Ionis Pharmaceuticals, Inc. earnings

Management highlights

• IONIS entered 2026 with significant momentum, with Tringolza demand accelerating, Donzera early launch metrics tracking well. • Advancing launches of Olazarsen and Zilgenersen, with Olazarsen receiving priority review by FDA and peak sales estimate increased to over $3 billion. • Partner pipeline advancing, including Peperaversin granted breakthrough therapy designation and priority review, and cardiovascular outcome trials on track. • Strong Q1 financial results with revenue growth and disciplined expense management.

Guidance

• Expect total revenue in 2026 range of $875 to $900 million, an increase of $75 million versus prior guidance. • Tringolza product sales expected between $100 and $110 million, Donzera between $110 and $120 million. • Operating expenses to increase in low teen percentage range. • Project non-GAAP operating loss between $425 and $475 million, a $75 million improvement over previous guidance. • Year-end cash balance expected greater than $1.6 billion.

Segment performance

First quarter total revenues were $246 million, an increase of 87% compared to the first quarter of 2025. Commercial revenue increased over 42% year-over-year in the first quarter, driven in large part from Tringolza and Donzera growth. Tringolza delivered over $27 million in product sales, Donzara contributed $16 million in the first quarter, an increase of 125% compared to the prior quarter.

Analyst Q&A

• Q: Jessica Fee asked about increasing peak expectations for Tringolza and gross-to-nets.

  A: Increase based on payer research, price, and priority review; not commenting on gross-to-nets. •

• Q: Mike Holtz asked on Tringolza trajectory.

  A: Strong Q1 demand, modest growth in SHTG launch with focus on high-risk patients. •

• Q: Gary Nachman asked on SHTG payer access and guidelines.

  A: Price change to help payer access, updated guidelines for FCS, education ongoing for less severe patient population. •

• Q: Jason Garbary asked on SHTG liver fat data.

  A: Minor increases in hepatic fat, no clinical sequelae, return to baseline in long-term extension, data to be presented in second half. •

• Q: Ellie Merle asked on SHTG competitor data.

  A: Focus on own phase III data, confident in $3 billion peak. •

• Q: Jay Olson asked on Donzara competitive landscape.

  A: Evolving landscape, positive patient and physician feedback, majority on four-week dosing. •

• Q: Yaron Werber asked on collaborative revenues and Zilgenersen market size.

  A: Collaborative revenue projections, Zilgenersen patient awareness efforts with ~300 patients in US, ~50% identified. •

• Q: Luca Issi asked on Wynua quarter weakness.

  A: January-February reauthorization pressure, pre-filled syringe optionality not impacting gross-to-net. •

• Q: Yanan Tsu asked on FCS growth and SHTG 2027.

  A: Strong FCS demand growth, SHTG launch to grow steadily with focus on high-risk patients initially. •

• Q: Salveen Richter asked on Donzera quarterly dynamics.

  A: Quarter-over-quarter growth from switch cadence, optimistic outlook for 2026. •

• Q: Miles Minter asked on TTR cardiomyopathy market.

  A: Generic entry news consistent with guidance, silencer class expected to be mechanism of choice for TTR amyloidosis.