpace and Grandview research. https://www.biospace.com/press-releases/u-s-autoimmune-disease-diagnostics-market-size-to-reach-usd-3-719-mn-by-2034. |. https://www.grandviewresearch.com/industry-analysis/autoimmune-disease-diagnostics-industry 1 13 ADVANCE ADOPTION
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Robust, multi-cohort body of evidence15+peer-reviewed publicationsSpanning 2012–2026 ~50KPatients studied in CAPSTONEReal-world EHR + claims data 3,500+Clinically characterized subjectsMulti-center across U.S. 12+rheumatology practicesIn longitudinal utility studies Anchor publications2014CB-CAPs in SLE — initial validationPutterman et al., Lupus Sci Med — n=794; established 80% sensitivity / 86% specificity2019Probable SLE (pSLE) and prospective utilityFirst randomized multi-center clinical utility trial of a novel SLE biomarker test2020Predicting progression from CTD to SLELiang et al. — AVISE positivity → 10.7-fold OR for confirmed SLE at 2 years at UCLA2021Real-world impact on diagnosis & treatmentLupus Sci Med, 12 practices — increased diagnostic certainty, drove HCQ initiation2022CAPSTONE — largest comparative utility studyO'Malley et al., JMCP — ~50,000 patients, EHR + Medicare + commercial claims2026Systematic analysis of AVISE Lupus evidenceKyttaris et al. Lupus Sci Med - comprehensive Analysis of >1,000 SLE Subjects and >1,500 controls 1ADVANCE ADOPTION 14
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Execution is delivering ASP growth 15 EXPAND ASP2 15 GROWTH DRIVERS REVENUE ($M) TTM $ASP $200 $275 $350 $425 $500 $0 $20 $40 $60 $80 2022202320242025 AVISE CTD TTM ASPREVENUE•Improving RCM•Strategic exit of unprofitable business•Launching new biomarkers•Engaging medical directors and payers with evidence•Expect LCD to contribute when released
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Enhanced AVISE CTD for lupus with T-cell markers*•Improves sensitivity•T-cell autoantibodies rarely present in patients with other autoimmune rheumatic diseases & healthy individuals•Enhances clinician value proposition•Patent protection through 2035•Accretive to gross margin & revenue Strengthened AVISE CTD with additional RA markers*•Anti-RA33 and anti-PAD4 improve sensitivity for Rheumatoid Arthritis •Novel markers for conventionally/ traditionally seronegative RA patients•Unrivaled ability to detect 30% of seronegative RA patients•Accretive to gross margin & revenue AVISE enhancements contribute to ASP 16 + +EXPAND ASP2 16. | *Launched in 2025
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Pipeline prioritizes innovation with impact 17 Lupus Nephritis (urine) AVISE CTD expansions: RA33, T-Cell, PAD4 Assay developed to CLIA standardsAlgorithmic discovery*Clinical validity & utilityDiscover markers ReimbursementCommercialized SLE disease activity RA disease activityMyositis INNOVATE3 |. * Not applicable for every pipeline project Lupus Nephritis (blood) PRIORITY
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18 | *https://pubmed.ncbi.nlm.nih.gov/32414409/ Positioning to advance Myositis testingLaunch of first new standalone product will address channel’s top request >100KARDUOUS, POORLY UNDERSTOOD DISEASEDIAGNOSTIC DILEMMA •Rare, but clinically severe autoimmune disease that can cause chronic interstitial lung disease, muscle inflammation and progressive weakness•Frequent misdiagnosis leads to delayed treatment, irreversible damage •Extends beyond muscles to vital organs of clinicians rely on standard testing to treat patients but lack confidence in the results*80% INNOVATE3 U.S. disease prevalence
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Q2’26 Results Summary KEY METRICSQ2’25Q2’26ChangeRevenue$17.2M$19.9M+16%Volume----+11%TTM ASP$428$446+4%Adjusted EBITDA*($1.7M)($0.1M)+93% 19*Numbers may not foot due to rounding. Reference appendix for non-GAAP and Adjusted EBITDA reconciliations FINANCIAL UPDATE Q2 2026
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Balance Sheet Highlights 20 $37MCash, cash equivalents & AR $10MAvailable debt capital for operating needs $30MAvailable debt capital for strategic opportunities Runway to execute growth strategy and fund business to positive free cash flow * Cash, cash equivalents & AR balance as of June 30, 2026. Available credit as of June 30, 2026, including: (1) $10 millionavailable through September 30, 2026. (2) $30 millionavailable throughMarch 31, 2027, at the discretion of Perceptive for the Company’s business development initiatives. Refer to the Company’s Form 10-K ,filed with the SEC on March 10, 2026, for further information on the credit facility with Perceptive Advisors. Cash, AR, and future credit capacity$77M* FINANCIAL UPDATE Q2 2026
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Increased FY 2026 Revenue Outlook 21. | Guidance as of May 11, 2026. Both volume and ASP contributing to growth $72M $75M•8% to 13% revenue growth YoY•Volume: High-single digit % growth•ASP: Mid-single digit % growth compared to Q4 2025 exit rateto FINANCIAL UPDATE Q2 2026 Increased from $70M to $73M previously
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Appendix Patient Focused. Discovery Driven. 22
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14%33%44%66%80% 0% 20% 40% 60% 80% 100% anti-Smithanti-dsDNAC3/C4CB-CAPsMAP OUR SCIENCE 23 Conventional markers TEST SENSITIVITY FOR LUPUS 1. Source: Putterman, et al., Lupus Science and Medicine2014. AVISE Lupus is a 10 marker sub-component of AVISE CTD including: ANA, anti-dsDNA, anti-Smith, CB-CAPs (EC4d and BC4d), and 5 ENA markers (anti-CCP, anti-SS-B/La, anti-CENP, anti-Scl-70, anti-Jo-1) AVISE lupus outperforms conventional biomarkers® 1 Proprietary markers Demonstrated 80% sensitivity | 98% specificity against healthy individuals SENSITIVITY SENSITIVITY RECEIVER OPERATING CURVE (ROC) FOR SLE DIAGNOSIS1 0 20 40 60 80 100100-SPECIFICITY AUC=overall test performance 23
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24 AVISE CTD test result reportPage 1 includes AVISE Lupus and additional SLE biomarkers including TC4d and autoantibodies to T Cells OUR SCIENCE Pages 2 and 3 contain a comprehensive antibody profile including novel anti-RA33 and anti-PAD4 biomarkersRheumatoid Arthritis BiomarkersValueInterpretationAnti-CCP IgG (ELFA)1.2 U/mLNegativeAnti-PAD4 IgA3.5 U/mLNegativeAnti-PAD4 IgG4.6 U/mLNegativeAnti-RA33 IgG (ELFA)1.5 U/mLNegativeAnti-RA33 IgM (ELFA)2.1 U/mLNegativeAnti-RA33 IgA (ELFA)0.8 U/mLNegativeRheumatoid Factor IgM (ELFA)<0.6 IU/mLNegativeRheumatoid Factor IgA (ELFA)0.9 IU/mLNegativeSjögren’s Disease BiomarkersValueInterpretationAnti-SSA/Ro52 IgG (ELFA)0.5 U/mLNegativeAnti-SSA/Ro60 IgG (ELFA)<0.4 U/mLNegativeAnti-SSB/La IgG (ELFA)0.8 U/mLNegativeMixed Connective Tissue Disease BiomarkersValueInterpretation+ Anti-U1RNP IgG (ELFA)22.8 U/mLPOSITIVEAnti-RNP70 IgG (ELFA)0.3 U/mLNegative Systemic Sclerosis BiomarkersValueInterpretationAnti-Scl-70 IgG (ELFA)<0.6 U/mLNegativeAnti-RNA Pol III IgG (ELFA)<0.7 U/mLNegativeAnti-Centromere Protein B (CENP) IgG (ELFA)0.7 U/mLNegative Myositis BiomarkersValueInterpretationAnti-Jo-1 IgG (ELFA)<0.3 U/mLNegative Thyroid BiomarkersValueInterpretationAnti-Thyroglobulin IgG (ELFA)<12 IU/mLNegativeAnti-Thyroid Peroxidase IgG (ELFA)<4 IU/mLNegative Anti-Histone and anti-CarP available by request Lupus Index Score Biomarkers Value Interpretation Reference Range T-Cell Biomarkers Value Interpretation Reference Range ANA (immunofluorescence) Value Interpretation Reference Range Page 1 Pages 2 and 324
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•AVISE: cell-bound complement activation product for diagnosing SLE - 2032•AVISE : treating & diagnosing likelihood of SLE - 2034•Lupus nephritis biomarkers - 2045•Use of T-cell autoantibodies + CB-CAPs in diagnosis of SLE - 2035•Method of estimating binding of a potential therapeutic antibody directed against a B lymphocyte antigen using CB-CAPs - 2036 Extensive, long-term I.P. protection 25 165Patents issued* 10 US, 6 OUSPatents pending* Patent Families |. *As of August 202625 OUR SCIENCE
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Financial impact of progress 26 Positioning organization for profitable long-term growth Revenue growth5%20%Volume growth(1%)11%TTM $ASP$344$441Gross margin %54%58%Adj. EBITDA margin %(46%)(15%)Balance sheet<2-year cash runwayBusiness funded to positive FCF •RCM: Expanding ASP•Sales force: Restructured, now expanding•Organization: Upgraded talent + culture•R&D: Refocused pipeline to emphasize high-demand, high-impact programs•Operations: Right-sized to reduce expenses & cash burn•Balance sheet: Secured capital to support path to cash flow positivity 2022 to 2024AVERAGE2025WHAT WE’VE DONE: |. *Reference appendix for non-GAAP and Adjusted EBITDA reconciliations
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Path to Breakeven AEBITDA & Cash GenerationExpect inflection at FY revenue of ~$80M and ~63% gross margin $50 $60 $70 $80 $90 $100 40%45%50%55%60%65%70%75% ($M)GROSS MARGIN OPEX REVENUETOTAL COSTS 63% $80M 27|. *Reference appendix for non-GAAP and Adjusted EBITDA reconciliations
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Use of Non-GAAP Financial Measures 28 UNAUDITED
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Cap TableAS OF AUGUST 2026 24.2M LOANWARRANTSPrincipalStatusSharesStatusTranche A*$25MDrawn400,000ExercisedTranche B^ $10MUndrawn150,000UnissuedTranche D^ $30MUndrawn450,000Unissued * In Nov 2025, Perceptive exercised all 400,000 Tranch A shares on a cashless basis and XGN issued a total of 173,220 shares of the common stock to Perceptive^ Exercise price for Tranche B and D warrants: 50% priced at 10-day VWAP and 50% priced at 12.5% premium to 10-day VWAP
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Reconciliation of Non-GAAP Financial MeasuresThis table presents the reconciliation of adjusted EBITDA, which is a non-GAAP financial measure. See previous slide for further information regarding the Company’s use of non-GAAP financial measures. 30 UNAUDITED