Pharma BD Deal Intelligence
The Akcea rare-disease commercialization bet collapsed within a year of full buyout — Ionis gutted 70% of the acquired workforce and outsourced the flagship product line it had just paid to bring in-house.
Full analysis, sources & comparables →FDA clears rare disease therapy from Akcea, Ionis; Tegsedi enters market with $450,000 annual price tag and a black-box warning matching its main RNAi…
Three Akcea executives including the CEO depart in a 'disconcerting surprise' as Tegsedi launch underperforms expectations and the company struggles against…
Ionis reels its spinoff Akcea back in after disappointing commercial execution on Tegsedi and Waylivra, effectively unwinding the 2018 partnership structure.
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Ionis licensed worldwide rights to Akcea for inotersen (Tegsedi) and follow-on AKCEA-TTR-LRx in March 2018. Akcea paid $150M upfront in stock plus Ionis purchased $200M of Akcea common stock; total deal up to $1.7B including $1.3B in commercial milestones. Profit-sharing 60/40 in Ionis's favor for inotersen, transitioning to 50/50 after AKCEA-TTR-LRx launch.
The Akcea rare-disease commercialization bet collapsed within a year of full buyout — Ionis gutted 70% of the acquired workforce and outsourced the flagship product line it had just paid to bring in-house.
Assessment window: 5yr post-close.
Hereditary transthyretin amyloidosis is a rare, progressive, and fatal genetic disease caused by misfolded TTR protein depositing as amyloid in nerves and heart, producing polyneuropathy and/or cardiomyopathy. Median onset is age 68 in the US; without treatment median survival is 5-15 years from symptom onset.
The hATTR market in 2018 became a three-horse race. Alnylam's Onpattro (patisiran) launched first in August 2018 as the first approved RNAi drug, an IV every-3-weeks infusion silencing TTR mRNA. Akcea/Ionis's Tegsedi (inotersen) followed in October 2018 as a once-weekly subcutaneous antisense oligonucleotide but carried black-box warnings for thrombocytopenia and glomerulonephritis requiring weekly platelet and renal monitoring. Pfizer's Vyndaqel/Vyndamax (tafamidis), a TTR stabilizer approved May 2019 for cardiomyopathy, dominated the larger ATTR-CM segment. Survey data showed clinicians strongly favored Onpattro over Tegsedi for polyneuropathy due to safety profile, with Onpattro outpacing Tegsedi by ~4x in net revenue ($38M vs $10M in Q2 2019). Tegsedi sales never reached blockbuster expectations; combined Akcea revenue was only ~$70M in 2020. Ionis re-acquired Akcea in 2020 and licensed follow-on AKCEA-TTR-LRx (eplontersen) to AstraZeneca for $200M upfront in 2021, effectively writing off this deal's commercial thesis.
| Deal | Year | Value | Outcome |
|---|---|---|---|
| Akcea Therapeutics, Inc. / Ionis Pharmaceuticals, Inc. (this deal) | 2018 | $1.7B | 27 |
| Pfizer Inc. / FoldRx Pharmaceuticals | 2010 | — | 99 |
| Abbott Laboratories / Knoll Pharmaceuticals (BASF Pharma) | 2000 | $6.9B | 95 |
| Astra AB / Zeneca Group plc | 1998 | $35.0B | 94 |
| Merck & Co. Inc. / Acceleron Pharma Inc. | 2021 | $11.5B | 90 |
| Johnson & Johnson / Actelion Ltd | 2017 | $30.0B | 90 |
| Eli Lilly and Company / Boehringer Ingelheim GmbH | 2011 | $444M | 89 |
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