IONS - NASDAQ

Good morning, and welcome to Ionis' Third Quarter 2023 Financial Results Conference Call. As a reminder this call is being recorded. At this time, I would like to turn the call over Mr. Wade Walke, Senior Vice President of Investor Relations to lead off the call. Please begin, sir.

Thank you, Chuck. Before we begin I encourage everyone to go to the Investors section of the Ionis website to view the press release and related financial tables we will be discussing today, including a reconciliation of GAAP to non-GAAP financials. We believe non-GAAP financial results better represent the economics of our business and how we manage our business. We have also posted slides on our website that accompany today's call. With me this morning are Brett Monia, Chief Executive Officer; Onaiza Cadoret, Chief Global Product Strategy and Operations Officer; Richard Geary, Chief Development Officer; and Beth Hougen, Chief Financial Officer; Eric Swayze, Executive Vice President of Research; and Eugene Schneider Chief Clinical Development Officer will also join us for the Q&A portion of the call. I would like to draw your attention to Slide 3, which contains our forward-looking statement. During this call, we will be making forward-looking language statements that are based on our current expectations and beliefs. These statements are subject to certain risks and uncertainties and our actual results may differ materially. I encourage you to consult the risk factors contained in our SEC filings for additional detail. With that, I'll turn the call over to Brett.

Thanks, Wade. Good morning, everyone, and thanks for joining us on today's call. Since taking the helm at Ionis nearly four years ago we have executed on a strategy to deliver next level value. And we have done so with a clear vision and laser focus on our strategic objectives to bring our medicines directly to patients build our wholly-owned pipeline and to extend our leadership in oligonucleotide therapeutics. Our successes this year which are a direct result of our efforts in these key areas move us closer to achieving our ultimate goal to deliver a steady cadence of new transformational medicines to patients and to generate next-level value for all Iona stakeholders. We are on the cusp of delivering our near-term commercial medicines to patients starting with the first potential approval of eplontersen this year. We and our co-commercialization partner Astra

Thank you, Brett. As Brett outlined and as you will hear from Richard in more detail in a moment Ionis' pipeline holds tremendous promise. And today we are ready to begin delivering our medicines to patients. With an estimated 40,000 patients worldwide and fewer than 20% of patients on an approved treatment, hereditary ATTR Polyneuropathy remains significantly under-diagnosed and largely underserved disease. In large part the low rate of diagnosis is driven by the systemic nature and the heterogeneous presentation of this disease, while Peripheral Neuropathy may be the most important symptom in many patients. Others may present with Cardiomyopathy and still others with symptoms like GI disease leading to muscle wasting. By leveraging Ionis' deep knowledge of ATTR and Astra

Thank you, Onaiza. We could not be more pleased with the performance of our pipeline. Eplontersen has continued to perform exceptionally well demonstrating durable and sustained efficacy and safety through 85 weeks of treatment in patients with ATTR polyneuropathy. Just this morning, we presented new data at the European ATTR amyloidosis meeting that further reinforces these results, demonstrating improvements in measures of neuropathy impairment and quality of life that were seen in a substantial number of patients at 35 and 66 weeks and were sustained through the 85 week analysis. And benefit across secondary endpoints at 85 weeks showed improved neuropathy specific and physical health related patient quality of life stabilized or improved ambulatory status, and stabilized nutritional status with eplontersen treatment. And last month at HFSA, we showed data demonstrating improvement in cardiac function and structure in a predefined cardiac subpopulation of polyneuropathy patients from the neuro transform study. The positive results from NEURO-TTRansform also support our confidence in the potential for eplontersen to benefit patients in the larger ATTR cardiomyopathy indication. With CARDIO-TTRansform fully enrolled, we remain on track for data as early as the first half of 2025. As a reminder, with over 1,400 patients CARDIO-TTRansform is the largest study in this patient population to-date, designed to generate the data physicians and payers want and need to understand the value of eplontersen offers for patients and to enable the best possible treatment decisions for patients. Following eplontersen, olezarsen is the next drug we expect to bring to the market, and is the first we expect to commercialize independently. In the BALANCE study the 80-milligram dose of olezarsen demonstrated statistically significant reductions in triglycerides, robust target engagement and a favorable safety and tolerability profile consistent with the profile seen with our other like medicines. In addition, olezarsen demonstrated unprecedented substantial and clinically meaningful reductions in acute pancreatitis attacks. This is remarkable, because it's the first time a lipid-lowering therapy has ever achieved this result in a clinical trial setting. Based on the positive data we reported from the Phase 3 BALANCE study, we believe that olezarsen is poised to become the standard of care for patients with FCS. Our next step will be to file for marketing approval in the U.S. and EU in the first half of next year positioning olezarsen for its first potential approval in late 2024 assuming priority review in the U.S. In addition to our clinical development program for FCS, we also have an ongoing program for patients with severe hypertriglyceridemia, or SHTG. Phase 3 studies in SHTG patients are ongoing, and we expect those studies to read out in late 2024 or early 2025 depending on enrollment. Following closely behind olezarsen is our next wholly-owned medicine donidalorsen to treat patients with hereditary angioedema. Despite several treatments already on the market, HAE continues to represent a significant unmet need. For example, in a study recently conducted by the Hereditary Angioedema Association of over 500 patients with HAE, only 13% of these patients reported having good control of their disease with more than 85% reporting two or more attacks per year. Data reported from the ongoing Phase 2 open-label extension study of donidalorsen show sustained and durable reductions in HAE attacks and favorable safety and tolerability over two years and support donidalorsen's potential to address the unmet need. We look forward to presenting a comprehensive look at the two-year OLE data next week at the ACAAI Conference. With enrollment completed in the Phase 3 OASIS-HAE study, we remain on track for data in the first half of next year. And from our robust late-stage pipeline we look forward to updates from bepirovirsen and IONIS-FB-LRx. Next week at AASLD GSK plans to present new data from the Phase 2b B together study of bepirovirsen in combination with pegylated interferon. In this weekend at Kidney Week, we plan to present new interim results from our ongoing Phase 2 study of our Roche partnered medicine IONIS-FB-LRx in patients with IgA nephropathy. We also made significant advances with our industry-leading neurology franchise this year. Today, we have two approved breakthrough medicines for neurological disease on the market SPINRA

Thank you, Richard. Our year-to-date financial results keep us on track to achieve our 2023 financial guidance, while we continue to execute on our strategy to unlock next level value. Revenue continued to be substantial and sustained with revenues of $144 million and $463 million in the three and nine months ended September 30, 2023 reflecting a 10% decrease and a 6% increase, respectively compared to the same periods last year and driven by the timing of certain partner payments. As anticipated, our operating expenses and operating loss for the third quarter and year-to-date increased over the same period last year as we advanced our commercial readiness activities and our pipeline, especially, our late-stage programs. We remain well capitalized with $2.2 billion in cash and investments at the end of September enabling us to continue investing in our strategic goals. Our commercial revenue from SPINRA

Thanks Beth. We are very proud of the remarkable progress we've made this year. We believe that the successes we've achieved so far this year position us to drive substantial value for patients, our shareholders, and all Ionis stakeholders. Strategically, we have arrived where we are today by being focused on a clear vision and by being focused on all our support and strategic objectives necessary to achieve our vision. We've now established all of the functional capabilities we need to deliver a steady cadence of new and potentially transformational medicines to the market. We are advancing and growing our wholly owned pipeline and have established Ionis as a leader in cardiovascular and neurology drug development. We continue to extend our leadership position in Oligonucleotide type therapeutics by expanding and diversifying our technology further optimizing our capabilities for existing therapeutic areas and opening up new areas for drug discovery and we continue to strengthen our financial foundation, providing the means to support all our strategic objectives. And today, with one of the most robust late-stage pipelines in the industry, with nine medicines in development for 11 indications, we're turning that promise into new medicines for patients in need and not just one or two, but a steady and growing cadence of new transformational medicines over the mid and long-term. And in achieving this goal, we are positioned to drive great value for all Ionis stakeholders. With that, I'll now open the call up for questions. Operator?

Thank you. We will now begin the question-and-answer session. [Operator Instructions] And the first question will come from Gary Nachman with Raymond James. Please go ahead.

Hi. Thanks for taking the question. So, on eplontersen for ATTRPN, any additional updates regarding your interactions with the FDA? And how everything is progressing in front of the PDUFA? Have they requested any additional data and are label discussions progressing in the way you would like them to? And then, just on the commercial plans. Given the competitive dynamics in the space with [Indiscernible], how will payers be viewing Eplontersen? What's your work telling you there? Will all these drugs be covered on most formularies? And where is Astra

Thank you, Gary. I'll take the first one and briefly give you an update on regulatory. And then I'll ask Onaiza to cover the second part of your question on competitive dynamics. So, it's -- we don't comment on ongoing regulatory discussions for drugs under review for potential approval. But what I can say with high confidence is that, we're very pleased with the progress we're making with the FDA and bringing up on teen to an on-time potential approval either PDUFA date on December 22. So there's been really -- everything is moving on track with that. And I also want to remind you everybody that we are now under review with our filings accepted in Canada and in Europe with potential approvals for those markets as well for next year for Eplontersen and TTR polyneuropathy. Onaiza?

Hi Gary. Your launch plans are really underway. I would say they're actually in place. We have hired all the necessary people for a very, very effective launch. The salespeople as you know is being led by Astra

All right. Great. Thank you.

The next question will come from Luca Issi with RBC Capital. Please go ahead.

Great. Thanks so much for taking the questions. Maybe two quick ones. One on Hepatitis B. What was your reaction to GSK in licensing the ex- RNAi from Arrowhead and J&J, given that they already have a sound thing agent with you, why do you think they need a second one? And then maybe circling back on the prior question so TTR polyneuropathy in PDUFA, any color on manufacturing? Has the tech transfer to Astra

Thanks, Luca. So we have a very good relationship with GSK. So we're aware of what was coming, what was announced this week. The way to think about it is that, the acquisition of the RNAi molecule from Vanson really represents a double down, a triple down if you will on Bepirovirsen. Bepirovirsen is the only treatment that has produced a meaningful percentage of patients achieving a functional cure patients with HPV, chronic HPV. And in the Phase IIb in the CLEAR study, what we demonstrated with GSK was about a 10% functional cure rate. However, in patients with a lower HPV burden like 1,000 IUs per million, I think per milliliter that functional cure rate was well into the 20%-plus range, which is really impressive. And so the strategy that GSK has stated for bringing in the RNAi molecule, which has not shown functional cures but what it has shown is reduction in HPV antigen levels, two levels that -- which has a substantial percentage of patients can get below that 1,000 IU level is to do a sequential treatment to reach even more patients to achieve even greater percentage of functional cures by bringing patients down to a level maybe below 1,000, more patients below 1,000 IUs per milliliter and then coming in with Bepirovirsen. So this is an added dimension to a very comprehensive clinical program for Bepirovirsen to reach as many patients as possible and to achieve the highest percentage possible for functional cures for Bepirovirsen. And it's also consistent with everything that GSK has been saying in which they will be exploring different combinations for Bepirovirsen to maximize success on this market, which as you know is hundreds of millions of people suffering from chronic HPV. So we're very pleased about this new outcome with GSK for Bepirovirsen. And Beth maybe you could talk a little bit about where we are with the our launch preparations for commercial supply?

Sure. Absolutely. We are all ready to go just as we are on the commercial side and the medical affairs side. All of the products needed for launch has been manufactured. It was manufactured through the regulatory process has been reviewed is ready to go. We just are waiting for a final label to do label and packaging and get product into channel shortly after approval, and all of the tech transfer necessary from Ionis to Astra

Great. Thanks so much.

The next question will come from Yale Jen with Laidlaw & Company. Please go ahead.

Good morning and thanks for taking the questions. I've got two quick ones here. The first one is for the SPINRA

So, what I would say is we're very pleased with the low single-digit growth in -- against last quarter and against the previous quarter -- same quarter last year. We believe that demonstrates SPINRA

Okay, great. That’s helpful. And in terms of a JAMA publication regarding the eplontersen to sustain the benefit, how should we think about that to incorporate into the marketing strategy, particularly for newly treated or untreated patients?

The publication specifically? I mean, that's going to be a really effective tool to, right, Onaiza?

Yeah, I think with the promotional and regulatory guidance, looking at the JAMA publication and where our promotional messages are headed. It's going to be highly supportive. The JAMA publication is also very consistent with the label that we expect so that will allow for use by both the medical teams as well as the sales teams as well and that's what we expect.

Yeah. So in other words, although our package that's under review at the FDA is based on the week 35 interim data that we reported last year having this publication for week 66 and week 85 is very, very helpful from a marketing standpoint and we expect to utilize that publication very effectively. I think that was the basis of your question.

Thanks On and Brett.

Thank you, Allison. The Phase 2 study evaluating tau in patients with Alzheimer's disease is underway and enrolling. And it's a very -- it's really quite an extensive study with more than 700 patients to be treated for well over a year, with the primary endpoint really being efficacy improvement in cognition. And the purpose of that Phase 2 study, is to really make a decision to set up and support a path forward to go to Phase 3 development for a pivotal study. And in this study, we are exploring different dose levels as well as different dose regimens including, twice a year dosing and that's based on the data that you're referring to which is the Phase 1/2 study that is now published in JAMA Neurology and was presented at CTAD last week and is incredibly supportive of that Phase 2 study and the Tau program overall. We and our partner Biogen could not be more thrilled with the data that was generated from the long-term extension of the Phase 1/2 study in patients with Alzheimer's disease. tau is considered by exploring essentially all the efforts in the field as being the most important target for Alzheimer's disease based on the neurofibrillary tangles that appeared just before cognition impairment occurs. It's downstream of beta amyloid, which can be present long before cognition deficits occur. But it's a difficult-to-drug target because what matters most is intracellular tau that closes the neurofibrillary tangles from neurodegenerative. What we have shown for the first time is not only can we substantially lower our all forms of tau in CSF, we can actually reverse tau pathology in the long-term extension data in patients by PET imaging. But now we also have from the long-term extension data actually signs, trends that patients are actually improving in cognition. So we couldn't be more thrilled about the data. And this has built on our confidence from the CLIA Phase 2 study that's underway that I referred to earlier. As far as combination monotherapy that kind of thing that's – this is the start of a development program for a drug that's leading the way to target tau. The Phase 2 study is intended to assess the benefits of tau on cognition as a monotherapy. That does not preclude future studies looking at different combinations as this field evolves, whether it be with the beta amyloid treatment in combination with the tau-driven and so on. That will require further development and – but it can make sense. We can see how those two mechanisms can actually complement each other and maybe even synergize with each other. So all that is on the table. But right now Biogen and Ionis are focused on the Phase 2 study to bring that forward as quickly as possible. And as far as confidence in neuro, this is just another piece of data, evidence, validation of our leading neurology platform. I would start with SPINRA

The next question will come from Yanan

Great. Thanks for taking the questions. Three questions if I may. On Eplontersen, what launch metrics would you provide so that we can have an understanding of how the drug is performing in the market in the early launch quarters? On the tau program, can you talk about how you see the visibility of the Inotersen [ph] route of the administration in this very large indication. On the –lastly on the Angelman syndrome program, following the recent updated data from Ultragenyx, any insights you could share regarding how your program could be differentiated from that program as we look forward to data in mid-2024? Thank you.

Thanks Yanan. And maybe we'll start with launch metrics?

Sure. So Yanan, I think the way to think about this market, as I said, it's a growth market and we have a lot of patients to get diagnosed and get treated on eplontersen. And I think the phenomenon that you might be seeing now with switches is very temporary. And I think we will have -- they will have worked through that. We're squarely focused on growth and growth mindset on newly diagnosed patients. As such our launch success will be measured on getting eplontersen as a preferred choice for newly diagnosed patients new to silencers.

Got it. Thanks.

So next year, we'll be providing some metrics and we'll see how that -- so stay tuned for that Yanan. Regarding the Tau program, so Alzheimer's disease, despite the really remarkable progress, that's been made recently on delivering medicines to the market to patients for AD, this is still a very severe neurodegenerative disease with a very high unmet medical need. And like I touched on earlier, we think Tau is the best target for treating this disease broadly. And with that comes the need for treatments and we don't -- we believe that intrathecal delivery will be well accepted if the drug is as efficacious as we expect it to be. With that said, the Tau program is an example of the great progress we're making in further optimizing and advancing our neurological disease drug discovery capabilities with homedicinal chemistry and just experience. In the Tau program, we actually have a treatment arm that we expect will be efficacious with twice a year dosing, so we've moved from monthly to every three months for many programs and now we've been moving some programs to twice per year dosing intrathecal. That is part of the Tau program that's in Phase 2 development today. In addition as we highlighted at Innovation Day, a few weeks ago, we're making great progress from our research organization in overcoming the blood-brain barrier as an obstacle for delivery of our treatments, our drugs for using subcutaneous or intravenous administration. And obviously, programs like Tau are on our radar as our other programs. So we also think that that could be in the future for a large population chronic disease indication like Alzheimer's disease. So, no promises there yet but we're very pleased with the progress we're making there. Regarding Angelman syndrome, I prefer not to comment on other people's programs other companies' programs. What I will say is that we are fully enrolled in our Angelman's program. We actually overenrolled the study a bit. We expect data midyear next year. We expect data on efficacy as well as, of course, safety and biomarker data from that trial. And that trial is designed to set up a potential Phase 3 decision based on all that. And then what I'll also say is that -- and it's kind of related to the earlier question that I got that I tried to address, which is we have a vast amount of experience with our platform in neurological diseases thousands and thousands and thousands of patients have been treated for very extended periods of time with our chemical platform, with our know-how with everything. And we think that that bodes very well for the Angelman's patient community, because they're going to be able to take -- they're going to benefit from the vast experience that we have at Ionis with delivering neuro drugs for the treatment of severe neurological diseases like Angelman syndrome. So stay tuned for all that. We're very much looking forward to the data next year.

Great. Very helpful. Thank you.

The next question will come from Debjit Chattopadhyay with Guggenheim. Please go ahead.

Hey. Good morning, team. This is Robert on for Debjit. Thanks for taking our questions. Two from us this morning. First, could you share any pricing thoughts on eplontersen. Specifically would you anticipate launch price in line with current PN treatments on the high end or CM treatments in the low end. And for the Alexander program, what pace of enrollment would you hope to see in the Phase 3? And subsequently when would you potentially anticipate a Phase 3 readout based on those time lines? Thank you.

Onaiza, would you want to take the launch price PN and CM?

Yes. So Robert I think that we would expect that again the two indications are both rare disease indications, but they are priced differently if you looked at analogs in the marketplace. Based on all the work that we've done, we don't believe there is any reason to kind of shift from that in terms of our pricing strategy. So I would expect that as the price is set by A

And regarding our newest Phase 3 program our Alexander disease program most of the time we're enrolling rare disease indications can be challenging, because they are rare in finding patients into your study obviously can present challenges. But what's unique about our Phase 3 program for Alexander disease is that we designed a seamless Phase 1 through 3 design such that it's all the same sites. It's all the same -- the protocol has already been baked and everything like that. And after our Phase 2 results, which was when we reviewed it we had two decisions to make not really. One was to dose escalate or to move into Phase 3 development. And during that review process when you go through all the data you're collecting the data you're cleaning the data and before we actually review the data enrollment is put on pause right? Because we don't know what the next step will be for the program. And what happened in this situation is that patients were on the sideline waiting to get into either the dose escalation phase of the next step or the Phase 3 part of the program. So with that said, we think actually enrollment will go well for the Alexander program because we have patients on the sideline waiting to qualify to enter our Phase 3 program now that we've activated it. So enrollment is ongoing and we expect data in 2025.

The next question will come from Yaron Werber with Cowen. Please go ahead.

Hi, guys. This is Brendan on for Yaron. Thanks so much for taking the question. Just a couple of quick ones from us. Just another one on Matt Tau -- excuse me, sorry if I missed this but -- just wondering if there's any plan for any interim look at the Phase 2 study or any possibility of any additional data updates there before the full Phase 2 readout assuming maybe 2026 for the full Phase 2. So just wondering if we can expect anything new there in the meantime? And then quickly on donidalorsen. Obviously you have a few different studies ongoing there. But I think you're planning to incorporate into one filing maybe including the switching study, et cetera. So can you just maybe give us a sense of timing for data beyond the top line readout in the first half of next year? Maybe how long thereafter do you think you'd need to collect and analyze data, and if you're thinking to maybe file in the second half of next year if that's fair to assume. Thanks very much.

Sure. So there's no plan for an interim look in the Phase 2 study for the tau program at this time. So that's a short answer quick answer. It's very important to get this study right, and you get the richest dataset as you possibly can. And as I mentioned earlier, it's -- this is -- what we're looking for here is actually evidence to support a Phase 3 decision that we're improving cognition impairment. So that's going to take time that studies over a year long, as I mentioned earlier, more than 700 patients. So no interim look at this time. For donidalorsen, I don't think we've said that we're expecting to include switch data in the filing for the NDA. Really the Phase 3 data along with all the other data that we've generated from Phase 1 and Phase 2 will be sufficient to support a filing assuming positive outcome. With that said, we expect Switch data from our Switch study which as a reminder to our knowledge we're the only sponsor that has actually conducted a true Switch study in which patients that are on an existing treatment therapy Prophylactic Treatment are switched over to power of investigational medicine Donidalorsen to and Onaiza mentioned which in our case is Donidalorsen. And then we assess everything, including protection against HAE attacks on identifying demonstrating that there's, no gaps between one treatment switching to, another treatment. Tolerability sustained efficacy and actually be able to generate the information that prescribers are going to want to have to understand how do I do this? Okay I want to switch to your drug. I want my patient to go on your drug, but how should I do this? And that's really the goals of the Switch study. We expect that data to be out next year or at least a cut into that data next year that's going to really allow us to actually demonstrate the value of Donidalorsen in this market which is a Switch market. But we have no plans to include that at this time to my knowledge in the NDA filing.

If we believe that the publication will be more than sufficient to be consistent with label to be used actively by our sales teams in promotion. And to the extent if it's all ready alongside of it, we could actually add it in, but it's really not a requirement nor that we think it's really necessary for commercial uptake. We like it in the publication. That's what we're really looking for is our strategy going forward.

Okay. Great. Thanks very much.

The next question will come from Jessica Fye with JPMorgan. Please go ahead.

Hey guys. Good afternoon. Thanks for taking my questions. Can you remind me of your expectations around whether in addition to a clear impact on triglycerides, whether you believe you could show an impact on pancreatitis for Olezarsen in sHTG? And then second forgive me if you stated this, but for CARDIO-TTRansform, I believe the ball is up to 140 weeks. I just wanted to clarify is there a minimum planned follow-up for those who do not reach 140 weeks. I noticed some of the endpoints are assessed a week I think 121. Is that the minimum assuming the study has not stopped early? Thanks.

Eugene, do you want to take those?

Sure. Happy to, maybe I'll start with the last one. So as you said of course the fair excruciating level of detail on the statistical analysis plan, but just to summarize it the exposure on the study is up to 140 weeks which means that in some patients if the study reads out early the exposure will be less than that. We've defined the minimal exposure and the time point specific time points for those early look in our SAP. And I don't think that we've come out and included specific time lines on those other than sort of the general statement about early opportunity for closing the study earlier based on some specific conditions being met. And then,…

In the event you don't stop the study early what the minimum would be?

Well, if we don't stop the study early we go -- all patients will be treated for 140 weeks. That's the double-blind period.

Yeah. Okay.

Okay. And then, likelihood of achieving AP in sHTG?

Yeah. So sHTG again it's of course a very different population from FCS in terms of risk for AP events. Having said that again the program that we designed the two very large studies certainly we believe we'll have an opportunity to show an effect. And what we are also going to be looking at is a combination of those two studies. So looking at sort of integrated analysis of efficacy combining those two large studies which together amount to about almost 1,000 patients. So we're fairly confident of course today we don't know what the data will show. What we can say is that we were extremely pleased with the effect on AP events in our FCS population. So we do believe that the thesis is very strong, but we need to wait until the data read out.

The next question will come from Kostas Biliouris with BMO Capital Markets. Please go ahead.

Hi, everyone. Thanks for taking our question. One quick question from us on ATTR. This morning [Indiscernible] presented data from the literature demonstrating that in addition to the percentage of TTR reduction, the absolute serum TTR levels after treatment are also very important as they can contribute to the ongoing fibril formation and they actually have an impact on survival. That said I'm wondering whether you have any thoughts around that given that most of the discussions in this space focus on the percentage of TTR reduction rather than the absolute levels of TTR post treatment? Thank you.

Thanks, Kostas. Not a lot of thoughts on gene editing efforts in the TTR space. I mean, the progress that they're making is steady. Percent reductions in TTR are absolutely important for efficacy. I don't think there's a -- I think we've known for a long time that there's not a threshold effect if that's your question that there's a specific threshold by which if you lower TTR is that you'll achieve benefit on neuropathy or cardiomyopathy or whatever. But then it's actually individualized per patient and percent reductions is very important and we're very pleased with the mid-80% mean reductions that we've achieved in the neuro transform study for eplontersen in polyneuropathy patients, mid-85% range. And as you know we've -- actually a substantial number of patients actually improve. And about the eplontersen [ph] and quality of life. So I don't know what to say about those other programs except that they have a long way to go. Cardiomyopathy indications are going to require an outcome trial in our view to not just be approvable but to actually compete. And it's going to take a long time to get there. And it's a new platform that you never know what will come up. So I don't know much else to say about it other than that Kostas, but we love our program and we're very much ahead.

Thank you very much.

The next question will come from Joseph Stringer with Needle & Company. Please go ahead.

Hi. Thanks for taking the question. Just a quick one on Phase 2 GOLDEN trial and geographic atrophy. When can we expect top line data? And given some of the competitor data that's out there, can you handicap expectations on what successful Phase 2 outcome looks like. And if the results are sufficiently positive what would be the next steps in the program collaboration with Roche?

You want to take that Richard?

Yeah. I'll take a stab at it. I think, of course, we want a positive trial on geographic atrophy and comparable if not better results than have been presented by other competitors. So that's the goal. We have no insight into what that is today, but the data will be out next year second half.

Yes. So second half as Richard said in the second half of next year, what I can add to that Joe is that we also had an interim look in this Phase 2 study that allowed us to select the doses to complete the study. We started with a number of those and then whittle goes down to two doses to complete the GOLDEN Phase 2 study bring it to the finish line. We're seeing excellent tolerability, we're seeing profound reductions in Factor B and in downstream effects like split products exactly where we expect to be. So we're getting great target engagement, we're not seeing any risk associated with that target engagement by blocking the alternative complement pathway, it's going great. And what we expect to see is -- what we hope to see is slowing down of lesion, formation and improvement in visual acuity. I mean these are the outcomes that we're expecting to support a decision whether to go to Phase 3 or not. As far as competitive landscape this is a subcu once-per-month drug using -- which could use an autoinjector once it got to the market if it gets there. Simple at home auto-injector like apontersen whereas the drugs that are under review or recently been approved or intravitreal and they have side effects as you well know. So I think this -- although there's been progress made in GA, I think patients are desperately waiting for a joint that's not so invasive and simple and convenient like a subcu at-home administration.

Great. Thank you for taking our questions.

The next question will come from Myles Minter with William Blair. Please go ahead.

I just had a question on ION904. I think you've got an upcoming presentation at American Heart Association. Just wondering whether we should be thinking about similar AGT knockdown to the previous like a molecule and just more infrequent dosing or is that potential to get more than that sort of 75% that we're seeing with that molecule? Thanks very much.

You got it, Myles. So our presentation on our AGT program at AHA will really focus on the dose-dependent reductions in AGT that we sought to achieve in our -- in the Phase II study. This is a molecule that is being dosed monthly. Our earlier generation molecule that you mentioned was weekly and we expect to see greater reductions in our earlier generation molecule because it's a more advanced chemistry. So that's what we're expecting.

Great. Thanks for the question.

The last question will come from David Lebowitz with Citi. Please go ahead.

Thank you very much for taking my question. With respect to Olezarsen given the recent pivotal data, as you look forward to severe hypertriglyceridemia, how -- I know that you achieved benefits with respect to pancreatitis, you received the reductions. But given the dynamics and differences in that population. How easy do you think it's going to be to show a pancreatitis benefit?

That's a great question, David. And it's a question that our answer today is a lot different than it would have been earlier this year. The SCS data, we in our wildest dreams we hope to see the AP reductions that we saw in FCS. And those are while the streams turned into reality. So -- and as we mentioned in our remarks earlier, we have been more pleased and this is the first time anyone has demonstrated that lowering of lipid like triglycerides can actually result in other outcome in AP. My point is that our confidence has grown because the efficacy was so remarkable on reduction in AP events. And that lends confidence to the SHTG population, which although it's not a genetic form of severely elevated triglycerides, at least no known genetic causes. It's not a monogenic disease like SCS. These patients still suffer from a highly elevated triglycerides much like FCS patients. Sure, some of those patients could be in the above 500 range to 1,000 range, but many, many of these patients are in the multiple thousands or at least above 1,000 which are which puts them at very high risk for AP. So I think we're going to get AP events and in the Phase III SHTG study. And based on the effect size or the effect that we saw with Olezarsen and FCS, our confidence is growing, but we have to see that. And despite the fact that the number of AP events per patient may be less in SHTG versus FCS, it's such a bigger study. It's a much bigger study. So we're going to have much more data that we're going to collect. And as Yuji said, we have the ability to combine two Phase III studies CORE and CORE2 to really look at overall the impact of Olezarsen on AP events in SHTG.

Thanks so much for taking my question.