Ionis Pharmaceuticals, Inc.

Ionis reported second-quarter revenue of $268 million and first-half revenue of $514 million, representing year-over-year growth of 56% and 69%, respectively, excluding the $280 million one-time Ono payment received in the first half of last year. Commercial revenue was $119 million in Q2 and $226 million in the first half, while R&D revenue was $149 million in Q2 and $288 million year-to-date. TRYNGOLZA product sales were $5 million in Q2 and $32 million in the first half, reflecting the April 1 WAC price reduction; DAWNZERA product sales were $26 million in Q2 and $42 million in the first half. The company ended Q2 with $2.1 billion in cash, cash equivalents and short-term investments. For 2026, Ionis reiterated revenue guidance of $875 million to $900 million, TRYNGOLZA sales of $100 million to $110 million, DAWNZERA sales of $110 million to $120 million, operating expenses up in the low teens percentage range, R&D expense roughly flat, non-GAAP operating loss of $425 million to $475 million, and year-end cash greater than $1.6 billion.

Brett Monia said Ionis enters the second half of 2026 “well positioned,” pointing to its R&D engine, commercial capabilities, and financial discipline. He emphasized TRYNGOLZA’s landmark FDA approval for severe hypertriglyceridemia, early prescription activity, and his confidence that it can become the first Ionis-owned multibillion-dollar medicine. He also framed DAWNZERA, Zilganersen, and Bepirovirsen as major growth drivers, while acknowledging disappointment with the eplontersen CARDIO-TTRansform result and noting that the team is still analyzing the data.

Beth Hougen said the company delivered strong first-half financial results, with revenue growth supported by commercial medicines and partnered R&D revenue while continuing to invest in growth. She reiterated full-year 2026 revenue guidance of $875 million to $900 million, TRYNGOLZA sales of $100 million to $110 million, DAWNZERA sales of $110 million to $120 million, and a non-GAAP operating loss of $425 million to $475 million. She also said operating expenses should rise in the low teens percentage range versus last year, R&D should be roughly consistent with last year, and Ionis expects to end 2026 with more than $1.6 billion in cash.

Analysts focused heavily on the early TRYNGOLZA launch, asking about the mix of FCS prescribers versus new sHTG prescribers, reimbursement speed, payer handling of >500 versus >880 triglyceride patients, the lack of a dedicated ICD-10 code, and whether the launch would see a pent-up demand burst. Management said early prescribers are often former FCS treaters, coverage is generally matching the label, early approvals are coming through medical exception, and launch uptake should build gradually through the back half of the year into 2027. On the pipeline side, questions addressed the impact of CARDIO-TTRansform on WAINUA and Pelacarsen/HORIZON; management said WAINUA polyneuropathy demand remains strong, the ATTR cardiomyopathy data are still being reviewed with AstraZeneca, and a Pelacarsen miss would not change 2026 guidance but could pressure the 2028 cash flow breakeven goal.