They can still turn things around in the next two years; but it’ll take flawless business execution and a little luck — both noticeably absent so far.

I trust AstraZeneca will do what they can to make the most of the eplontersen launch for the polyneuropathy indication next year. Of course the big deal is the cardio indication. They must have a significant survival benefit there, especially against Alnylam, not to mention Pfizer. That would be lucky indeed. There’s reason to believe it might happen. Suffice it to say that the company never did make a compelling case for inotersen, which failed miserably in the marketplace against onpattro.) If the stars align, AstraZeneca is far less likely to fumble the opportunity than Ionis.

The other big deal, in my mind, is the Alzheimer’s drug with Biogen. If we’re lucky enough to have compelling results and an approvable drug, I think Biogen might decide to acquire Ionis. I suspect Ionis doesn’t have a very good deal for that drug, so maybe Biogen can live with that drain on their profits. But it would be a huge market opportunity, and Ionis is cheap, so I think a buyout is a possibility. Certainly there will be further savings with a complete overhaul of the company. (Many executives and scientists to blame for non-performance.)

Maybe Ionis can successfully execute on their fully owned prospects: olesarsen (sp?) and donidalorsen. I wouldn’t count out Onaiza just yet. (If she pulls them off, I think she might make a good COO.) Or maybe the company will have some luck with GSK, or Novartis. I think the old Bayer drug is dead — too far behind the competitive pack to be of interest to Big Pharma.

That’s as positive as I can be for the time being.