Breakfast News: A Conversation With Ionis CEO

Aug. 22, 2026

Ionis silences disease at the source

Biotech has been hot in 2026. The sector, tracked by the SPDR S&P Biotech ETF, (NYSEMKT: XBI) is up 39% year to date -- beating tech and running even with energy. But it's been volatile, too. Moderna's (NASDAQ: MRNA) 177% single-day pop just pulled the whole sector sharply higher. Yet as recently as April, pharma tariffs, most-favored-nation pricing, and regulatory upheaval had biotech in the red.

Ionis Pharmaceuticals (NASDAQ: IONS) knows volatility. A catalyst-rich year drove the stock to an all-time high in February. Then a surprising clinical failure sent it down more than 30% in two sessions. With four months left in the year, Ionis still has a lot ahead:

• Tryngolza won Food and Drug Administration (FDA) approval in June for extremely high levels of triglycerides, a type of fat in the blood. Eyes are now on the commercial launch.
• Zilganersen for Alexander disease: an FDA approval decision is expected by September 22.
• Bepiroversen for hepatitis B: an FDA decision is expected by October 26.
• Pelacarsen for elevated lipoprotein: results from a large study in this potentially landmark heart indication should land before year-end.

We sat down with CEO Brett Monia to talk through 2026 and beyond -- and why Ionis is thinking well past its near-term milestones.

Key insights from Ionis' CEO

On the company's transformation

• "When I moved into the CEO role in January 2020, I made the decision to fully integrate Ionis and to commercialize our own drugs, retain value, control our own destiny."
• "We are on target for the first time in our 36-year history to be cash flow break-even in 2028, and to be sustainably revenue generating after that, with a laser focus on profitability right after that."

On the technology

Antisense is Ionis's core technology. Rather than act on proteins the way most pills and antibodies do, it targets the RNA "instructions" a cell uses to build them -- switching a disease off closer to its source.

• "There's a perception that your father's antisense is Ionis's antisense today, and it's not."

On valuation

• "Just with the late-stage programs alone -- either the programs that have been recently approved or the late-stage programs that are about to read out -- we're looking at $7 billion between royalties and wholly owned commercial revenue at peak. And that is highly probabilized."

On Lp(a)

Monia defines the term himself:

• "Lipoprotein little a is produced by the liver, and we all have it. Most of us have normal levels, but if you have high levels of it -- which afflicts millions of people around the world -- you're prone to cardiovascular disease, heart attacks and strokes. And it could happen in your 20s, 30s, 40s, because you're predisposed at birth."

On the Horizon readout

Pelacarsen is an Ionis-discovered drug that lowers Lp(a), licensed to Novartis (NYSE: NVS). Novartis's ~8,300-patient Lp(a) HORIZON trial is the first to test whether lowering Lp(a) actually prevents heart attacks and strokes; the readout is expected in the second half of 2026.

• "These results will be groundbreaking, whether positive or negative, in the sense that we will be the first to test the Lp(a) hypothesis."

On neurology

• "Spinraza [was] the first-ever treatment for spinal muscular atrophy, which basically transformed a fatal condition for newborns into a chronic, manageable condition."
• "Most recently, we showed proof of concept for Alexander disease, a severe neurodegenerative disease that we expect to be approved in September. And that's our first independent launch in neurology."
• "Today we have 13 [neurology] drugs in clinical trials, more than half of which are wholly owned by Ionis."

On competition

• "When you are first, there's a lot of smart people in this world, and they follow with new chemistries. Those days are over at Ionis."

Your Take

Will Ionis Pharmaceuticals beat the market over the next 5 years and why?

The Motley Fool has positions in and recommends Ionis Pharmaceuticals and Moderna. The Motley Fool recommends SPDR Series Trust-SPDR S&P Biotech ETF. The Motley Fool has a disclosure policy.