Ionis Pharmaceuticals at Bank of America Conference: Strategic Growth Insights

On Wednesday, 14 May 2025, Ionis Pharmaceuticals (NASDAQ:IONS) presented at the Bank of America 2025 Health Care Conference, highlighting its strategic growth initiatives. The company showcased its transition into a commercial-stage biotech entity with recent product launches and an optimistic outlook on its pipeline developments. While the tone was generally positive, the potential challenges of market expansion and the European approval process were also discussed.

Key Takeaways

• Ionis successfully launched Tringolza for familial chylomicronemia syndrome (FCS), marking a key milestone in its commercial journey.
• The company anticipates becoming cash flow positive soon, driven by its robust pipeline and partner programs.
• Four Phase III readouts and product launches are expected within the next three years.
• Ionis is targeting significant market expansion through healthcare provider (HCP) education and strategic patient identification.
• The European approval process for FCS and the ongoing partnership with Novartis for pelacarsen were key discussion points.

Financial Results

• Q1 Launch Data for Tringolza: Ionis expressed satisfaction with the independent launch of Tringolza for FCS, noting a diverse prescriber base of cardiologists and endocrinologists.
• Future Revenue Growth: The company is optimistic about substantial and sustained revenue growth in the near term.
• Cash Flow Positive Outlook: Ionis anticipates achieving a cash flow positive status soon, bolstered by its wholly-owned pipeline.

Operational Updates

• Tringolza Launch: The launch has been well-received, with effective coverage through the medical exception process.
• Donidalorsen Launch: Approval for donidalorsen in hereditary angioedema is anticipated in August, with a PDUFA date of August 21.
• Ozarsan Data: Ionis expects data from the ESSENCE safety study this quarter and pivotal studies next quarter for ozarsan in severe hypertriglyceridemia (SHTG).
• Alexander Disease Program: Phase III data for this rare leukodystrophy program is expected by the end of the year.
• European Approval: Approval for FCS in Europe is expected this year, with Sovi as the commercial partner for OUS commercialization.
• Pelacarsen: Novartis has shared promising baseline data, with expectations of significant Lp(a) reductions.

Future Outlook

• Pipeline Readouts: Ionis is set for four Phase III readouts and launches over the next three years from its wholly-owned pipeline.
• SHTG Commercialization: Initial commercialization of ozarsan will target patients with triglycerides above 500 mg/dL and a history of acute pancreatitis.
• Market Expansion: Plans are in place to expand the SHTG market through HCP education and potential post-marketing studies.
• Pelacarsen Data: Landmark results from the Horizon Phase III study are anticipated in the first half of next year.

Q&A Highlights

• FCS Launch Dynamics: Ionis is pleased with the patient demographics, including those genetically confirmed and clinically diagnosed.
• SHTG Clinical Benefit: The goal is a substantial triglyceride reduction, aiming for a 50% decrease.
• Acute Pancreatitis Data: Efforts are underway to enhance the power of adverse event data.
• SHTG Pricing Strategy: A tentative price range of $15,000 to $20,000 for SHTG treatment is being considered.
• Pelacarsen Trial Enrichment: Trials are enriched for success, with inclusion criteria set at 70 mg/dL for Lp(a).

In conclusion, Ionis Pharmaceuticals is strategically positioned for growth with its robust pipeline and commercialization efforts. For further details, readers are encouraged to refer to the full conference call transcript.

Full transcript - Bank of America 2025 Health Care Conference:

Jason Gerber, Analyst, BofA: I can introduce our next company presenter at the BofA Annual Healthcare Conference. Pleased to be introducing Ionis and CEO, Brett Monea. I’m Jason Gerber. I cover Smith Camp Biotech at BofA. And Ionis has been at the forefront of developing therapies, RNA targeted therapies with this ASO platform and expanding into other modalities earlier stage, which we might get into as well.

But Brett, I don’t know, coming out of the quarter and the year, maybe, you know, we did a dinner last night and a lot of focus is on your APOC3 targeted program, which is more near term, but you have a lot going on both this year and next year. So I don’t know. One of the challenges with Ionis is you have a lot of programs, and you gotta hone people in and focus them in. And so where would you focus us in as we start our conversation? I imagine I know where it’s gonna go, but I I figured it’s good for the group to to hear it.

Brett Monea, CEO, Ionis: Yeah. Sure. First of all, thank you for the invitation, Jason. It’s a pleasure to be here. Let me start here.

We’re really proud and excited about all of the recent success that we’ve had, over the recent past. We’ve had a lot of positive pipeline news and and now a successful independent launch. You know, Trangolza is a very important, success for for Ionis. It represents our, our commitment and now, achievement to, evolve Ionis into a commercial stage fully, integrated biotech company. And, and we’re really we’re really, encouraged by the Q1 launch data so far for Tringolsan in familial chylomicronemia syndrome, FCS, the first and only treatment that’s now available for this devastating severe rare disease indication.

Things are going very well there, we’re looking forward to the rest of the year for Trigol’s and FCS. And right behind Trigol’s is our second independent anticipated launch down at Doloresin for hereditary angioedema. We’re looking forward to a expected approval in August of this year with a PDUFA date of August 21, and we’re ready to go. We also are looking forward to independent pipeline of additional phase three data this year. The second indication for tringolzar, ozarsan, the generic name, for severe hypertriglyceridemia, a very large, highly prevalent population of patients with high unmet need, again, to severely elevated triglycerides.

We’re expecting data, this quarter for the safety SM study, and next quarter for the, pivotal study, COR and COR two. We’re also expecting phase three data for our wholly owned Alexander disease program towards the end of this year, a severe rare leukodystrophy that there are no treatment options available. And then, of course, we have a rich pipeline of partner programs. We’re expecting, four phase three readouts and launches over the next three years from our wholly owned pipeline with substantial economics, towards coming to Ionis if they’re successful. And all of this, is setting us up for substantial and sustained revenue growth and for and for positive cash flow being becoming positive cash flow, in the relative near term.

So things are really looking really positive at Ionis. We’re really looking forward, to the future.

Jason Gerber, Analyst, BofA: Got it. Okay. I probably won’t spend a ton of time on SCS just because ultimately it’s going to be usurped by SHTG. But nonetheless, I think it’s important over the next two years before SHTG comes online that investors see, you know, Ionis can go out and commercialize the drug and build a market and execute. And so as we think about what the launch looks like, this is a market where there’s a bit of wide range maybe in epidemiology out there.

There’s questions about how many patients are in the treatment pool versus sort of the heavy lifting to kind of build and pull more patients into the treatment pool. So how much of it is the doctor’s got these patients, they’re in their office, maybe he doesn’t recognize or diagnose versus patients needing to be more aware of symptoms and coming in and now realizing they have a treatment option available to them? Yeah.

Brett Monea, CEO, Ionis: So severe hypertriglyceridemia is defined as triglycerides five hundred milligrams per deciliter and above. Normal triglycerides are 150 and below. The greatest risk for having elevated severely elevated triglycerides is the risk of potentially fatal acute pancreatitis event. What we know, based on all the work we’ve done with HCPs, all the market research we’ve done, and the engagements with the HCP community and the patient community, is that, patients, particularly patients that are above eight eighty milligrams per deciliter, which puts them at even higher risk for acute pancreatitis, or patients that are above 500 that have had a history of acute pancreatitis are already being aggressively treated by cardiologists, endocrinologists, lipidologists, and even some primary care docs.

Jason Gerber, Analyst, BofA: Sorry, guess I was more meaning the FCS opportunity. And are those patients in the pool, treatment pool? Or are they needing to be made more aware of treatment options to come into treatment for those with either genetically or clinically defined FCS?

Brett Monea, CEO, Ionis: Yeah, so FCS patients is really a severe form of severe hypertriglyceridemia, it’s all the same pool.

Jason Gerber, Analyst, BofA: Yep.

Brett Monea, CEO, Ionis: And SCS patients are being managed by the same HCPs that will ultimately manage SHDG. So it really is, the success we’re having in the SCS launch really does provide a real, you know, take off point, for SHTG. It really builds on the SHTG momentum. Of course, there’s a lot more HCPs that are managing SHTG that don’t see SCS patients, but all of the SCS HCPs will are managing patients with SHT gene.

Jason Gerber, Analyst, BofA: Yep. And are you surprised at all? I don’t know if there’s any anecdotes you can share in terms of like, since you’ve not in the market, how many patients did these HCPs tend to see with FCS? I’m just wondering how that process is going. You put up a maybe a better than expected 1Q.

And so I guess I’m wondering how to think through kind of what the next few quarters or two years look like.

Brett Monea, CEO, Ionis: Yeah. So, we are, like as I mentioned in my opening, very pleased and encouraged with the launch, of Trugolz and FCS to date. We’re pleased, with the dynamics across the board. We have patients that are a good segment of patients that are genetically confirmed as well as patients that are clinically diagnosed. A really nice mix of cardiologists and endocrinologists prescribing Trigosia to patients with FCS.

We’re seeing really great coverage through the medical exception process and fast. Very efficient coverage. Payers are recognizing the unmet need here, a severe disease. And we’re also starting to put policies in place that are also covering patients that are genetically diagnosed or clinically diagnosed. And we’re seeing reauthorizations.

We’re seeing patients get reauthorization even through the medical exception process. So we couldn’t be more pleased. H this is a rare disease. HCPs that manage, SCS patients, they’re they’re they’re managing each of them are managing just a handful. But as I mentioned before, these same HCPs are managing, you know, dozens and and maybe even, you know, far more than that, just with SHTG.

One of the things that, I don’t know if it was a surprise, but it’s certainly been very encouraging, is that as we approach HCPs and make them aware of Tringolza for FCS, they’re coming back to us and asking when can they when will they be able to use this drug for their SHTG patients because they’re managing FCS and SHTG patients. And they’re and they’re very, very much looking forward to prescribing for SHTG. You know, our launch was based initially on getting essentially all of our US patients converted, clinical trial patients in The US converted to commercial. We’ve accomplished that. There’s also a lot of patients that have been previously diagnosed with FCS, and we’re really doing well in that pool.

And all the work we did prior to launch, in identifying all of our medical team and identifying potential patients is also paying off. And that’s really where we have to focus, for the next subsequent quarters is patient identification. Because the vast majority of the up to three thousand people with FCS in The US are not diagnosed today. So we’re working through that, both genetic as well as clinical diagnosis of more FCS patients.

Jason Gerber, Analyst, BofA: Do you see a meaningful difference? Know you’re in the process of getting a European approval of the markets in terms of how the products are going to be viewed by the ultimate paying authorities in terms of how policies will be set around utilization? You’ve got the ultra rare pricing point The U. S. I imagine that wouldn’t be magnitude of order different in the OUS setting, but I don’t know how you’d sort of

Brett Monea, CEO, Ionis: maybe frame the two different market opportunities. Yeah. The prevalence of FCS in Europe is about the same as as The US based on our our estimations. We’re under review now. We expect approval in FCS this year.

We have, we have secured a our commercial partner for OUS, commercialization, Sovi. And we have a lot of we have a lot of, history here. We have a lot of experience, in FCS in Europe with our our with the drug that we’ve brought forward, WAYLIVRA, which is an early generation antisense inhibitor against APOC3 for SH, or for FCS. And SOBI is commercializing that drug, they have a lot of experience there. The definitions of FCS in Europe may be a little bit more strict, may require more genetic, confirmation.

We don’t rule out the possibility of clinical diagnosis. There are methods that are established in Europe for clinical diagnosis of FCS. It’s called the Mulan criteria. In North America, the North American FCS, criteria. So we think it’ll be very similar to The US, but the prevalence and the, you know, and the expectations and certainly the uptake of Trengolsa we think is going to be very, very successful in Europe as it is so far in The US.

Jason Gerber, Analyst, BofA: Okay. Well, let’s pivot to SHTG. It’s an important readout. I believe it’s 3Q. We have the Phase III data readouts for this program.

Curious how you’d frame clinically meaningful benefit in this setting, be it either triglyceride lowering or proportion of study subjects getting a more normal threshold, which is something that we often hear from physician KOLs, that the ability to get patients out of the danger zone is really important to them. So maybe ahead of the data, curious how you frame clinically meaningful signal here.

Brett Monea, CEO, Ionis: Yeah. As mentioned earlier, high unmet medical need, highly prevalent disease by patient population. Cardiologists, endocrinologists, lymphologists that treat these patients basically throw everything at them that they can to get their triglycerides down. Patients that are above 500 or even higher, fibrates, fish oils, all patients are essentially on this, and they can’t really budge their triglycerides. That’s why they’re looking so so much to a drug like Trincula to really substantially reduce their their triglycerides.

We have the ESSENCE study, a safety study with more than 1,400 patients with mildly elevated triglycerides. It’s a safety study to support the highly prevalent, disease opportunity from a safety database standpoint in the eyes of the FDA. That study is going to read out this quarter, the primary endpoint being triglycerides, but of course what’s most important is safety in that study. And then the SHTG core and core two studies to read out in the third quarter. What we have heard, directly from a large, number of HCPs that Angie’s patients is that they’re looking for anything that can, substantially lower their triglycerides on top of standard of care.

Our clinical trials are on top of standard of care. These patients still have SHCG, they’re above 500. Nearly fifty percent of our patients are above eight eighty in our phase three trials. So these patients are at high risk of almost around twenty percent or so, in the CORE study, patients have a history of acute pancreatitis. So they just want to get their triglycerides down.

Our experience in FCS, and in our BRIDGE study, the safety study for FCS that we presented last year, we’re seeing placebo adjusted reductions of triglycerides in the 50% range, or so. That’s a huge win. If we can cut triglyceride levels in these patients in half, you’re going to get a lot of patients out of significant risk of acute pancreatitis and other comorbidities. And that’s really what we’re looking to.

Jason Gerber, Analyst, BofA: So you have a patient presumably who maybe gets an omega-three or a fibrate and gets 20%, thirty % reduction. And then you’re getting that patient, you’re taking them down another 50%.

Brett Monea, CEO, Ionis: That’s correct. I mean, that’s the range that we were expecting based on our experience in FCS and in mildly elevated triglycerides from the BRIDGE study. Yeah. About a 50% reduction, give or take, is a big win on top of standard of care.

Jason Gerber, Analyst, BofA: Yep. So when you hosted a KOL webinar recently on SHTG, and one of the things that I took away is your market segmentation is that, like, you really see the opportunity here as a patient who’s highly afraid of another pancreatitis event. And so likely to adopt therapy as a means to mitigate and prevent that from happening. So you’re gonna generate data around pancreatitis, we all know that event rates are a little fuzzy, right, to characterize, but you are seeing event rates on a blinded basis. So that’s encouraging.

So I’m just wondering if you can talk about what we’ll expect to see at least in 3Q. I know that we talked in the past about pooling the two studies so that you can have a more robust data set from AP for acute pancreatitis. And so I’m wondering if when we get that update, we’ll be able to have a sense of have a support data set around hepatitis, at least on an area of trend, which is important, I think, to both U. S. And those markets.

Yeah.

Brett Monea, CEO, Ionis: So just touch on, you said about patient segregations, clearly patients that have had an ED event, triglycerides above are highly highly motivated. Can get on a Drolite Dulsa. Acute pancreatitis is incredibly, incredibly dangerous, potentially fatal. It can cause, pancreatic failure, high risk for diabetes, and, other organ failures, as as well. Puts them in the ICU for more than a week time on average, so they are highly motivated indeed.

And that’s a lot of people. But HCPs that have patients, have triglycerides, of eight eighty who don’t even have a history of pancreatitis are already convinced, that they need to take care of their patients. It’s analogous to having cholesterol in the multiple hundreds, LDL cholesterol hundreds, be put on the treatment by an HCP to manage cholesterol so you don’t get that first heart attack. It’s the same in the eyes of HCPs when you have severely elevated triglycerides. And that’s our target.

That’s our first tranche of focus for our commercial launch is those patients and those HCPs. The core and core two studies to read out in the third quarter of this year, primary endpoint is triglycerides. So obviously we’re going to present that in our top line data, or or announce that in our top line data for safety and and, and tolerability will also be, in our top line data for core and core two. If we have, the adjudicated AP data, We will certainly check, you know, top line data, but we have to firstly make sure we have all of the events properly adjudicated before we speak to them. What we are planning to do for sure is to present both ESSENCE as well as the COR and COR two studies at medical meetings in detail following top line data in the second half of this year.

And yes, we’re doing everything we can to power AE. It’s not powered for AP. Of course, these are secondary endpoints and AP event rate in SATG is not well understood. It’s actually studies like ours that are gonna really help establish AP. As you know, we had a statistically significant reduction in AP in our SCS study, but SATG is an unknown.

So we’ll see. Yes, indeed, we are seeing blinded AP events in our phase three study. And we’re doing everything we can to, maximize, the signal by, pooling the CORE study and the CORE two study, SHTG, which is over 1,000 patients. And we’re also looking at a twelve month time point in the study for the AP secondary endpoint to maximize the duration of time exposure to the drug and accumulation of events. Whereas our primary endpoint on triglycerides is at six months, with a six month So we’re doing everything we can, and we’ll share the data if we have it.

Jason Gerber, Analyst, BofA: So is the challenge to having all that data adjudicated by 3Q, the longer twelve month follow-up period, and maybe not having all of that data in house whereas you’d have the six month triglyceride lowering data in house for sure. I’m just trying to maybe follow-up on that point around that maybe

Brett Monea, CEO, Ionis: No, it’s not that because all of the patients on the primary end, all the patients that read out at six months have to be followed up for another six months. So that all patients will have been followed for twelve months. It really comes down to whether our central adjudication committee has all the data, properly, accounted for for us to currently share the data when the top line data comes out. I think we’ll be able to, share the data, though.

Jason Gerber, Analyst, BofA: Okay. So sounds like 50% placebo adjusted triglyceride lowering, you know, at least the numerical trend on acute pancreatitis and safe, that would be a home run for you.

Brett Monea, CEO, Ionis: Is that fair? That would be a Brant’s plan. Yeah. It’s in this highly prevalent disease patient population. Again, there’s there’s pent up demand by HCPs to really to really to get a drug electrical to manage their SHTG patients.

They believe in APOC3 as a as a as a new paradigm for managing, trigretide brileoarthritis. We’re proud of the fact that Ionis innovation is what led to the discovery of APOC3 as a target. We’re first validate it bring forward the first marketed drug to target APOC3.

Jason Gerber, Analyst, BofA: And so I think you’ve framed maybe a million patients or so that sort of are in that higher risk buckets of either eight eighty milligrams of triglyceride level or five hundred with the prior AB event. So that would be maybe the initial low segments after and then there may be additional broadening of the market opportunity subsequent to that. And I don’t know if that’s gonna be data driven by subsequent kind of core market studies, or how how would you kind of outline the initial opportunity and then how you may broaden over time?

Brett Monea, CEO, Ionis: HC education. The expansion from that initial tranche of about a million people in The US above 500 with a history of AP and above eight eighty is the initial focus on that as stated, as we said. But then it comes down to HCP education that if kids are above 500, you still need to get them within guidelines. There are established guidelines

Jason Gerber, Analyst, BofA: Mhmm.

Brett Monea, CEO, Ionis: In the cardiology community, in the endocrinology community, that if your patient is above five hundred, you need to put them on any and all medications to get their triglycerides down below 500 because they’re at risk of acute pancreatitis. That’s why all these patients, so many of these patients are on fibrates and omega-3s now, because they’re matching guidelines. With the availability of Trangolza potentially for SHCG, now that’ll be another tool in the toolbox to manage SHCG patients 500 above. So that comes down to HCP education. Post marketing studies, we will consider those, but I don’t think they’re essential.

Think it’s really about education.

Jason Gerber, Analyst, BofA: Yep. I think you’ve mentioned, if you’re addressing a market of that size, the ultra rare pricing kind of paradigm really can’t exist anymore. And and you’ve talked to thinking the 50 to 20 ks is sort of a tentative preliminary number. Do I have that right in in terms of how how where where do you see kinda like the price range ultimately within SHTG, if you had to put brackets around it? I think

Brett Monea, CEO, Ionis: you have that right with the caveat that we’re still working through it. Yeah. And it’ll also we need to see the data and what the data will support, but I think that’s reasonable.

Jason Gerber, Analyst, BofA: Okay. And any US, OUS particulars with this data set that that that we need to be mindful of in terms of the the filings and how, what the regulators care more about? Do the studies broadly support kind of a global filing strategy?

Brett Monea, CEO, Ionis: Yeah, the guidelines are global, to get patients below 500 if they have SHTG. And the approval will be based on we expect the approval to be based for SHTG in Europe to be based on triglyceride lowering as well. Payer requirements are always a little bit more strict outside The US than they are in Europe. So there may be a requirement for some trends in acute pancreatitis outside The US for payers to cover. We expect that not to be needed in The US.

So there might be a little bit more pressure on the need to convince that patients are at or at or that there’s a benefit on AP for SHTG, but that remains

Jason Gerber, Analyst, BofA: to be determined. Okay. The shift to pelicarcin, the Lp lowering, approach as a secondary prevention strategy for cardiovascular disease. You’ve got a phase three outcome trial through your partner Novartis looking at MACE outcomes. I generally believe, like, there’s a perception that this trial is maybe more enriched than the Amgen Ocean trial in terms of patients and some of the events that were explicitly outlined to get into the trial, even though there were some differences in the Lp levels at baseline.

But I think you’ve published some baseline demographic data. How do you see this trial ultimately enriched for success? And you’ve been through two interims, now you’re going to, I guess, a final update next year. You know, how do think things are tracking generally with this trial?

Brett Monea, CEO, Ionis: Yeah, this is another landmark trial. We seem to we’re proud of the fact that we’re at the forefront of so many of them. You know, LP is an independent cardiovascular risk factor, which means that patients are at high risk for heart attack, stroke, potentially death related to cardiovascular disease due to high LP independent of LDL cholesterol, independent of hypertension, independent of anything else, diabetes and so on. The baseline paper that our partner Novartis shared really shows how really well conducted this study is. With an oral inclusion criteria, it was at seventy milligrams per deciliter, which is well above in the range of risk for cardiovascular disease.

The median number is one hundred and eight in that study. The powering looks impressive, with the overall population, hazard ratio of 0.8. And in a subpopulation with patients 90 and above in milligrams per deciliter, the hazard ratio is 0.75. Really well conducted study. We expect eighty percent plus reductions in Lp.

And and, yes, we’ve, now cleared two interim analyses that were based on efficacy, futility, or and, safety and, green light go. So we’re looking forward to, this landmark result from the Horizon Phase three study, in the first half of next year. There are no more interns. Yep. So we’re ready to ready to roll.

And, it’s it’s a it’s a big it’s a really exciting, time in the cardiovascular world because of this trial.

Jason Gerber, Analyst, BofA: It was initially published something like 900 to a thousand events needed to occur. Are you, I imagine, privy to the blinded data that the events are tracking to to where they need to be to have it the actual liver data

Brett Monea, CEO, Ionis: hoping Norris is a great partner for this program. We have a very transparent relationship. We work with them. We have we have Ionis leaders, development from our development team on the steering committee. So, yeah, we work we we we see what’s happening with Novartis.

Jason Gerber, Analyst, BofA: Okay. And maybe, talk a little bit about what you see as the clinical support versus the, genetic data, that supports the role of Lp. I think primarily, like, what would you ascribe greater weight to here, in terms of confidence that this target, I think we’ve seen with other genetically defined targets like HDL, the outcome trials didn’t work. As you say, it’s a landmark trial. It’s the first trial in this space, and I guess that’s the main risk that people focus in on.

Brett Monea, CEO, Ionis: There are not good, pharmacological, approaches for lowering LP, because everything that’s been out there to date that people have looked towards for some to build some confidence in a successful outcome are based on small reductions in LP like PCSK9 inhibitors, have marginal reductions in in in LP. There’s some apheresis data, that filter out LP in Europe that has shown evidence of benefit in these patients long term. That’s nice, but it’s all about epidemiology. It’s all about the epidemiology data that really shows independent of all other risk factors, LDL, hypertension, what have you, that high LP levels are associated with high risk for cardiovascular disease. The higher the LP is, the higher the risk.

So it’s really mostly driven by the epidemiology data, and there’s a lot of it. You know, one of the great things about of being you know, having a a company as innovative as Ionis is that, when you go when you’re first, it brings risk. Right? You’re the first readout for for for, a drug for, you know, targeting a new risk factor, like LP, but you also have the benefit of being first to market by years And the study the study is well executed, well conducted, well designed, and we’re and and this we’re looking forward to the data in the first half of next year.

Jason Gerber, Analyst, BofA: Can you remind us how you’ve kind of defined this addressable market? And one thing that we hear from some physicians is, a lot these patients, they’re just treating to prevent an MI event, oftentimes patients just don’t treat. Right? And so, I don’t know. There’s yeah.

How would you kind of segment and and define this market given given those dynamics that are out there? And we’ve seen some analogs with other drugs that address risk factors in these different Yeah. So the way patients that have had a they typically have

Brett Monea, CEO, Ionis: a cardiovascular event, if it’s a really knowledgeable HCP, even before they have an event, a cardiovascular event, they’ll measure LP little I mean, if it’s super high, in either case, what what if what an HCP does is try to manage all their other risk factors because they can’t reach l p little a. Get their LDL down. Get their hypertension controlled. Get them on antidiabetic medicines if they’re if they have high glucose, all of that. And that’s because they can’t do anything with Lp.

Once an inhibitor once pelicarcen, for example, is potentially approved and and and the data supports that we’re putting patient getting patients out of harm’s way that have high Lp, it’ll be used along side drugs to manage other other other risk factors like LDL cholesterol because those those other drugs don’t manage it, LP level. So it’ll be added on top of a statin if patients have multiple risk factors, for example, LDL and LP. If a patient has TTR amyloidosis, it’ll be measured on top of a TTR drug alongside an ilpilicarcine and those sorts of things. It’s independent and has to be directly controlled. And we believe that HCPs will understand this.

They they they have a long history of doing this kind of thing. But today, since there’s no treatments, they’ll they’ll just use whatever they can to get them out of harm’s way for other to control other risk factors.

Jason Gerber, Analyst, BofA: All right. Well, we’re pretty much out of time. So Brett, thanks so much for joining us.

Brett Monea, CEO, Ionis: Thanks, Jason. It was a pleasure.

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