5. Ionis Pharmaceuticals
2018 median employee pay: $244,261
2018 number of employees: 737 (including 248 Akcea)
CEO: Stanley Crooke
2018 CEO pay: $7.63 million
CEO-to-employee pay ratio: 31.2:1
Ionis Pharmaceuticals and its affiliate Akcea Therapeutics officially entered commercial stage in 2018 with the launch of Tegsedi in the EU and U.S. for ultrarare disease hereditary transthyretin amyloidosis (hATTR) with polyneuropathy, which is marked by damaged nerves. But before that, its antisense technology gave commercial partner Biogen the first FDA-approved spinal muscular atrophy therapy, Spinraza, in 2016.
Thanks to Spinraza’s early approval, Stanley Crooke, M.D., Ph.D., the founder and CEO of Ionis, saw his compensation peak that year at $9.19 million. For 2018, he racked up $7.63 million, a slight increase from the $7.32 million he got in 2017.
At the same time, the pay package Ionis handed its median employee swelled 58%. In 2017, the median employee, a senior research associate, made $155,073. Last year, the median employee Ionis identified is an assistant director in drug discovery, and that person got $244,261.
Ionis also expanded its team from 547 in total as of February 2018 to 737 a year later. That was mainly thanks to new hires at Akcea, the development and commercialization branch Ionis spun out in 2015. During the period, Akcea’s total headcount increased from 100 to 248.
That said, Ionis still considers it important to remain “a small organization” that's focused on drug discovery and development. It describes the company as a place where “we get to know each other, respect each other, have each other’s back, and treat one another fairly.” To be an “Ion,” an employee is expected to have a passion for patients, be courageous to take on tough problems and challenge the status quo, set high standards, and be transparent, among other traits.
Despite Tegsedi’s green lights, 2018 was a bumpy year for Ionis. The FDA extended its review for Tegsedi for three months, handing rival Alnylam’s Onpattro the honor of being the first in the group of RNA interference drugs. But being a close second isn’t necessarily a bad thing. Ionis basically dodged a public scrutiny bullet over pricing, as first mover Alnylam defended questions around its annual list price of $450,000.
Ionis’ commercial team has its own convincing to do: Tegsedi’s label carries boxed warnings over low platelet counts and kidney toxicity that require monitoring during treatment. Patients can administer Tegsedi themselves once weekly, while Onpattro is given intravenously by a trained medical professional once every three weeks.
During the first half of 2019, Tegsedi sold $17 million, while Onpattro nabbed $64.5 million. Both drugs might soon face off against Pfizer’s oral therapy tafamidis, now being sold as Vyndaqel and Vyndamax in ATTR cardiomyopathy. Ionis is developing Tegsedi follow-on therapy AKCEA-TTR-LRx for all forms of ATTR amyloidosis, with a phase 1 readout expected this fall. That candidate aims to reduce the frequency of dosing to once a month or even less.
Then there is Waylivra (volanesorsen), Ionis’ second in-house commercial product. Last August, the FDA went against an expert panel’s earlier 12-8 favorable vote and dealt the antisense drug a complete response letter for its application in familial chylomicronemia syndrome, an ultrarare lipid disorder. Once again, the FDA flagged the risk of thrombocytopenia. And that was the only corporate objective used to evaluate executives’ pay that Ionis didn’t meet.
On the company’s second-quarter call in August, Crooke told analysts he is “encouraged by our recent productive discussions with the FDA to clarify a path” for Waylivra in the U.S. Meanwhile, the drug has won an EU nod in May and an initial launch in Germany is underway. The company also just posted positive topline results for the drug in familial partial lipodystrophy, another rare lipid disorder.
Ionis’ revenue for now is still largely dependent on collaboration payments—and it has plenty of those from large biopharma firms.
Last year, Spinraza sales almost doubled for Biogen, reaching $1.72 billion, and Ionis earned $238 million from royalties. That money helped the company’s 2018 total revenue increase 17%, to $600 million. In December, Biogen exercised its option to license tofersen (BIIB067), which Ionis designed to reduce the production of SOD1 in familial amyotrophic lateral sclerosis, on the back of positive interim phase 1 results.
Besides Biogen, Ionis has partnerships with Novartis, Bayer, AstraZeneca, Roche, GlaxoSmithKline and Janssen that span various therapeutic areas including cardiovascular, neurological disorders, cancer, hepatitis B and others.