Ionis (IONS) Q4 FY25 earnings call: guidance and Q&A

Ionis' olezarsen demonstrated groundbreaking Phase III results in severe hypertriglyceridemia (sHTG), achieving up to 72% reduction in triglycerides and an 85% reduction in acute pancreatitis events. This positions olezarsen as the first medicine to show benefit in reducing acute pancreatitis risk, earning it Breakthrough Therapy Designation from the FDA. The sNDA was submitted at the end of 2025, and the company anticipates being launch-ready by June 2026, with an expected approval in Q4 2026 under a standard review assumption. The company has increased its annual peak revenue estimates for olezarsen to over $2 billion, driven by strong product profile and HCP enthusiasm.

Zilganersen, an innovative medicine for Alexander's disease, delivered positive Phase III results in 2025, marking the first time any therapy demonstrated a disease-modifying impact in this ultra-rare neurodegenerative condition. The NDA was submitted in January 2026, with anticipated approval and launch in the second half of 2026. Zilganersen is expected to be Ionis' first independent launch from its neurology franchise, targeting approximately 300 patients in the U.S. and projected to achieve peak revenues greater than $100 million. An expanded access program has been initiated to provide early patient access.

The partnered pipeline is poised for multiple significant events in 2026. Bepirovirsen for chronic hepatitis B showed positive top-line Phase III data in January, demonstrating clinically meaningful functional cure rates, with GSK preparing global regulatory submissions for a potential launch later this year. Key cardiovascular outcome trials, pelacarsen Lp(a) HORIZON and Eplontersen CARDIO-TTRansform, are expected to read out midyear and in H2 2026, respectively. Additionally, sefaxersen for IgA nephropathy and ulefnersen for FUS-ALS are slated for Phase III readouts later in the year, potentially leading to four additional launches by the end of 2027.

TRYNGOLZA had a strong first year on the market, generating $108 million in product sales for FY25, with Q4 sales reaching $50 million, a 56% increase QoQ. Demand remains strong, with no meaningful impact from new market entrants. DAWNZERA, launched in August 2025, showed an encouraging start with $8 million in product sales for FY25 and 100% conversion from its free trial program. Both products are seeing high prescriber and patient satisfaction, though TRYNGOLZA revenues are expected to decline meaningfully in 2026 ahead of the sHTG launch due to payer negotiations.

Ionis reported $944 million in total revenue for 2025, a 34% increase YoY, split between $436 million from commercial products and $508 million from R&D collaborations. For 2026, the company projects adjusted revenue of $800 million to $825 million, representing a 20% increase on a like-for-like basis. Operating expenses are expected to increase in the low-teen percentages, driving improved operating leverage. The company anticipates a non-GAAP operating loss of $500 million to $550 million for 2026, while remaining on track to achieve cash flow breakeven by 2028.

The neurology pipeline continues to advance with Obudanersen for Angelman Syndrome receiving Breakthrough Therapy Designation in late 2025. The Phase III REVEAL study for Obudanersen is expected to achieve full enrollment in 2026, with data anticipated in 2027. Furthermore, ION464 for multiple system atrophy and ION717 for Prion disease are undergoing studies with additional dose cohorts, and data from both programs are now expected in 2027. The company is also making progress on its blood-brain barrier penetrating platforms, with the first VHH BBB molecule in manufacturing and IND-supporting toxicology studies planned for later in 2026.