Ionis Cuts Tryngolza 2026 Sales Outlook to About $50 Million

The Tip Desk · November 9, 2026 · 3 min read

The RNA-therapy company generated $243 million of third-quarter revenue and reaffirmed full-year guidance of $875 million to $900 million after a slower-than-expected severe hypertriglyceridemia launch.

Ionis Pharmaceuticals (IONS) reported third-quarter 2026 revenue of $243 million and lowered 2026 product sales guidance for TRYNGOLZA (olezarsen) to approximately $50 million from $100 million to $110 million after the severe hypertriglyceridemia launch ramped more gradually than the company anticipated, while reaffirming full-year total revenue of $875 million to $900 million.

The RNA-therapy company said the cut reflected early dynamics of establishing a new treatment paradigm for people with sHTG. Chief executive Brett P. Monia said initial sales progress had been more gradual than anticipated and that Ionis remained confident in TRYNGOLZA’s long-term growth potential.

Third-quarter revenue was $243 million, up 55% from $157 million a year earlier, excluding the one-time sapablursen upfront payment recognized in the second quarter of 2025. Sequential revenue declined from $268 million in the second quarter.

Commercial revenue was $136 million, up 18% from $116 million a year earlier, driven primarily by DAWNZERA (donidalorsen). U.S. net product sales of DAWNZERA were $37 million in the third quarter, versus $1 million a year earlier. Ionis said it is on track for full-year 2026 DAWNZERA product sales of $110 million to $120 million.

TRYNGOLZA U.S. net product sales were $9 million in the third quarter, versus $32 million a year earlier. Nine-month TRYNGOLZA sales were $41 million. The company received a positive CHMP opinion for sHTG, with a final European approval decision expected in the fourth quarter of 2026.

ZANVASTRO (zilganersen), the first approved medicine for Alexander disease, generated $2 million of net product sales in the third quarter as the first independent neurology launch began, with first patients dosed with commercial drug.

Research and development revenue was $107 million in the third quarter, versus $41 million a year earlier, driven by multiple collaboration payments and excluding the $280 million sapablursen upfront received in the second quarter of 2025.

SPINRAZA (nusinersen) generated global sales of $461 million in the third quarter, up 23% from the same period in 2025, producing $69 million of royalty revenue. WAINUA (eplontersen) global sales were $68 million, producing $7 million of royalty revenue, versus $13 million of WAINUA royalties a year earlier.

GAAP operating expenses were $373 million in the third quarter, versus $317 million a year earlier, primarily from commercialization of TRYNGOLZA, DAWNZERA and ZANVASTRO. Full-year expenses remained on track for low-teens percentage growth. GAAP loss from operations narrowed to $130 million from $160 million a year earlier; non-GAAP operating loss was $87 million versus $129 million a year earlier. Net loss was $110 million, or $0.66 a share, versus $129 million, or $0.80 a share, a year earlier.

Cash, cash equivalents and short-term investments were $1.9 billion at September 30, 2026, down from $2.7 billion at December 31, 2025, primarily due to repayment of the 0% convertible notes on April 1, 2026 and cash used to fund operations. Ionis reaffirmed year-end cash above $1.6 billion and non-GAAP operating loss of $425 million to $475 million.

Chief financial officer Elizabeth L. Hougen said commercial revenue growth was driven by DAWNZERA and that the results keep Ionis on track to achieve 2026 total revenue, operating loss and cash guidance.

The company also reported that HIBSAGO (bepirovirsen) was approved in the U.S., Japan and Canada for chronic hepatitis B, that the Phase 3 IMAgINATION study of sefaxersen in IgAN met its primary endpoint with a 43.1% reduction in proteinuria versus placebo at week 37, and that the Phase 3 study of ulefnersen in FUS-ALS met its primary endpoint. Obudanersen completed enrollment in the Phase 3 REVEAL study in Angelman syndrome, with data expected in the second half of 2027.