As with most uncommon ailments, the marketplace for hereditary angioedema medication is small. It’s additionally comparatively crowded, served by a number of well-established merchandise and two new therapies authorized earlier this summer season. An injection from Ionis Prescribed drugs is becoming a member of the listing, and whereas the biotech firm plans to seize new sufferers, it additionally goals to develop gross sales by getting sufferers to change over from different merchandise. Ionis has the medical knowledge to help this technique.
The FDA’s approval of donidalorsenmodel identify Dawnzera, makes this Ionis drug the primary genetic drugs for hereditary angioedema, or HAE, an inherited dysfunction that results in swelling assaults all through the physique. These assaults come with out warning and might turn into deadly after they shut off a affected person’s airway. The FDA’s Thursday approval of the Ionis drug covers prevention of HAE swelling assaults in sufferers age 12 and older.
An estimated 7,000 individuals within the U.S. have HAE, which stems from the inherited deficiency or dysfunction of C1 esterase. This protein regulates different proteins related to swelling and irritation. Swelling comes from uncontrolled activation of the kallikrein-kinin system. Whereas a number of the at present out there HAE medication block a protein known as kallikrein, Ionis goes even earlier on this pathway by going after prekallikrein (PKK), a protein that’s a precursor of kallikrein.
Dawnzera is an antisense oligonucleotide designed to bind to PKK messenger RNA, lowering manufacturing of this protein within the liver, the place it’s made. The drug, administered as a subcutaneous injection each 4 weeks or each eight weeks, is the primary and solely RNA-targeted remedy for HAE. In a 24-week Part 3 trial, dosing of the research drug each 4 weeks led to a median 81% discount in HAE assaults in comparison with placebo. Within the one-year open-label extension research, Dawnzera decreased assaults by a median of 94% throughout each four-week and eight-week dosing. On this research, Ionis reported that 93% of members achieved well-controlled illness as measured by a check to evaluate HAE episodes.
Takeda Pharmaceutical’s lanadelumab, model identify Takhzyro, dominates the HAE prophylaxis market. This antibody kallikrein inhibitor is authorized for sufferers age 2 and older, administered as a subcutaneous injection each two weeks, although dosing could also be prolonged to each 4 weeks for some sufferers. BioCryst Prescribed drugs markets Orladeyoa once-daily oral small molecule kallikrein inhibitor authorized for HAE prophylaxis in sufferers age 12 and older. CSL Behring takes a special strategy with garadacimab, model identify Andembry, a once-monthly antibody inhibitor of a protein known as issue XIIa that received FDA approval in June.
Acute remedies for HAE embody the C1 esterase inhibitors Ruconest, from Pharming Group, and Berinert, from CSL Behring. Takeda’s acute HAE medication are the kallikrein inhibitor Kalbitor and the bradykinin inhibitor Firazyr. The latest acute HAE remedy is KalVista Prescribed drugs’ Ekterly, an oral small molecule kallikrein inhibitor authorized by the FDA final month.
Ionis’s open-label extension research for Dawnzera included a cohort of sufferers who switched to the research drug from a special HAE prophylactic remedy. Outcomes confirmed the HAE assault charge fell by a median 62% from prior prophylactic remedy. Moreover, 93% of members achieved well-controlled illness. The total outcomes have been revealed in July in The Journal of Allergy and Medical Immunology in Follow.
Talking throughout a convention name Thursday, Kyle Jenne, government vp, chief international product technique officer for Ionis, characterised HAE prophylaxis as a “swap market.” Information present that about 20% of sufferers transfer between therapies, no matter whether or not it’s an injectable or oral drug. Jenne additionally cited outcomes from an Ionis-sponsored Harris Ballot of HAE sufferers exhibiting that 9 out of 10 sufferers could be enthusiastic about attempting a brand new prophylactic remedy.
“There’s a number of motivation and a number of dissatisfaction from sufferers which can be at present on present remedies,” Jenne stated. “We count on that over time, sufferers can be switching and we consider that Dawnzera is a superb selection for these sufferers primarily based on the profile that we’ve outlined.”
Past the efficacy knowledge, Dawnzera presents sufferers higher comfort. The drug could also be self-administered at a affected person’s residence with an injection pen, Jenne stated. Having an extended dosing interval can even make a distinction for some sufferers. Whereas Ionis expects most sufferers will begin with dosing each 4 weeks, it is going to be as much as a doctor to find out whether or not to increase dosing to each eight weeks.
William Blair analyst Myles Minter sees Dawnzera as a extremely aggressive within the HAE prophylaxis market. In response to Ionis estimates, 75% of HAE sufferers at present obtain HAE prophylactic remedy; most of them take Takeda’s Takhzyro.
“Market analysis indicating 20% of HAE sufferers swap to different remedies yearly signifies an unmet want, in addition to a transparent alternative for Ionis to seize market share with Dawnzera’s differentiated, much less frequent dosing and at-home auto-injector dosing,” Minter stated in a be aware despatched to buyers. “Moreover, the swap research carried out by Ionis signifies that sufferers who attempt Dawnzera choose it over their prior remedy possibility, strongly indicative of a sticky profile.”
Dawnzera’s listing value is $57,462 per dose; about $747,000 yearly for each 4 week dosing. Ionis initiatives this product may obtain $500 million in peak gross sales. Otsuka Pharmaceutical licensed the rights to commercialize this drug in Europe in a 2023 deal.
Dawnzera is a vital a part of Ionis’s technique to develop income from gross sales of its personal merchandise. For a lot of its historical past, Ionis partnered with bigger corporations that took accountability for later-stage growth and commercialization of its oligonucleotide medication. Ionis’s prime supply of economic income is royalties from Spinraza, the spinal muscular atrophy drug that’s marketed by accomplice Biogen. Ionis reported $216 million in Spinraza royalty income in 2024.
The first drug that Ionis commercialized by itself was Tryngolzaa remedy for the uncommon metabolic dysfunction familial chylomicronemia syndrome that the FDA authorized in late 2024. For the primary half of 2025, Ionis reported $25.5 million in Tryngolza income.
Photograph by Ionis Prescribed drugs
