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Akcea Therapeutics, Inc.

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FY2018 Annual Report · Akcea Therapeutics, Inc.
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
FORM 10-K

☒ ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the fiscal year ended December 31, 2018

☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from ___________ to ___________

Commission file number 001-38137

Akcea Therapeutics, Inc.

(Exact name of Registrant as specified in its charter)

Delaware
(State or other jurisdiction of incorporation or organization)

22 Boston Wharf Road, 9th Floor, Boston, MA
(Address of Principal Executive Offices)

47-2608175
(IRS Employer Identification No.)

02110
(Zip Code)

617-207-0202
(Registrant’s telephone number, including area code)

Securities registered pursuant to Section 12(b) of the Act:

Title of each class
Common Stock, $.001 Par Value

Name of each exchange on which registered
The Nasdaq Stock Market, LLC

Indicate by check mark if the Registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes ☐ No ☒

Indicate by check mark if the Registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. Yes ☐ No ☒

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the
preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.
Yes ☒ No ☐

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation

S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes ☒ No☐

Indicate by check mark if disclosure of delinquent filers pursuant to Item 405 of Regulation S-K is not contained herein, and will not be contained, to the best of

Registrant’s knowledge, in definitive proxy or information statements incorporated by reference in Part III of this Form 10-K or any amendment to this Form 10-K. ☐

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company or an emerging
growth  company.  See  the  definitions  of  “large  accelerated  filer,”  “accelerated  filer,”  “smaller  reporting  company”  and  “emerging  growth  company”  in  Rule  12b-2  of  the
Exchange Act:

Large accelerated filer

Non-accelerated filer

Emerging growth company

☐  
☐  
☒  

Accelerated filer

Smaller reporting company

☒

☐

If  an  emerging  growth  company,  indicate  by  check  mark  if  the  registrant  has  elected  not  to  use  the  extended  transition  period  for  complying  with  any  new  or

revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☒

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12(b)-2 of the Securities Exchange Act of 1934). Yes ☐ No ☒

The aggregate market value of the common stock held by non‑affiliates of the registrant was approximately $209.3 million as of June 30, 2018 based upon the
closing sale price on the NASDAQ Global Select Market reported for such date. Shares of common stock held by each executive officer and director and certain holders of
more than 10% of the outstanding shares of the registrant’s common stock have been excluded in that such persons may be deemed to be affiliates. Shares of common stock
held  by  other  persons,  including  certain  other  holders  of  more  than  10%  of  the  outstanding  shares  of  common  stock,  have  not  been  excluded  in  that  such  persons  are  not
deemed to be affiliates. This determination of affiliate status is not necessarily a conclusive determination for other purposes.

The number of shares of common stock outstanding as of February 20, 2019 was 89,433,187.

DOCUMENTS INCORPORATED BY REFERENCE

Portions of the Registrant’s definitive Information Statement with the Securities and Exchange Commission in connection with the Registrant’s annual meeting of
stockholders are incorporated by reference into Part III of this Report. Such information statement will be filed with the Securities and Exchange Commission not later than
120 days following the end of the Registrant’s fiscal year ended December 31, 2018.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
FORWARD-LOOKING STATEMENTS

This  report  on  Form  10-K  and  the  information  incorporated  herein  by  reference  includes  forward-looking  statements  regarding  our
business. Any statement describing our goals, expectations, financial or other projections, intentions or beliefs, is a forward-looking statement and
should be considered an at-risk statement. Such statements are subject to certain risks and uncertainties, particularly risks related to our financial
condition and need for additional capital, the clinical development and regulatory review and approval of our drugs, the commercialization of our
drugs, our dependence on third parties to develop and commercialize our drugs, our relationship with Ionis Pharmaceuticals, Inc., our controlling
stockholder,  and  risks    related  to  our  business  and  industry  generally,  such  as  risks  inherent  in  the  process  of  discovering,  developing  and
commercializing drugs that are safe and effective for use as human therapeutics. Our forward-looking statements also involve assumptions that, if
they  never  materialize  or  prove  correct,  could  cause  our  results  to  differ  materially  from  those  expressed  or  implied  by  such  forward-looking
statements. Factors that could cause or contribute to such differences include, but are not limited to, those discussed in this report on Form 10-K,
including  those  identified  in  Item  1A  entitled  “Risk  Factors”.  Although  our  forward-looking  statements  reflect  the  good  faith  judgment  of  our
management,  these  statements  are  based  only  on  facts  and  factors  currently  known  by  us.  As  a  result,  you  are  cautioned  not  to  rely  on  these
forward-looking statements. These statements, like all statements in this report, speak only as of the date of this annual report on Form 10-K (unless
another date is indicated), and we undertake no obligation to update or revise these statements in light of future developments.

In  this  report,  unless  the  context  requires  otherwise,  “Akcea,”  “Company,”  “we,”  “our,”  and  “us”  refers  to  Akcea  Therapeutics,  Inc.  and  its

subsidiaries.

"Akcea," the Akcea logo, TEGSEDI, and other trademarks or service marks of Akcea Therapeutics, Inc. appearing in this report are the property of
Akcea  Therapeutics,  Inc.  This  report  contains  additional  trade  names,  trademarks  and  service  marks  of  others,  which  are  the  property  of  their  respective
owners. Solely for convenience, trademarks and trade names referred to in this report may appear without the ® or TM symbols.

TRADEMARKS

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PART I

Item 1.
Item 1A.
Item 1B.
Item 2.
Item 3.
Item 4.
PART II
Item 5.
Item 6.
Item 7.
Item 7A.
Item 8.
Item 9.
Item 9A.
Item 9B.

PART III
Item 10.
Item 11.
Item 12.
Item 13.
Item 14.

PART IV
Item 15.
Item 16.

Signatures

AKCEA THERAPEUTICS, INC.
ANNUAL REPORT ON FORM 10-K FOR THE YEAR ENDED DECEMBER 31, 2018
INDEX

Business
Risk Factors
Unresolved Staff Comments
Properties
Legal Proceedings
Mine Safety Disclosures

Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities
Selected Financial Data
Management’s Discussion and Analysis of Financial Condition and Results of Operations
Quantitative and Qualitative Disclosures About Market Risk
Financial Statements and Supplementary Data
Changes in and Disagreements with Accountants on Accounting and Financial Disclosure
Controls and Procedures
Other Information

Directors, Executive Officers and Corporate Governance
Executive Compensation
Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters
Certain Relationships and Related Transactions, and Director Independence
Principal Accounting Fees and Services

Exhibits, Financial Statement Schedules
Form 10-K Summary

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Item 1. Business

Overview

PART I

We are a commercial stage biopharmaceutical company developing and marketing drugs globally to treat patients with rare and serious diseases.
We are bringing novel and transformative medicines to patients by driving clinical program execution, understanding patient and physician needs, preparing
the market, creating market access, and commercializing our products on a global basis. As an affiliate of Ionis Pharmaceuticals, Inc., or Ionis, we have a
robust portfolio of development-, registration- and commercial-stage drugs covering multiple targets and diseases using antisense therapeutics. Our immediate
focus is on the commercial launch of our first commercially approved therapy, TEGSEDI in the United States, or U.S., the European Union, or E.U., and
Canada. TEGSEDI treats the polyneuropathy caused by hereditary transthyretin-mediated amyloidosis, or hATTR amyloidosis, in adults. We estimate that
there are approximately 50,000 patients globally with hATTR amyloidosis, the majority of whom have symptoms of polyneuropathy. We are also focused on
commercial preparations for WAYLIVRA in the E.U. and on regulatory discussions for WAYLIVRA in the U.S. and Canada. The Committee for Medicinal
Products  for  Human  Use,  or  CHMP,  of  the  European  Medicines  Agency,  or  EMA,  has  adopted  a  positive  opinion  recommending  conditional  marketing
authorization of WAYLIVRA as an adjunct to diet in adult patients with genetically confirmed familial chylomicronemia syndrome, or FCS, who are at high
risk for pancreatitis, in whom response to diet and triglyceride lowering therapy has been inadequate. The positive opinion will now be referred to the EC,
which  grants  marketing  authorization  for  medicines  in  the  European  Union,  as  well  as  to  European  Economic  Area  members  Iceland,  Liechtenstein  and
Norway. With this positive opinion, and, pending adoption of the positive opinion by the EC, we plan to leverage our existing commercial infrastructure in
Europe to market WAYLIVRA. FCS is an ultra-rare, devastating hereditary disease that causes unpredictable and potentially fatal acute pancreatitis, chronic
complications  due  to  permanent  organ  damage,  and  a  severe  impact  on  daily  living.  The  hallmark  of  FCS  is  extremely  elevated  triglycerides.  There  are
approximately 3,000 to 5,000 patients with FCS worldwide. We are advancing a mature pipeline of novel drugs with the potential to treat multiple diseases.
TEGSEDI,  WAYLIVRA  and  our  pipeline  drugs,  AKCEA-APO(a)-LRx,  AKCEA-ANGPTL3-LRx,  AKCEA-APOCIII-LRx  and  AKCEA-TTR-LRx,  are  all
based on Ionis’ antisense technology platform. Our pipeline drugs use Ionis' advanced Ligand Conjugated Antisense, or LICA, technology, which enhances
the effective uptake and activity of these drugs in particular tissues.

TEGSEDI is the world’s first subcutaneous, RNA-targeted therapeutic that substantially reduces the production of transthyretin, or TTR protein.
Importantly,  TEGSEDI  is  Akcea’s  first  commercially  approved  drug,  and  our  launch  is  underway  in  three  regions:  the  U.S.,  the  E.U.  and  Canada.  We
continue to work toward our goal to make TEGSEDI available to people globally.

We are continuing to build our commercial infrastructure to support TEGSEDI, and plan to use this infrastructure to support WAYLIVRA and the
other drugs in our pipeline, if approved in the future as we anticipate further commercialization in serious and rare diseases. A key element of our commercial
strategy  is  to  provide  the  specialized,  patient-centric  support  required  to  successfully  address  rare  disease  patient  populations.  We  believe  our  focus  on
treating  patients  with  inadequately  addressed  rare  and  serious  diseases  will  allow  us  to  partner  efficiently  and  effectively  with  the  specialized  medical
community that supports these underserved patient communities. For example, at approval we launched Akcea ConnectTM, a drug treatment program made
up  of  dedicated,  regionally-based  nurse  case  managers  who  have  a  wide  range  of  medical  knowledge  and  experience,  in  the  United  States.  This  program
offers free, private and personalized support to patients and their caregivers and families across the country. Internationally, Akcea Connect is being rolled out
in  each  of  the  countries  where  we  launch  with  what  we  believe  is  the  highest  level  of  patient  and  physician  support  allowed  in  accordance  with  local
regulations. In addition, in August 2018 we entered into an agreement with Express Scripts’ Accredo to be our specialty pharmacy partner for the distribution
of TEGSEDI in the U.S. We chose Express Scripts’ Accredo Health Group, Inc., or Accredo because of their experience supporting the unique needs of rare
disease communities and their proven track record for simplifying access to therapy. Accredo has a team of specialty clinicians, pharmacists and over 600
field-based nurses located throughout the U.S. who are augmenting the Akcea Connect team of nurse case managers to provide support and address the needs
of  the  hATTR  amyloidosis  community.  Our  supply  chain  is  fully  operational  in  the  U.S.,  E.U.  and  Canada.    To  further  support  the  hATTR  amyloidosis
community, Akcea and Ambry Genetics Corporation, or Ambry, a Konica Minolta company, launched hATTR Compass™ in the U.S. and Canada, a no-cost,
confidential genetic testing and genetic counseling program for people with suspected hATTR amyloidosis. This program is intended to empower people with
accurate genetic information, so they can make informed decisions about their healthcare.

4

 
As we build Akcea, we continue to execute a strategy for expansion of our business globally. Depending on the geographic region, the number of
patients  impacted  by  the  diseases  we  are  treating  and  the  regulatory  environment  of  the  local  countries,  in  some  regions  we  may  choose  to  build  out  the
commercial  infrastructure  ourselves,  and  in  other  instances,  we  may  choose  to  partner  with  another  company  for  commercial  sales  and  distribution.  For
instance,  in  August  2018,  we  entered  into  a  licensing  agreement  with  PTC  Therapeutics  International  Limited,  or  PTC  Therapeutics,  to  commercialize
TEGSEDI and WAYLIVRA in Latin America and certain Caribbean countries. Our decision to partner with PTC to accelerate commercial access for patients
in Latin America reflects our commitment to bringing TEGSEDI and WAYLIVRA to patients as rapidly as possible. PTC has an established rare disease team
in Latin America that has experience in patient identification, in physician and patient education and support programs and in efficiently obtaining market
access. PTC’s patient-focused approach for rare diseases aligns with our approach, making them a great partner for this region.

To  maximize  the  commercial  potential  of  two  of  the  drugs  in  our  pipeline,  we  initiated  a  strategic  collaboration  with  Novartis  Pharma AG,  or
Novartis, for the development and commercialization of AKCEA-APO(a)-LRx and AKCEA-APOCIII-LRx. In February 2019, Novartis exercised its option to
license AKCEA-APO(a)-LRx. Novartis is currently preparing to initiate a Phase 3 study of AKCEA-APO(a)-LRx in patients with established cardiovascular
disease (CVD) and elevated levels of lipoprotein(a), or Lp(a). We believe Novartis brings significant resources and expertise to the collaboration that can
accelerate our ability to deliver these potential therapies to the large populations of patients who have high cardiovascular risk due to inadequately treated
lipid  disorders.  As  part  of  our  collaboration,  we  received  $75.0  million  in  an  upfront  option  payment,  of  which  we  retained  $60.0  million  and  paid
$15.0 million to Ionis as a sublicense fee. We also earned a $150.0 million license fee when Novartis exercised its option to license AKCEA-APO(a)-LRx of
which we will pay $75.0 million to Ionis as a sublicense fee. We will pay Ionis the sublicense fee in Akcea common stock. Novartis is now responsible for all
future development and commercialization activities for AKCEA-APO(a)-LRx. We are eligible to receive license fees, milestone payments and royalties on
sales of AKCEA-APO(a)-LRx from Novartis if and when it meets the development, regulatory and sales milestones specified in our agreement. In connection
with Novartis’ exercise of its option to exclusively license AKCEA-APO(a)-LRx, Akcea and Novartis established a more definitive framework under which
they would negotiate the co-commercialization of AKCEA-APO(a)-LRx between the two companies in selected markets. Included in this framework is an
option  by  which  Novartis  could  solely  commercialize  AKCEA-APO(a)-LRx  in  exchange  for  Novartis  paying  Akcea  increased  commercial  milestone
payments based on sales of AKCEA-APO(a)-LRx. We will share any license fees, milestone payments and royalties equally with Ionis.

For AKCEA-APOCIII-LRx,  under  our  agreement  with  Novartis,  after  we  complete  Phase  2  development  and  if  Novartis  exercises  its  option  to
license  AKCEA-APOCIII-LRx,  we  would  receive  an  additional  $150.0  million  license  fee  which  we  would  also  share  equally  with  Ionis.  If  exercised,
Novartis would conduct and pay for a Phase 3 cardiovascular outcome study in patients with hypertriglyceridemia and prior cardiovascular risk. If approved,
Novartis  would  commercialize  AKCEA-APOCIII-LRx worldwide.  Novartis  will  have  60  days  plus  additional  time  that  could  be  required  for  Hart-Scott-
Rodino, or HSR, filing and review following the end-of-Phase 2 meeting to exercise its option for AKCEA-APOCIII-LRx. As part of the collaboration, we
may  co-commercialize  AKCEA-APOCIII-LRx  in  selected  markets,  on  mutually  agreed  terms  and  conditions.  Similar  to  AKCEA-APO(a)-LRx,  we  are
eligible to receive license fees, milestone payments and royalties on sales of AKCEA-APOCIII-LRx from Novartis if and when it meets the development,
regulatory and sales milestones specified in our agreement. We will share any license fees, milestone payments and royalties equally with Ionis.

Our Strategy

We believe we are on our way to becoming a premier global biotechnology company offering treatments for previously inadequately treated serious

and rare diseases. The critical components of our business strategy to achieve this goal include the following:

•

Successfully commercialize TEGSEDI in multiple geographies and WAYLIVRA in the E.U.:  We are currently marketing TEGSEDI in the
U.S., E.U. and Canada. In addition, we are preparing to market WAYLIVRA in the E.U. pending the EC’s adoption of the positive CHMP
opinion. We have built a commercial organization in multiple countries and will continue to assess opportunities to grow in other markets as
well.  We  are  providing  high  touch  patient  and  healthcare  provider  support  through  Akcea  Connect.  This  team  of  dedicated  nurse  case
managers provide reimbursement assistance, injection training and support for routine platelet monitoring, which we believe enables strong
integration with treating physicians and should facilitate patient uptake and compliance. We also have partnered with PTC Therapeutics to
commercialize TEGSEDI and WAYLIVRA in Latin America (LATAM) and certain countries in the Caribbean. We believe our collaboration
with PTC is the best way to provide these drugs to patients quickly in these markets. We also believe PTC shares the same patient-focus that
we do and will be able to provide the same patient services as appropriate in each of the LATAM countries. Now that TEGSEDI is approved,
our  aim  is  to  make  it  available  globally  and  we  will  continue  to  assess  expanding  our  own  global  footprint  as  well  as  additional  strategic
partnerships as we continue to commercialize TEGSEDI.

5

 
 
•

•

Advance multiple novel clinical-stage drugs to commercialization and further grow our pipeline. We seek to maximize near-term and long-
term commercial opportunities through development paths in both orphan and broader patient populations. Our pipeline of antisense drugs
currently contains five clinical-stage novel therapies that we plan to develop and commercialize by ourselves or in conjunction with a partner
for multiple indications. To sustain our goal of being the premier rare and serious disease company, we also plan to actively replenish our
pipeline as our current drugs advance through development. For example, we will have the opportunity to potentially license antisense drugs
that Ionis advances to treat rare cardiometabolic and rare inherited metabolic diseases under our right of first negotiation that Ionis granted us.
In addition to antisense technology, we are open to other technologies and products where we could potentially leverage our commercial and
development expertise in rare diseases.

Create  value  through  strategic  collaborations,  to  drive  drugs  to  their  fullest  potential.   We  believe  that  some  of  our  drugs  could  address
diseases with very large patient populations. In these patient populations, large, costly, late-stage clinical development programs, as well as
large sales forces, are required to maximize a drug's commercial potential. As a result, in some cases, partnering with a large organization with
global  scale  may  be  the  optimal  approach  for  maximizing  the  potential  of  drugs  in  these  indications.  As  an  example,  we  have  a  strategic
collaboration with Novartis for AKCEA-APO(a)-LRx and AKCEA-APOCIII-LRx. Novartis recently exercised its option to license AKCEA-
APO(a)-LRx and as a result they are responsible for all future clinical development and commercial activities and costs. Novartis is currently
planning for a Phase 3 cardiovascular outcomes study for AKCEA-APO(a)-LRx and initiation activities are underway. If they exercise their
right to license AKCEA-APOCIII-LRx they could also provide us with an opportunity to move rapidly to Phase 3 cardiovascular outcome
studies, enhancing the commercial potential of that drug as well. We also may co-commercialize these two drugs in selected markets, under
terms and conditions that we plan to negotiate with Novartis in the future. We believe Novartis brings significant resources and expertise to
the  collaboration  that  can  accelerate  our  ability  to  deliver  these  potential  therapies  to  the  large  populations  of  patients  who  have  high
cardiovascular risk due to inadequately treated lipid disorders.

MARKETED THERAPY

TEGSEDI

TEGSEDI is a drug that Ionis discovered and developed using Ionis’ proprietary antisense technology platform. TEGSEDI is designed to reduce
the production of transthyretin, or TTR, protein. In patients with hereditary transthyretin, or hATTR, amyloidosis, a severe, rare and fatal genetic disease, both
the hereditary and wild-type, or wt, TTR protein builds up as fibrils in tissues, such as the peripheral nerves, heart, gastrointestinal system, eyes, kidneys,
central  nervous  system,  thyroid  and  bone  marrow.  The  presence  of  TTR  fibrils  interferes  with  the  normal  functions  of  these  tissues.  The  progressive
accumulation of TTR amyloid deposits in these tissues and organs leads to sensory, motor and autonomic dysfunction often having debilitating effects on
multiple aspects of a patient’s life and eventually leads to death.

TEGSEDI is now approved in three markets: the U.S., E.U. and Canada. On October 5, 2018, we received approval from the U.S. Food and Drug
Administration,  or  FDA,  for  TEGSEDI  for  the  treatment  of  the  polyneuropathy  of  hATTR  amyloidosis  in  adults.  On  October  3,  2018,  TEGSEDI  was
approved  by  Health  Canada  for  the  treatment  of  stage  1  or  stage  2  polyneuropathy  in  adult  patients  with  hATTR  amyloidosis.  And  on  July  11,  2018,
TEGSEDI received marketing authorization, or MA, approval from the European Commission, or EC, for the treatment of stage 1 or stage 2 polyneuropathy
in adult patients with hATTR amyloidosis.  We estimate that there are approximately 50,000 patients globally with hATTR amyloidosis, the majority of whom
have symptoms of polyneuropathy. TEGSEDI is available in the U.S., Germany and Canada and we continue to work today on making TEGSEDI available to
patients across various European countries with the ultimate goal of making TEGSEDI available to patients globally.

Disease Background

hATTR amyloidosis is a rare, progressive, and fatal disease that often affects multiple organs, including the nerves, heart, gastrointestinal tract and
kidneys. hATTR amyloidosis occurs when misfolded TTR protein deposits throughout the body as amyloid fibrils, disrupting tissue and organ structure and
function. The burden of hATTR amyloidosis is high as patients often suffer from progressive neuropathy, cardiac, gastrointestinal and psychosocial symptoms
affecting every aspect of their life. Without therapeutic intervention, patient quality of life progressively and rapidly deteriorates, leading to a reduction in
ambulation and daily function, and ultimately resulting in premature death. As the disease progresses, many patients are no longer able to work and or are
forced to take substantial time off. The impact of the disease is not limited to physical symptoms but also impacts mental health and outlook as patients often
live in fear and isolation. An accurate and timely diagnosis and early treatment initiation is critical to optimize disease management.

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PIPELINE

All products were discovered by Ionis and either developed by Ionis or co-developed by Ionis and Akcea.

WAYLIVRA

WAYLIVRA  was  discovered  by  Ionis  and  is  being  co-developed  by  Akcea  and  Ionis  and  is  based  on  Ionis’  antisense  technology  platform.
WAYLIVRA  is  designed  to  address  the  serious  and  unmet  medical  needs  of  the  underserved  FCS  patient  community.  We  are  focused  on  commercial
preparations  for  WAYLIVRA  in  the  E.U.  and  on  regulatory  discussions  for  WAYLIVRA  in  the  U.S.  and  Canada.  The  CHMP  of  the  EMA  has  adopted  a
positive opinion recommending conditional marketing authorization of WAYLIVRA as an adjunct to diet in adult patients with genetically confirmed FCS
who  are  at  high  risk  for  pancreatitis,  in  whom  response  to  diet  and  triglyceride  lowering  therapy  has  been  inadequate.  The  positive  opinion  will  now  be
referred  to  the  EC,  which  grants  marketing  authorization  for  medicines  in  the  European  Union,  as  well  as  to  European  Economic  Area  members  Iceland,
Liechtenstein and Norway. With this positive opinion, and, pending adoption of the positive opinion by the EC, we plan to leverage our existing commercial
infrastructure in Europe to market WAYLIVRA. In the U.S., on May 10, 2018, the FDA’s Endocrinologic and Metabolic Drugs Advisory Committee voted to
support approval of WAYLIVRA for the treatment of people with FCS. On August 27, 2018, we and Ionis announced that we received a Complete Response
Letter from the Division of Metabolism and Endocrinology Products of the FDA regarding the New Drug Application for WAYLIVRA. The FDA did not cite
any  new  concerns  beyond  those  described  in  the  advisory  committee  briefing  book,  in  which  the  main  areas  of  focus  were  the  dosing  schedule  and
management of thrombocytopenia, a deficiency of platelets in the blood. In November 2018, we received a Notice of Noncompliance withdrawal letter, or
NON-W, from Health Canada for WAYLIVRA. We and Ionis are engaged with the FDA and plan to work with Health Canada to confirm a path forward for
WAYLIVRA.

FCS is a severe and rare lipid disorder characterized by extremely elevated levels of triglycerides. FCS has life-threatening consequences such as
acute  pancreatitis  and  the  lives  of  patients  with  this  disease  are  impacted  daily  by  the  associated  symptoms.  In  our  clinical  program,  we  have  observed
consistent and substantial (>70%) decreases in triglycerides and improvements in other manifestations of FCS, including pancreatitis attacks and abdominal
pain. We believe the safety and efficacy data from the WAYLIVRA program demonstrate a favorable risk-benefit profile for patients with FCS. The FDA and
EMA have granted orphan drug designation to WAYLIVRA for the treatment of patients with FCS.

7

 
 
 
WAYLIVRA is also in Phase 3 clinical development for the treatment of familial partial lipodystrophy, or FPL. People with FPL lack subcutaneous
adipose  tissue  and  have  abnormal  subcutaneous  fat  distribution  causing  increased  incidence  of  potentially  life-threatening  pancreatitis,  diabetes,  extreme
insulin resistance and increased liver fat. BROADEN is a randomized, double-blind, placebo-controlled study of 300 mg of WAYLIVRA administered by a
subcutaneous injection in patients with FPL. We plan to report results from the BROADEN study this year.

LICA Pipeline

The  other  drugs  in  our  pipeline  -  AKCEA-APO(a)-LRx, AKCEA-ANGPTL3-LRx,  AKCEA-APOCIII-LRx  and  AKCEA-TTR-LRx  utilize  Ionis'
advanced Ligand Conjugated Antisense, or LICA, technology. LICA technology conjugates specific chemical structures or molecules to antisense drugs to
increase the efficiency of drug uptake in a particular tissue. We believe the enhancements from LICA technology have the potential to allow for less frequent
administration  and  significantly  lower  doses,  providing  greater  patient  convenience.  Data  from  a  number  of  Phase  1  studies  and  our  Phase  2  study  of
AKCEA-APO(a)-LRx  have  shown  that  doses  up  to  30-fold  lower  than  non-LICA  drugs  result  in  consistent  target  reductions  and  a  favorable  safety  and
tolerability  profile.  Our  current  pipeline  includes  drugs  with  the  potential  to  treat  patients  with  ATTR  and  a  wide  range  of  lipid  disorders  associated  with
cardiometabolic disease that other technologies, such as small molecules and antibodies, have not been able to adequately address.

Our clinical pipeline contains novel drugs with the potential to treat inadequately addressed serious and rare disorders.

AKCEA-APO(a)-LRx. We are developing AKCEA-APO(a)-LRx for patients who are at significant risk of cardiovascular disease, or CVD,
because of their elevated levels of Lp(a). AKCEA-APO(a)-LRx inhibits the production of the apolipoprotein(a), or apo(a), protein, thereby
reducing  Lp(a).  Apo(a)  is  a  form  of  low-density  lipoprotein,  or  LDL,  that  is  very  atherogenic  (promoting  the  formation  of  plaques  in  the
arteries) and very thrombogenic (promoting the formation of blood clots). In September 2018, we reported positive results from the Phase 2
dose-ranging study of AKCEA-APO(a)-LRx in patients with elevated levels of Lp(a) greater than 60 mg/dL, and established CVD.

In February 2019, Novartis exercised its option to license AKCEA-APO(a)-LRx. Planning and initiation activities are underway for Novartis
to  run  a  Phase  3  cardiovascular  outcomes  study  of  AKCEA-APO(a)-LRx  in  patients  with  established  CVD  and  elevated  levels  of
lipoprotein(a), or Lp(a). We believe Novartis brings significant resources and expertise to the collaboration that can accelerate our ability to
deliver this potential therapy to patients at risk of CVD due to elevated levels of Lp(a). If AKCEA-APO(a)-LRx is approved, Novartis will be
responsible  for  worldwide  commercialization.  As  part  of  the  collaboration,  we  may  co-commercialize  AKCEA-APO(a)-LRx  in  selected
markets, on mutually agreed terms and conditions.

Novartis’ decision follows positive results from a Phase 2 study in this patient population. The Phase 2 study was designed to evaluate the
safety  and  tolerability  of  AKCEA-APO(a)-LRx  and  to  determine  the  appropriate  dosing  for  a  planned  Phase  3  cardiovascular  outcomes
study.  The randomized, double-blind, placebo-controlled, dose-ranging Phase 2 study included 286 patients with established CVD and high
Lp(a) levels (baseline mean of approximately 100mg/dL [250 nmol/L] - more than three times the upper limit of normal). The trial had five
cohorts: 20 mg (every 4 weeks), 40 mg (every 4 weeks), 60 (every 4 weeks), 20 mg (every 2 weeks), and 20 mg (every week). The primary
efficacy  endpoint  was  the  percent  change  in  Lp(a)  from  baseline  at  the  primary  analysis  time  point  (6  months)  compared  to  placebo.  The
secondary  efficacy  endpoints  were  mean  percent  change  in  LDL-C,  apoB,  OxPL-apoB,  OxPL-apo(a),  and  the  number  of  patients  reaching
pre-specific  thresholds  of  Lp(a)  reduction  of  <125  nmol/L  (<50  mg/dL)  or  <75  nmol/L  (<30  mg/dL).  Patients  were  treated  with  AKCEA-
APO(a)-LRx or placebo for at least six months, with some patients treated up to one year. The study met all primary and secondary efficacy
endpoints analyzed at 6 months. Results from the study show statistically significant and dose dependent reductions from baseline in Lp(a)
levels:

Lp(a)

LSMean % change in Lp(a)

Pooled placebo
(n=47)
-6

*LSMean: Least squares mean

20 mg every
4 weeks
(n=48)
-35
P=0.0032

8

40 mg every
4 weeks
(n=48)
-56
P<0.0001

20 mg every
2 weeks
(n=48)
-58
P<0.0001

60 mg every
4 weeks
(n=47)
-72
P<0.0001

20 mg weekly
(n=48)
-80
P<0.0001

 
 
•

•

Approximately 98% of patients in the 20mg weekly cohort and approximately 81% of patients in the 60mg every 4 week cohort achieved
clinically significant reductions in Lp(a) levels bringing them below the recommended threshold of risk for CVD events (<50 mg/dL).

Treatment with AKCEA-APO(a)-LRx was associated with decreases in LDL-C, apoB, OxPL-apoB, OxPL-apo(a).

• Most adverse events were mild.  The most frequent adverse events were injection site reactions, or ISRs. ISRs occurred in 26% of patients and

•

•

were mostly mild and one patient discontinued due to an ISR.

There were no safety concerns related to platelet counts, liver function or renal function.

No  patient  in  the  study  experienced  a  confirmed  platelet  count  below  100,000/mm3.  The  incidence  of  platelet  levels  below  normal
(140,000/mm3) was comparable between the active (10.5%) and placebo (14.9%) groups.

Approximately  90%  of  patients  completed  treatment  and  the  rate  of  discontinuation  was  comparable  between  the  active  (12.1%)  and  placebo
(14.9%) groups.

Disease Background

Despite the management of LDL-C with statins and other therapies, the incidence of CVD continues to rise dramatically. Lipid disorders
are a cause of this continuing rise. Hyperlipoproteinemia(a), defined as levels of Lp(a) above 30mg/dL,  which is present in approximately 20% of
the general population, causes CVD.

Currently, there is no effective drug therapy to specifically and robustly lower elevated levels of Lp(a). Lp(a) levels are determined at
birth and, therefore, lifestyle modification, including diet and exercise, do not impact Lp(a) levels. Statins do not have significant effects on Lp(a)
levels. Further, a new class of drugs that lower LDL-C and modestly lower Lp(a) levels, known as PCSK9 inhibitors, inactivate a protein in the
plasma that regulates the number of LDL receptors on the liver cell surface, thereby capturing and removing additional LDL particles from the
blood. While PCSK9 inhibitors reduce Lp(a) by approximately 25%, we believe this level of reduction is unlikely to materially reduce the risk of
cardiovascular  events  related  to  hyperlipoproteinemia(a).  The  only  currently  known  effective  way  to  significantly  reduce  plasma  Lp(a)  is  to
physically  remove  the  particles  from  blood  through  a  process  called  apheresis.  In  this  process,  the  patient's  blood  is  filtered  through  a  machine
where  the  LDL-C  and  Lp(a)  particles  are  removed  and  the  blood  is  returned  to  the  patient's  body.  Since  2010,  apheresis  has  been  an  approved
therapy in Germany to treat patients with hyperlipoproteinemia(a), but it is expensive, time consuming and only performed by a small number of
centers worldwide. Lp(a) apheresis has been shown to lower the rate of cardiovascular events, providing support that lowering Lp(a) can provide
therapeutic benefit.

A  number  of  expert  groups,  including  the  National  Institutes  for  Health,  European  Society  of  Cardiology  and  the  National  Lipid
Association,  and  publications  have  stated  that  Lp(a)  is  an  independent  cause  of  cardiovascular  risk.  The  authors  of  three  such  publications
evaluated  data  from  over  180,000  participants  and  used  statistical  and  genetic  approaches  to  evaluate  the  correlation  between  Lp(a)  levels  and
cardiovascular  risk.  The  specific  techniques  the  authors  used  were  epidemiological/meta-analyses,  Mendelian  randomization  and  genome  wide
associations. In each technique used, the authors demonstrated a clear relationship between elevated levels of Lp(a) and increased cardiovascular
risk.

The graphics below further illustrate these correlations:

9

 
 
 
 
 
 
 
 
AKCEA-APO(a)-LRx Commercial Opportunity

Elevated levels of Lp(a) are associated with increased cardiovascular risk and lowering Lp(a) may reduce the risk. We estimate eligible
population, patients with elevated levels of Lp(a) and prior CVD, to be greater than 8 million people globally. We believe that positive results from
a large cardiovascular outcome study will be required to support marketing authorization for the treatment of these patients. Since Novartis has
licensed  AKCEA-APO(a)-LRx,  it  will  conduct,  at  its  expense,  such  a  study  pursuant  to  our  strategic  collaboration  and,  if  approved,  will
commercialize AKCEA-APO(a)-LRx for these patients. As part of the collaboration, we may co-commercialize AKCEA-APO(a)-LRx in selected
markets, on mutually agreed terms and conditions.

•

AKCEA-ANGPTL3-LRx.  We  are  developing  AKCEA-ANGPTL3-LRx  to  treat  nonalcoholic  fatty  liver  disease,  or  NAFLD.  In  preclinical
studies,  an  analog  of  AKCEA-ANGPTL3-L  Rx  inhibited  the  production  of  the  angiopoietin-like  3,  or  ANGPTL3,  protein  in  the  liver,
inhibiting liver fat accumulation and lowering blood levels of triglycerides, LDL-C and very-low-density lipoprotein cholesterol, or VLDL-C.
We have completed a Phase 1/2 program for AKCEA-ANGPTL3-L Rx in people with elevated triglycerides. We observed that the people with
elevated triglycerides treated with AKCEA-ANGPTL3-LRx achieved dose-dependent, statistically significant mean reductions in ANGPTL3
of up to 83%. Treatment with AKCEA-ANGPTL3-LRx was also associated with statistically significant mean reductions in triglycerides of up
to 66%, in LDL-C of up to 35% and in total cholesterol of up to 36%. In this study, AKCEA-ANGPTL3-LRx showed a safety and tolerability
profile supporting further development. The most common adverse events in the AKCEA-ANGPTL3-LRx treated group of patients were mild
headaches and dizziness that were approximately equal to the rate observed in the placebo group. We reported results for the initial cohort
from this study at the AHA meeting in November 2016 and published the data in the New England Journal of Medicine. We initiated a study
of  AKCEA-ANGPTL3-L  Rx  in  patients  with  NAFLD  with  metabolic  complications  that  include  hypertriglyceridemia,  type  2  diabetes  or
nonalcoholic steatohepatitis, or NASH. We expect data from this study in 2020. Further, we have a small ongoing pilot study of AKCEA-
ANGPTL3-L Rx in patients with rare hyperlipidemias.

Disease Background

Fatty liver disease

While some fat in the liver is normal, a significant percentage of individuals have elevated levels of liver fat. Individuals with excessive
fat accumulation in the liver also have elevated risk of developing insulin resistance and metabolic syndrome, type 2 diabetes and CVD. These
risks are further elevated in patients with hyperlipidemia, especially those with elevated triglyceride levels. The most common form of fatty liver
disease is NAFLD, which is associated with obesity-related disorders even in patients who drink little or no alcohol, and is characterized by the
gradual accumulation of fat in the liver, or steatosis. One of the key causes of this condition is the Western diet, which is rich in processed foods
with high fat and sugar content. In the early stages of NAFLD, patients typically experience steatosis that is slow progressing. Over time, a subset
of these patients progresses to steatohepatitis, a more severe and progressive form of NAFLD characterized by chronic inflammation and liver-cell
damage,  called  NASH.  Eventually,  the  chronic  inflammation  caused  by  NASH  can  lead  to  the  formation  of  scar  tissue  in  the  liver,  known  as
fibrosis. As scar tissue gradually replaces healthy liver tissue, blood flow is restricted, which can lead to the loss of normal liver function, cirrhosis,
portal hypertension, liver cancer and ultimately liver failure. Currently, there are no approved treatments specifically for NAFLD or NASH. If the
disease ultimately progresses beyond NASH, the only alternative is a liver transplant.

AKCEA-ANGPTL3-LRx Commercial Opportunity

NAFLD is the most common chronic liver disease worldwide and more than 75 million patients are affected in the United States alone.
Approximately 30% of patients with NAFLD will eventually progress to NASH. In the United States, the most recent epidemiological studies show
that approximately 3% to 5% of the general population has NASH. We believe there are a comparable number of patients in Europe and the rest of
the world. While there are a number of treatments currently in development for the treatment of NAFLD and NASH, none are currently approved
and we believe there will continue to be a significant unmet medical need in this population.

•

AKCEA-APOCIII-LRx.  We  are  developing  AKCEA-APOCIII-LRx  to  inhibit  the  production  of  apoC-III,  the  same  protein  inhibited  by
WAYLIVRA, for the broad population of patients who have cardiometabolic disease due to their elevated triglyceride levels. We believe that
the enhancements offered by Ionis' LICA technology can provide greater patient convenience by allowing for significantly lower doses, less
frequent administration and a favorable safety and tolerability profile. We conducted a Phase 1/2 study of AKCEA-APOCIII-L Rx in people
with  elevated  triglycerides  and  reported  positive  results  from  this  study  in  the  second  half  of  2017  with  a  safety  and  tolerability  profile
supporting

10

 
 
 
further development. We have initiated a strategic collaboration with Novartis for this drug. In this collaboration, we intend to complete the
Phase 2 program required to define the appropriate dose and regimen to support a planned cardiovascular outcome study. We recently initiated
a Phase 2b dose-ranging study of AKCEA-APOCIII-L Rx in patients with hypertriglyceridemia and established CVD and plan to report data
from this study in 2020. At the completion of Phase 2 development, Novartis has an option to license the drug. Novartis will have 60 days
plus  additional  time  that  could  be  required  for  a  Hart-Scott-Rodino,  or  HSR,  filing  and  review  following  the  end-of-Phase  2  meeting  to
exercise its option for AKCEA-APOCIII-LRx. If Novartis exercises its option to license AKCEA-APOCIII-LRx, Novartis plans to conduct
and  pay  for  a  Phase  3  cardiovascular  outcome  study  in  high-risk  patients  and,  if  approved,  to  commercialize  AKCEA-APOCIII-L  Rx
worldwide. As part of the collaboration, we may co-commercialize AKCEA- APOCIII-LRx in selected markets, on mutually agreed terms and
conditions.

Disease Background

ApoC-III is an important emerging target linking hypertriglyceridemia with CVD. Several studies have found that apoC-III levels are an
independent risk factor for CVD. Further, its presence on lipoproteins may increase their atherogenicity. A study in the New England Journal of
Medicine reported that out of a sample of over 100,000 people, individuals with an apoC-III gene loss of function mutation had a reduced risk of
clinical coronary heart disease. Each decrease of 1 mg/dL in plasma levels of apoC-III was associated with a 4% decrease in the risk of incident
coronary  heart  disease.  Triglycerides  may  also  play  a  role  in  cardiovascular  risk.  As  shown  in  the  figure  below,  in  two  separate  studies
encompassing  nearly  20,000  patients,  as  triglyceride  levels  increased,  so  did  the  risk  of  a  cardiovascular  event.  In  summary,  apoC-III  impacts
triglyceride levels and may also increase inflammatory processes, and this combination of effects makes apoC-III a promising target for reducing
the residual CVD risk in patients already on statin therapy, but for whom triglycerides are poorly controlled.

AKCEA-APOCIII-LRx Commercial Opportunity

ApoC-III levels and elevated triglycerides have been linked to increased cardiovascular risk and lowering apoC-III and triglycerides may
reduce  this  risk.  We  estimate  the  eligible  population  to  be  greater  than  8  million  people  globally.  We  believe  that  positive  results  from  a  large
cardiovascular outcome study will be required to support marketing authorization for the treatment of these patients. If Novartis exercises its option
to license AKCEA-APOCIII-LRx, it plans to conduct, at its expense, such a study pursuant to our strategic collaboration to conduct this study and
to  commercialize  AKCEA-APOCIII-LRx  for  these  patients.  As  part  of  the  collaboration,  we  may  co-commercialize  AKCEA-APOCIII-LRx  in
selected markets, on mutually agreed terms and conditions.

•

AKCEA-TTR-LRx. We are developing AKCEA-TTR-LRx to treat the broad population of patients with both hereditary and wild-type forms of
transthyretin amyloidosis, or ATTR amyloidosis.  Based on its profile, we believe AKCEA-TTR-LRx treatment can significantly reduce levels
of  the  TTR  protein,  which  we  believe  will  translate  to  efficacy  in  terms  of  both  clinical  benefit  and  quality  of  life  improvements  with  a
favorable  safety  and  tolerability  profile.  As  with  other  LICA  medicines,  we  believe  we  can  achieve  this  positive  efficacy,  safety  and
tolerability profile with low doses and with the potential for monthly dosing. We initiated a Phase 1/2 study of AKCEA-TTR-LRx in the fourth
quarter of 2018 and are working toward a goal of initiating the Phase 3 program in 2019.

11

 
 
 
 
 
Disease Background

hATTR amyloidosis is a rare, progressive, and fatal disease that often affects multiple organs, including the nerves, heart, gastrointestinal
tract and kidneys. hATTR amyloidosis occurs when misfolded TTR protein deposits throughout the body as amyloid fibrils, disrupting tissue and
organ  structure  and  function.  The  burden  of  hATTR  amyloidosis  is  high  as  patients  often  suffer  from  progressive  neuropathy,  cardiac,
gastrointestinal  and  psychosocial  symptoms  affecting  every  aspect  of  their  life.  Without  therapeutic  intervention,  patient  quality  of  life
progressively and rapidly deteriorates, leading to a reduction in ambulation and daily function, and ultimately resulting in premature death. As the
disease progresses, many patients are no longer able to work and or are forced to take substantial time off. The impact of the disease is not limited
to physical symptoms but also impacts mental health and outlook as patients often live in fear and isolation. An accurate and timely diagnosis and
early treatment initiation is critical to optimize disease management.

AKCEA-TTR-LRx Commercial Opportunity

The introduction of new medicines for the ATTR amyloidosis community will increase awareness and diagnosis while AKCEA-TTR-
LRx is  being  developed.  There  are  currently  around  50,000  hATTR  amyloidosis  patients  worldwide  and  we  believe  that  approximately  60%  of
patients  have  symptoms  of  both  polyneuropathy  and  cardiomyopathy.  We  believe  the  number  of  people  with  predominant  cardiomyopathy
symptoms is significantly underdiagnosed. We believe this is especially true in the African American population in which approximately 3% carry
the  V122I  mutation,  one  of  the  most  dominant  mutations  causing  ATTR.  The  epidemiology  of  wild-type  TTR  amyloidosis  is  not  well
characterized, but the number of patients diagnosed is rapidly increasing. It is estimated that there are more than 200,000 diagnosed people with
wild-type ATTR.

Technology Overview

Antisense Technology

Ionis discovered each of the drugs in our pipeline using its innovative antisense technology platform. Antisense technology is based on the use of
synthetic nucleic acid sequences, which are primarily used to interrupt the production of a specified protein by targeting the specific corresponding messenger
RNA, or mRNA, that encodes that protein. In this way, antisense drugs can be used to reduce the level of proteins that cause, or contribute to, the progression
of  various  diseases.  Because  there  are  virtually  no  undruggable  mRNA  targets,  we  believe  antisense  technology  may  have  broader  potential  than  small
molecule- and antibody-based technologies that target proteins. Furthermore, antisense technology has the potential to target a growing number of disease-
related  genes  more  directly  and  efficiently  than  other  protein-directed  modalities.  We  believe  this  technology  represents  an  important  advance  in  treating
diseases.

The production of a protein starts with a process called transcription, where the instructions for making a protein are transcribed from a gene, or
DNA, into mRNA. The cell's protein production process is called translation, and antisense drugs can be designed to interrupt this process by causing the
destruction  of  the  targeted  mRNA  and  therefore  preventing  the  production  of  a  protein  of  interest.  The  graphic  below  further  illustrates  the  impact  of
antisense drugs on the production of proteins via this mechanism of action:

Ionis  has  made  significant  improvements  in  its  antisense  drug  technology  in  recent  years,  most  notably  the  creation  of  the  advanced  ligand
conjugated antisense, or LICA technology. Other improvements include the discovery screening processes, which resulted in second-generation drugs with
better safety and tolerability properties compared to Ionis' generation 2.0 drugs. These improved second-generation drugs are referred to as generation 2+
drugs.

12

 
 
 
The unique properties of our antisense drugs provide several potential advantages over traditional drug modalities. These advantages include:

•

•

•

•

•

Precise specificity.  Our  antisense  drugs  are  created  using  Ionis'  generation  2+  screening  processes  to  bind  specifically  to  the  mRNAs  they
were  designed  to  target,  which  minimizes  or  eliminates  the  possibility  of  our  drugs  binding  to  unintended  genetic  targets  and  causing
unwanted side effects.

Favorable dosing properties. We believe our drugs have predictable safety, pharmacokinetic and pharmacodynamic properties based on Ionis'
research  and  development  experience.  Further,  our  drugs  have  a  relatively  long  half-life  of  two  to  four  weeks,  which  enables  second
generation drugs such as WAYLIVRA to be dosed once weekly and other drugs in our pipeline, which incorporate Ionis' LICA technology, to
potentially be dosed once monthly or less frequently. Upon dosing, our drugs distribute well throughout the body, eliminating the need for
special formulations or delivery vehicles.

No  anticipated  drug-to-drug  interactions.  Because  they  are  nucleic  acid  based,  we  believe  our  drugs  can  be  used  in  combination  with
virtually any existing treatment modality without the risk of drug-to-drug interactions or susceptibility to traditional enzyme degradation or
metabolism pathways.

Broad applications to multiple disease targets, multiple tissues and multiple mechanisms. There are virtually no "undruggable" targets with
antisense technology.

Efficient discovery and early development. Because of the efficiency of antisense technology, drug discovery and early development costs
and success rates compare favorably to small molecule or antibody drug discovery and development.

Our Relationship with Ionis

Ionis formed Akcea as a wholly owned subsidiary to complete development of and commercialize Ionis’ drugs to treat lipid disorders. We began
business operations in January 2015. We licensed our cardiometabolic franchise from Ionis at the beginning of 2015. Prior to licensing these drugs, Ionis’
employees performed all of the development, regulatory and manufacturing activities for these drugs either themselves or through third-party providers. As
such, Ionis incurred all of the expenses associated with these activities and reported them in its consolidated financial statements. We licensed TEGSEDI and
AKCEA-TTR-L Rx  from  Ionis  in  April  2018.  Prior  to  then,  Ionis  had  been  advancing  these  drugs  in  development  and  incurring  the  expenses  for  those
activities. Under our license agreements with Ionis, Ionis continued and is continuing to conduct development, regulatory or manufacturing activities for most
of our drugs and to charge us for this work. As of December 31, 2018, Ionis owned approximately 75 percent of our outstanding stock.

Exclusive Rights to Development Pipeline and Intellectual Property; Right of First Negotiation

Ionis is the leading company researching and developing antisense drugs. Under our agreements with Ionis, we have rights to Ionis' proprietary
technologies  for  use  with  our  drugs.  Specifically,  we  obtained  an  exclusive  license  from  Ionis  to  globally  commercialize  our  pipeline  of  drugs,  including
TEGSEDI, WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-ANGPTL3-LRx, AKCEA-APOCIII-LRx and AKCEA-TTR-LRx. Ionis also agreed that it would not
work  on  its  own  or  with  other  parties  to  develop  or  commercialize  antisense  drugs  that  target  the  same  gene  targets  as  the  drugs  we  are  developing  and
commercializing.  Under  our  agreements  with  Ionis,  we  have  a  license  to  use  Ionis'  technology  platform  with  our  drugs.  We  also  have  access  to  future
improvements Ionis may make to its antisense technology platform, such as improved manufacturing technologies.

In  addition,  Ionis  has  granted  us  a  right  of  first  negotiation  with  respect  to  Ionis  development  candidates  that  are  designed  to  treat  a  rare

cardiometabolic disease or a rare inherited metabolic disease.

Our Strategic Collaboration with Novartis

In  January  2017,  we  initiated  a  strategic  collaboration  with  Novartis  for  the  development  and  commercialization  of  AKCEA-APO(a)-LRx  and
AKCEA-APOCIII-LRx. In February 2019, Novartis exercised its option to license AKCEA-APO(a)-LRx. Novartis is currently preparing to initiate a Phase 3
study  of  AKCEA-APO(a)-LRx  in  patients  with  established  cardiovascular  disease  (CVD)  and  elevated  levels  of  lipoprotein(a),  or  Lp(a).  Novartis  is  now
responsible for all future development and commercialization activities for AKCEA-APO(a)-LRx. We are eligible to receive license fees, milestone payments
and  royalties  on  sales  of  AKCEA-APO(a)-LRx  from  Novartis  if  and  when  it  meets  the  development,  regulatory  and  sales  milestones  specified  in  our
agreement. In connection with Novartis’ exercise of its option to exclusively license AKCEA-APO(a)-LRx, Akcea and Novartis established a more definitive
framework under which they would negotiate the co-commercialization of AKCEA-APO(a)-LRx between the two companies in selected markets. Included in
this  framework  is  an  option  by  which  Novartis  could  solely  commercialize  AKCEA-APO(a)-LRx  in  exchange  for  Novartis  paying  Akcea  increased
commercial milestone payments based on sales of AKCEA-APO(a)-LRx. We will share any license fees, milestone payments and royalties equally with Ionis.

13

 
 
 
 
 
 
Under  the  strategic  collaboration,  option  and  license  agreement,  Novartis  also has  an  exclusive  option  to  develop  and  commercialize  AKCEA-
APOCIII-LRx. We are responsible for completing a Phase 2 program and conducting an end-of-Phase 2 meeting with the FDA for AKCEA-APOCIII-LRx and
delivering API. Following the successful completion of the Phase 2 program, and prior to initiation of the Phase 3 study, Novartis will be able to exercise its
option to license and commercialize AKCEA-APOCIII-LRx. Novartis will have 60 days plus additional time that could be required for Hart-Scott-Rodino, or
HSR, filing and review following the end-of-Phase 2 meeting to exercise its option for AKCEA-APOCIII-LRx. If Novartis exercises its option, Novartis will
be responsible, at its expense, to use commercially reasonable efforts to develop and commercialize AKCEA-APOCIII-LRx.

From this collaboration, we received $75.0 million in an upfront option payment, of which we retained $60.0 million and paid Ionis $15.0 million
as a sublicense fee under our license agreement with Ionis. In conjunction with this collaboration, Novartis purchased $100.0 million of Ionis' common stock
at a premium. We also earned a $150.0 million license fee when Novartis exercised its option to license AKCEA-APO(a)-LRx of which we will pay $75.0
million to Ionis as a sublicense fee. The $75.0 million obligation to Ionis will be settled in Akcea common stock. During the years ended December 31, 2018
and 2017, we recognized $50.6 million and $43.4 million of revenue related to our Novartis collaboration, respectively.

In  addition,  for  AKCEA-APO(a)-LRx,  we  are  eligible  to  receive  up  to  $675.0  million  in  milestone  payments,  including  $25.0  million  for  the
achievement of a development milestone, up to $290.0 million for the achievement of regulatory milestones and up to $360.0 million for the achievement of
commercialization milestones. In addition, for AKCEA-APOCIII-LRx, we are eligible to receive a license fee of $150.0 million and up to $530.0 million in
milestone  payments,  including  $25.0  million  for  the  achievement  of  a  development  milestone,  up  to  $240.0  million  for  the  achievement  of  regulatory
milestones and up to $265.0 million for the achievement of commercialization milestones. We will earn the next milestone payment of $25.0 million under
this collaboration if Novartis advances the Phase 3 study for either drug. We are also eligible to receive tiered royalties in the mid-teens to low-twenty percent
range  on  net  sales  of  AKCEA-APO(a)-LRx and AKCEA-APOCIII-LRx.  Novartis  will  reduce  these  royalties  upon  the  expiration  of  certain  patents  or  if  a
generic competitor negatively impacts the product in a specific country. We will pay 50% of these license fees, milestone payments and royalties to Ionis as a
sublicense fee.

For  each  product  Novartis  commercializes  under  this  agreement,  we  may  co-commercialize  with  Novartis  in  selected  markets,  through  our

specialized sales force, on terms and conditions that we plan to negotiate with Novartis in the future.

If Novartis does not exercise its option, or stops developing or commercializing after exercising its option with respect to a particular drug, we will
have  all  rights  to  develop  or  commercialize  the  drug  (including  the  right  to  sublicense  these  rights  to  a  third  party)  at  our  sole  expense.  If  Novartis  stops
developing  or  commercializing  a  drug  after  exercising  its  option,  and  we  subsequently  commercialize  the  drug  on  our  own  or  with  another  party,  we  are
required to negotiate in good faith and mutually agree with Novartis the terms of a royalty payable to Novartis on the returned drug.

The  agreement  with  Novartis  will  continue  until  the  earlier  of  the  date  that  all  of  Novartis'  options  to  obtain  the  exclusive  licenses  under  the
agreement  expire  unexercised  or,  if  Novartis  exercises  its  options,  until  the  expiration  of  all  payment  obligations  under  the  agreement.  In  addition,  the
agreement as a whole or with respect to any drug under the agreement may terminate early under the following situations:

•

•

•

Novartis may terminate the agreement as a whole or with respect to any drug at any time by providing written notice to us;

Either we or Novartis may terminate the agreement with respect to any drug by providing written notice to the other party in good faith that
we  or  Novartis  have  determined  that  the  continued  development  or  commercialization  of  the  drug  presents  safety  concerns  that  pose  an
unacceptable risk or threat of harm in humans or would violate any applicable law, ethical principles or principles of scientific integrity;

Either we or Novartis may terminate the agreement for a drug by providing written notice to the other party upon the other party's uncured
failure to perform a material obligation related to the drug under the agreement, or the entire agreement if the other party becomes insolvent;
and

• We may terminate the agreement if Novartis disputes or assists a third party to dispute the validity of any of our or Ionis' patents.

Additionally,  in  January  2017,  we  and  Ionis  entered  into  a  Stock  Purchase  Agreement,  or  SPA,  with  Novartis.  Under  the  SPA,  in  July  2017,
Novartis purchased $50.0 million of our common stock in a separate private placement concurrent with the completion of our IPO at a price per share equal to
the IPO price.

14

 
 
 
 
 
Competition

The  commercialization  of  new  drugs  is  competitive,  and  we  may  face  worldwide  competition  from  major  pharmaceutical  companies,  specialty
pharmaceutical  companies,  biotechnology  companies,  nutraceutical  companies  and  ultimately  generic  companies.  Our  competitors  may  develop  or  market
therapies  that  are  more  effective,  safer,  more  convenient  to  use,  or  less  costly  than  any  that  we  are  commercializing,  or  may  obtain  regulatory  or
reimbursement approval for their therapies more rapidly than we may obtain approval for ours. Many of our competitors have substantially greater financial,
technical and human resources than we have. Additionally, mergers and acquisitions in the pharmaceutical industry may result in even more resources being
concentrated in our competitors. Competition may increase further as a result of advances made in the commercial applicability of technologies and greater
availability of capital for investment in these fields.

With respect to TEGSEDI and AKCEA-TTR-LRx, ONPATTRO (patisiran), which is an RNAi therapy made by Alnylam, is currently marketed for
hATTR  amyloidosis  with  polyneuropathy  in  the  U.S.  and  E.U.  The  product  label  for  TEGSEDI  in  the  United  States  has  a  boxed  warning  for
thrombocytopenia and glomerulonephritis, requires periodic blood and urine monitoring, and TEGSEDI has a Risk Evaluation and Mitigation Strategy, or
REMS, program. Though ONPATTRO requires intravenous administration and pre-treatment with steroids, it does not have a boxed warning or REMS. In
addition, Tafamidis is currently available in the E.U. for stage 1 hATTR amyloidosis with polyneuropathy, and is currently under review in the U.S. for ATTR
with  cardiomyopathy,  with  a  PDUFA  date  in  July  2019.  Beyond  these  drugs  that  are  either  marketed  or  under  regulatory  review,  there  are  also  additional
drugs in clinical development. Alnylam is developing next generation RNAi drug vutrisiran which is currently in Phase 3 clinical development in hATTR
amyloidosis with polyneuropathy, with plans to move into cardiomyopathy. Eidos is developing AG10 for patients with ATTR with cardiomyopathy and has
recently completed Phase 2, with plans to move into Phase 3.

With  respect  to  WAYLIVRA  to  treat  patients  with  FCS,  Gemphire's  Gemcabene  is  being  studied  in  patients  with  severe  hypertriglyceridemia,
defined  as  triglycerides  above  500  mg/dL.  Gemphire  announced  in  June  2018  that  Gemcabene  met  its  Phase  2b  primary  endpoint  and  demonstrated
statistically significant lowering of triglycerides in SHTG. In August 2018, however, the FDA has requested that Gemphire produce data from a sub-chronic
toxicology  study  to  lift  the  partial  clinical  hold  that  was  issued  in  2004  (The  FDA  issued  the  partial  clinical  hold  as  PPAR  agonists  are  potential  liver
toxins).  The initiation of Phase 3 will not take place until the partial hold is lifted and Gemphire has announced that it plans to conduct these required studies
and expects to submit the additional results to the FDA in the second quarter of 2019.

Metreleptin  is  in  a  Phase  3  trial  for  FPL  patients  who  also  have  NASH.  Metreleptin  is  currently  approved  for  use  in  the  U.S.  and  E.U.  in
generalized lipodystrophy, or GL patients. Metreleptin does not affect apoC-III levels. ApoC-III levels have been shown to be elevated in FPL patients and
directly  correlated  to  triglyceride  levels.  In  addition,  many  patients  with  FCS  and  FPL  use  diet,  niacin,  fish  oils  and/or  fibrates  to  reduce  their  elevated
triglycerides. Niacin, fish oils and fibrates are generally not effective in patients with FCS. The ultra-low-fat diet that patients with FCS and FPL are required
to maintain is extremely burdensome to patients and their families. Based on our WAYLIVRA clinical experience, including in individuals with FCS, we
believe that WAYLIVRA will work equally well as a single agent or in combination with other triglyceride-lowering drugs or approaches.

With  respect  to  WAYLIVRA  and  AKCEA-APOCIII-LRx,  in  January  2019,  Arrowhead  filed  for  regulatory  clearance  to  begin  Phase  1  study  of
ARO-APOC3, an RNAi-based drug targeting apoC-III for treatment of hypertriglyceridemia.  Arrowhead has announced that it intends to proceed with this
Phase  1  single  and  multiple  dose-escalating  study  to  evaluate  the  safety,  tolerability,  pharmacokinetics,  and  pharmacodynamic  effects  of  ARO-APOC3  in
adult healthy volunteers, hypertriglyceridemic patients, and patients with FCS.  To our knowledge, there are currently no other direct competitors for lowering
apoC-III in clinical development.

With  respect  to  AKCEA-APO(a)-LRx,  we  are  not  aware  of  any  other  drugs  currently  in  clinical  development  specifically  for  the  treatment  of
hyperlipoproteinemia(a) and associated cardiovascular disease. Arrowhead and Amgen have a Phase 1 program ongoing for AMG890, formerly referred to as
ARO-LPA, which uses an RNAi drug conjugated with a GalNAc for the same target as AKCEA-APO(a)-LRx . Under its strategic collaboration agreement
with Alnylam Pharmaceuticals, Inc., or Alnylam, Ionis received an exclusive, royalty-bearing license to Alnylam's chemistry, RNA targeting mechanism and
target-specific intellectual property for oligonucleotides against apo(a), which means that Alnylam agreed not to use the exclusively licensed technology to
develop or commercialize an oligonucleotide against apo(a).

AKCEA-ANGPTL3-LRx may compete with Evinacumab, a monoclonal antibody that binds to ANGPTL3 that Regeneron Pharmaceuticals, Inc. is
developing. Evinacumab is currently in Phase 2 development for the treatment of HoFH and severe forms of hyperlipidemia. Additionally, many patients with
familial hyperlipidemias are treated using diet and statins, which have limited effect in these patients.

15

 
Intellectual Property

We  have  in-licensed  numerous  patents  and  patent  applications  and  possess  substantial  know-how  and  trade  secrets  relating  to  WAYLIVRA,
AKCEA-APO(a)-LRx,  our  other  drugs  in  development  and,  more  generally,  the  development  and  commercialization  of  oligonucleotide  therapeutics.  Our
objective is to continue to develop and strengthen our proprietary position to further protect our drugs.

We obtained our rights to the patents covering WAYLIVRA, AKCEA-APO(a)-LRx  and  our  other  drugs  in  development  and  our  rights  in  Ionis'
proprietary technology platform and know-how under our development, commercialization and license agreement with Ionis. We seek to expand our portfolio
of patents and patent applications by filing and prosecuting existing patent rights and filing additional patent applications.

We seek patent protection in significant markets and/or countries for each drug in development. We also seek to maximize patent term. The patent
exclusivity period for a drug will prevent generic drugs from entering the market. Patent exclusivity depends on a number of factors, including initial patent
term and available patent term extensions based upon delays caused by the regulatory approval process.

TTR, TEGSEDI and AKCEA-TTR-LRx Intellectual Property

We have an exclusive license under Ionis' TTR patent estate to develop and commercialize TEGSEDI and the LICA follow-on drug AKCEA-TTR-

LRx.  

The TTR patent estate includes granted US patents covering the TEGSEDI compound, composition, and uses (e.g. US 8,101,743; US 8,697,860;
US 9,061,044; and US 9,399,774) that together provide natural patent term to 2031. We have applied for patent term extension to recapture a portion of the
term lost during regulatory review.  The issued claims protect TEGSEDI from generic competition in the United States until at least 2031.  Similar patents
covering TEGSEDI are granted in several foreign jurisdictions including Europe and Japan.

The  TTR  patent  estate  also  includes  granted  and  pending  claims  covering  AKCEA-TTR-L Rx  worldwide.    Granted  claims  in  Europe  cover  the
sequence of AKCEA-TTR-L Rx and its use in treating transthyretin amyloidosis with natural patent term to 2031 (EP2563920). Claims covering the specific
chemical composition of AKCEA-TTR-LRx and use in treating transthyretin amyloidosis are pending and have natural patent term to 2034 excluding any
additional term adjustments or patent term extensions.

ApoC-III, WAYLIVRA and AKCEA-APOCIII-LRx Intellectual Property

We  have  an  exclusive  license  under  Ionis'  apoC-III  patent  estate  to  develop  and  commercialize  WAYLIVRA  and  the  LICA  follow-on  drug
AKCEA-APOCIII-LRx. The apoC-III patent estate includes patent claims in the United States drawn to the use of antisense compounds complementary to the
mRNA  of  human  apoC-III,  including  compounds  designed  to  the  region  targeted  by  WAYLIVRA  and  AKCEA-APOCIII-LRx  (US  7,598,227)  which,
excluding  any  additional  term  adjustments  or  patent  term  extensions,  expires  in  2023.  Similar  claims  covering  compounds  complementary  to  any  site  on
human apoC-III have granted in Australia.

The apoC-III patent estate also includes issued patent claims to the specific antisense sequence and chemical composition of WAYLIVRA in the
United  States  (US  7,750,141),  Australia  and  Europe  (EP1622597).  The  issued  claims  in  the  United  States  should  protect  WAYLIVRA  from  generic
competition in the United States until at least 2023. In addition, depending upon the timing, duration and specifics of FDA regulatory review, this patent may
be eligible for patent term restoration to recapture a portion of the term lost during such review. We are also pursuing additional patent applications directed to
methods  of  using  WAYLIVRA  and  other  apoC-III  compounds  for  treating  various  disorders,  including  FCS  in  jurisdictions  worldwide.  Claims  drawn  to
methods of using apoC-III specific inhibitors, and specifically compounds designed to target the same sequence as WAYLIVRA and AKCEA-APOCIII-LRx,
for  treating  FCS  have  issued  in  the  United  States  (US  9,593,333)  and  will  expire  in  2034,  excluding  any  additional  term  adjustments  or  patent  term
extensions.

The apoC-III patent estate also includes issued patent claims covering the specific chemical composition of AKCEA-APOCIII-LRx in the United
States  (US  9,163,239).  The  claims  should  protect  AKCEA-APOCIII-LRx  from  generic  competition  until  at  least  2034.  We  are  pursuing  additional  patent
coverage for AKCEA-APOCIII-LRx in jurisdictions worldwide.

16

 
Apo(a) and AKCEA-APO(a)-LRx Intellectual Property

We  have  an  exclusive  license  under  Ionis'  apo(a)  patent  estate  to  develop  and  commercialize  AKCEA-APO(a)-LRx.  The  apo(a)  patent  estate
includes issued patent claims to the specific antisense sequence and chemical composition of AKCEA-APO(a)-LRx in the United States (US 9,181,550). The
issued claims directed to the composition should protect AKCEA-APO(a)-LRx from generic competition in the United States until at least 2034. In addition,
patent  term  restoration  may  be  available  to  recapture  a  portion  of  the  term  lost  during  FDA  regulatory  review.  We  are  also  pursuing  additional  patent
applications designed to protect the AKCEA-APO(a)-LRx composition and additional dosing and methods of use in jurisdictions worldwide.

ANGPTL3 and AKCEA-ANGPTL3-LRx Intellectual Property

We have an exclusive license under Ionis' ANGPTL3 patent estate to develop and commercialize AKCEA-ANGPTL3-LRx. The ANGPTL3 patent
estate includes issued patent claims drawn to the use of antisense compounds complementary to ANGPTL3 RNA for inhibiting the production of ANGPTL3
(US  8,653,047).  The  ANGPTL3  patent  estate  also  includes  issued  patent  claims  covering  the  specific  antisense  sequence  and  chemical  composition  of
AKCEA-ANGPTL3-LRx in the United States (US 9,382,540). The issued claims directed to the chemical composition should protect AKCEA-ANGPTL3-
LRx from generic competition until at least 2035. We are pursuing additional patent claims designed to protect the sequence and chemical composition of
AKCEA-ANGPTL3-LRx in jurisdictions worldwide.

Trade Secrets

In addition to the protections afforded by patents and other regulatory protections, we may rely, in some circumstances, on trade secrets to protect
our technology. Trade secrets may be useful to protect proprietary know-how that is not patentable or which we elect not to patent. Trade secrets may also be
useful  for  processes  or  improvements  for  which  patents  are  difficult  to  enforce.  We  also  protect  our  drugs  and  the  proprietary  technology  platform  by
confidentiality agreements with employees, consultants, advisors, contractors and collaborators. We also seek to preserve the integrity and confidentiality of
our data and trade secrets by maintaining physical security of our premises and physical and electronic security of our information technology systems.

Manufacturing

Ionis has dedicated significant resources to develop ways to improve manufacturing efficiency and capacity. Since Ionis can use variants of the
same nucleotide building blocks and the same type of equipment to produce our oligonucleotide drugs, we and Ionis found that the same techniques used to
efficiently manufacture one oligonucleotide drug could help improve the manufacturing processes for many other oligonucleotide drugs. With Ionis’ expertise
in optimizing manufacturing of oligonucleotides, we and Ionis believe we can develop new processes to scale up manufacturing of our LICA medicines at
commercially competitive prices. By developing several proprietary chemical processes to scale up our manufacturing capabilities, Ionis has greatly reduced
the cost of producing oligonucleotide drugs. For example, they have significantly reduced the cost of raw materials through improved yield efficiency, while
at  the  same  time  increasing  capacity  to  make  the  drugs.  Through  both  Ionis’  internal  research  and  development  programs  and  collaborations  with  outside
vendors we and Ionis may achieve even greater efficiency and further cost reductions. In connection with Novartis’ exercise of its option to license AKCEA-
APO(a)-LRx, and if Novartis exercises its option to license AKCEA-APOCIII-LRx, Novartis will be responsible for the long-term supply of drug substance
and finished drug product for the licensed drug.

TEGSEDI

For TEGSEDI’s commercial drug supply, we are using contract manufacturing organizations, or CMOs, to produce custom raw materials, active
pharmaceutical ingredient, or API, and finished goods. Our CMO partners have extensive technical expertise and current good manufacturing practice, or
cGMP, experience. We believe our current network of CMO partners are capable of providing sufficient quantities to meet anticipated commercial demands.
Additionally, we continue to evaluate relationships with additional suppliers to increase overall capacity as well as reduce further risks. While we believe that
there are alternate sources of supply that can satisfy our commercial requirements, we cannot be certain that identifying and establishing relationships with
such sources, if necessary, would not result in significant delay or material additional costs. We also cannot provide assurance that we will not experience a
disruption in supply from our current CMO partners.

CMOs are subject to the FDA’s cGMP requirements and other rules and regulations prescribed by foreign regulatory authorities. We depend on our

CMO partners for continued compliance with cGMP requirements and applicable foreign standards.

17

 
 
WAYLIVRA

Ionis  has  supplied  us  with  API  and  finished  drug  product  to  complete  our  ongoing  activities  for  WAYLIVRA  through  either  Ionis’  own
manufacturing processes or through outside vendors. Ionis has also supplied the API and the finished drug product for WAYLIVRA’s commercial launch, if
approved.  We  believe  the  API  and  drug  product  is  adequate  for  at  least  the  first  two  years  of  WAYLIVRA’s  commercial  launch.  We  plan  to  leverage  our
relationships with CMOs, to procure our own long-term raw material and drug supplies at competitive prices in the future.

LICA Pipeline

We believe we have sufficient manufacturing capacity, through Ionis, to meet our current development needs, including the ongoing studies for
AKCEA-ANGPTL3-LRx, AKCEA-APOCIII-LRx and AKCEA-TTR-LRx. We believe that we have, or will be able to develop or acquire, sufficient supply
capacity to meet our anticipated future needs. Ionis has supplied the API and the finished drug product for the clinical studies for each of the drugs in our
pipeline through the completion of the on-going studies. Ionis also has agreed to supply and has supplied the API and the finished drug product for our drugs.
We  and  Ionis  have  long-standing  and  strong  relationships  with  third-party  vendors  who  can  supply  us  with  both  API  and  finished  drug  product  and  are
currently  supplying  API  and  finished  drug  product  to  other  of  Ionis'  partners.  Ionis  also  has  long-standing  and  strong  relationships  with  the  vendors  who
supply the key raw materials to Ionis to make our drugs and to a major oligonucleotide CMO. We also believe that with anticipated benefits from increases in
scale and improvements in chemistry, through Ionis or third parties, we will be able to manufacture our antisense drugs at commercially reasonable prices.

For LICA-conjugated drugs, to date, Ionis has manufactured itself or through a contract manufacturing organization only limited supplies of LICA
for  their  own  and  our  own  nonclinical  and  clinical  studies.  LICA  enables  lower  doses  than  unconjugated  oligonucleotides.  Along  with  Ionis'  expertise  in
optimizing  manufacturing  of  oligonucleotides,  we  believe  this  will  enable  the  development  of  new  processes  to  scale  up  manufacturing  of  these  LICA
conjugated drugs at commercially competitive prices.

Government Regulation and Approval

United States—FDA Process

In  the  United  States,  the  FDA  regulates  drugs.  The  Federal  Food,  Drug  and  Cosmetic  Act,  or  FDCA,  and  other  federal  and  state  statutes  and
regulations,  govern,  among  other  things,  the  research,  development,  testing,  manufacture,  storage,  recordkeeping,  approval,  labeling,  promotion  and
marketing, distribution, post-approval monitoring and reporting, sampling and import and export of drugs. To obtain regulatory approvals in the United States
and in foreign countries, and subsequently comply with applicable statutes and regulations, we will need to spend substantial time and financial resources.

Approval Process

The FDA must approve any new unapproved drug or certain changes to a previously approved drug before a manufacturer can market it in the
United States. If a company does not comply with applicable United States requirements, it may be subject to a variety of administrative or judicial sanctions,
such as FDA refusal to approve pending applications, Warning or Untitled Letters, clinical holds, drug recalls, drug seizures, total or partial suspension of
production or distribution, injunctions, fines, civil penalties and criminal prosecution. The steps we must complete before we can market a drug include:

•

•

•

•

•

•

completion  of  preclinical  laboratory  tests,  animal  studies,  and  formulation  studies,  all  performed  in  accordance  with  the  FDA's  Good
Laboratory Practice, or GLP, regulations;

submission to the FDA of an IND application for human clinical testing, which must become effective before human clinical studies start. The
sponsor must update the IND annually;

approval of the study by an independent institutional review board, or IRB, or ethics committee representing each clinical site before each
clinical study begins;

performance of adequate and well-controlled human clinical studies to establish the safety and efficacy of the drug for each indication to the
FDA's satisfaction;

submission to the FDA of an NDA;

potential review of the drug application by an FDA advisory committee, where appropriate and if applicable;

18

 
 
 
 
 
 
 
•

•

satisfactory completion of an FDA inspection of the manufacturing facility or facilities to assess compliance with current good manufacturing
practices, cGMP, or regulations; and

FDA review and approval of the NDA.

It generally takes companies many years to satisfy the FDA approval requirements, but this varies substantially based upon the type, complexity
and novelty of the drug or disease. Preclinical tests include laboratory evaluation of a drug's chemistry, formulation, and toxicity, as well as animal trials to
assess  the  characteristics  and  potential  safety  and  efficacy  of  the  drug.  The  conduct  of  the  preclinical  tests  must  comply  with  federal  regulations  and
requirements, including GLP. The company submits the results of the preclinical testing to the FDA as part of an IND along with other information, including
information about the drug's chemistry, manufacturing and controls, and a proposed clinical study protocol. Long term preclinical tests, such as animal tests of
reproductive toxicity and carcinogenicity, may continue after submitting the initial IND.

The FDA requires a 30-day waiting period after the submission of each IND before a company can begin clinical testing in humans in the United
States.  If  the  FDA  has  neither  commented  on  nor  questioned  the  IND  within  this  30-day  period,  the  IND  sponsor  may  begin  the  proposed  clinical  study.
However, the FDA may, within the 30-day time period, raise concerns or questions relating to one or more proposed clinical studies and place the clinical
study  on  a  clinical  hold.  In  such  a  case,  the  company  and  the  FDA  must  resolve  any  outstanding  concerns  before  the  company  begins  the  clinical  study.
Accordingly, the submission of an IND may or may not be sufficient for the FDA to permit the sponsor to start a clinical study. The company must also make
a separate submission to an existing IND for each successive clinical study conducted during drug development.

Clinical Studies

Clinical  studies  involve  administering  the  investigational  new  drug  to  healthy  volunteers  or  patients  under  the  supervision  of  a  qualified

investigator. The company must conduct clinical studies:

•

•

•

in compliance with federal regulations;

in compliance with good clinical practice, or GCP, an international standard meant to protect the rights and health of patients and to define the
roles of clinical study sponsors, administrators and monitors; and

under protocols detailing the objectives of the trial, the safety monitoring parameters and the effectiveness criteria.

The company must submit each protocol involving testing on United States patients and subsequent protocol amendments to the FDA as part of the
IND.  The  FDA  may  order  the  temporary,  or  permanent,  discontinuation  of  a  clinical  study  at  any  time,  or  impose  other  sanctions,  if  it  believes  that  the
sponsor is not conducting the clinical study in accordance with FDA requirements or presents an unacceptable risk to the clinical study patients. The sponsor
must also submit the study protocol and informed consent information for patients in clinical studies to an IRB for approval. An IRB may halt the clinical
study, either temporarily or permanently, for failure to comply with the IRB's requirements, or may impose other conditions.

Companies generally divide the clinical investigation of a drug into three or four phases.

•

•

•

•

Phase 1. The company evaluates the drug in healthy human subjects or patients with the target disease or condition. These studies typically
evaluate  the  safety,  dosage  tolerance,  metabolism  and  pharmacologic  actions  of  the  investigational  new  drug  in  humans,  the  side  effects
associated with increasing doses and, if possible, gain early evidence on effectiveness.

Phase 2. The company administers the drug to a limited patient population to evaluate dosage tolerance and optimal dosage, identify possible
adverse side effects and safety risks and preliminarily evaluate efficacy.

Phase 3. The company administers the drug to an expanded patient population, generally at geographically dispersed clinical study sites, to
generate enough data to statistically evaluate dosage, clinical effectiveness and safety, to establish the overall benefit-risk relationship of the
investigational drug and to provide an adequate basis for product approval.

Phase 4. In some cases, the FDA may condition approval of an NDA for a drug on the company's agreement to conduct additional clinical
studies after approval. In other cases, a sponsor may voluntarily conduct additional clinical studies after approval to gain more information
about the drug. We typically refer to such post-approval studies as Phase 4 clinical studies.

19

 
 
 
 
 
 
 
 
 
 
While companies usually conduct these phases sequentially, they are sometimes overlapped or combined. A combined phase trial, such as a Phase
1/2 or a Phase 2/3 trial, is one that combines elements of objectives from two ordinarily sequential phases of development. For example, in a Phase 1/2 trial,
the objectives may include both dose-finding and initial efficacy. In a Phase 2/3 trial, dosing regimen or population selection objectives are combined with
confirmation of the safety and efficacy of the administration schedule in the intended population.

A  pivotal  study  is  a  clinical  study  that  adequately  meets  regulatory  agency  requirements  to  evaluate  a  drug's  efficacy  and  safety  to  justify  the
approval of the drug. Generally, pivotal studies are Phase 3 studies, but the FDA may accept results from Phase 2 studies if the study design provides a well-
controlled and reliable assessment of clinical benefit, particularly in situations in which there is an unmet medical need and the results are sufficiently robust.

The FDA, the IRB or the clinical study sponsor may suspend or terminate a clinical study at any time on various grounds, including a finding that
the research subjects are being exposed to an unacceptable health risk. Additionally, an independent group of qualified experts organized by the clinical study
sponsor, known as a data safety monitoring board or committee, may oversee some clinical studies. This group provides authorization for whether or not a
study may move forward at designated check points based on access to certain data from the study. We may also suspend or terminate a clinical study based
on evolving business objectives and the competitive climate.

Submission of an NDA

After we complete the required clinical testing, we can prepare and submit an NDA to the FDA, which must approve the NDA before we can start
marketing the drug in the United States. An NDA must include all relevant data available from pertinent preclinical and clinical studies, including negative or
ambiguous  results  as  well  as  positive  findings,  together  with  detailed  information  relating  to  the  drug's  chemistry,  manufacturing,  controls  and  proposed
labeling, among other things. Data can come from company-sponsored clinical studies on a drug, or from a number of alternative sources, including studies
initiated  by  investigators.  To  support  marketing  authorization,  the  data  we  submit  must  be  sufficient  in  quality  and  quantity  to  establish  the  safety  and
effectiveness of the investigational drug to the FDA's satisfaction.

The cost of preparing and submitting an NDA is substantial. The submission of most NDAs is additionally subject to a substantial application user
fee, and the manufacturer and/or sponsor under an approved new drug application are also subject to annual program user fees. The FDA typically increases
these fees annually. Orphan drug designation entitles a party to financial incentives such as opportunities for grant funding towards clinical study costs, tax
advantages and user-fee waivers.

The FDA has 60 days from its receipt of an NDA to determine whether it will accept the application for filing based on the agency's threshold
determination that the application is sufficiently complete to permit substantive review. Once the FDA accepts the filing, the FDA begins an in-depth review.
The FDA has agreed to certain performance goals in the review of NDAs. Under the Prescription Drug User Fee Act, the FDA has a goal of responding to
standard review NDAs within ten months after the 60-day filing review period, but this timeframe is often extended. The FDA reviews most applications for
standard review drugs within ten to 12 months and most applications for priority review drugs within six to eight months. Priority review can be applied to
drugs that the FDA determines offer major advances in treatment or provide a treatment where no adequate therapy exists.

The FDA may also refer applications for novel drugs that present difficult questions of safety or efficacy to an advisory committee. This is typically
a panel that includes clinicians and other experts that will review, evaluate and recommend whether the FDA should approve the application. The FDA is not
bound by the recommendation of an advisory committee, but it generally follows such recommendations. Before approving an NDA, the FDA will typically
inspect one or more clinical sites to assure compliance with GCP and will inspect the facility or the facilities at which the drug is manufactured. The FDA will
not approve the drug unless compliance with cGMP is satisfactory and the NDA contains data that provide evidence that the drug is safe and effective in the
indication studied.

The FDA's Decision on an NDA

After the FDA evaluates the NDA and the manufacturing facilities, it issues either an approval letter or a complete response letter. A complete
response letter indicates that the FDA has completed its review of the application and the agency has determined that it will not approve the application in its
present form. A complete response letter generally outlines the deficiencies in the submission and may require substantial additional clinical data and/or other
significant,  expensive  and  time-consuming  requirements  related  to  clinical  studies,  preclinical  studies  and/or  manufacturing.  The  FDA  has  committed  to
reviewing resubmissions of the NDA addressing such deficiencies in two or six months, depending on the type of information included. Even if we submit
such data, the

20

 
FDA may ultimately decide that the NDA does not satisfy the criteria for approval. Also, the government may establish additional requirements, including
those resulting from new legislation, or the FDA's policies may change, which could delay or prevent regulatory approval of our drugs under development.

An approval letter authorizes commercial marketing of the drug with specific prescribing information for specific indications. As a condition of
NDA approval, the FDA may require a risk evaluation and mitigation strategy, or REMS, to help ensure that the benefits of the drug outweigh the potential
risks. REMS can include medication guides, communication plans for healthcare professionals, special training or certification for prescribing or dispensing,
dispensing  only  under  certain  circumstances,  special  monitoring  and  the  use  of  patient  registries.  The  requirement  for  REMS  can  materially  affect  the
potential market and profitability of the drug. Moreover, the FDA may condition approval on substantial post-approval testing and surveillance to monitor the
drug's  safety  or  efficacy.  Once  granted,  the  FDA  may  withdraw  drug  approvals  if  the  company  fails  to  comply  with  regulatory  standards  or  identifies
problems following initial marketing.

Changes to some of the conditions established in an approved application, including changes in indications, labeling or manufacturing processes or
facilities, require submission and FDA approval of a new NDA or NDA supplement before we can implement the change. An NDA supplement for a new
indication typically requires clinical data similar to that in the original application, and the FDA uses the same procedures and actions in reviewing NDA
supplements  as  it  does  in  reviewing  new  NDAs.  As  with  new  NDAs,  the  FDA  often  significantly  extends  the  review  process  with  requests  for  additional
information or clarification.

Expedited review and accelerated approval programs

A sponsor may seek approval of its drug candidate under programs designed to accelerate the FDA's review and approval of NDAs. For example,
the FDA may grant Fast Track Designation to a drug intended for treatment of a serious or life-threatening disease or condition that has potential to address
unmet medical needs for the disease or condition. The key benefits of Fast Track Designation are the eligibility for priority review, rolling review (submission
of  portions  of  an  application  before  the  complete  marketing  application  is  submitted),  and  accelerated  approval,  if  the  application  meets  relevant  criteria.
Based on results of the Phase 3 clinical study(ies) submitted in an NDA, upon the request of an applicant, the FDA may grant the NDA a priority review
designation,  which  sets  the  target  date  for  FDA  action  on  the  application  at  six  months  after  the  FDA  accepts  the  application  for  filing.  The  FDA  grants
priority review where there is evidence that the proposed drug would be a significant improvement in the safety or effectiveness of the treatment, diagnosis,
or prevention of a serious condition. If the criteria for priority review are not met, the application is subject to the standard FDA review period of ten months
after  the  FDA  accepts  the  application  for  filing.  Priority  review  designation  does  not  change  the  scientific/medical  standard  for  approval  or  the  quality  of
evidence necessary to support approval.

Under the accelerated approval program, the FDA may approve an NDA on the basis of either a surrogate endpoint that is reasonably likely to
predict clinical benefit, or on a clinical endpoint that can be measured earlier than irreversible morbidity or mortality, that is reasonably likely to predict an
effect on irreversible morbidity or mortality or other clinical benefit, taking into account the severity, rarity or prevalence of the condition and the availability
or lack of alternative treatments. The FDA generally requires post-marketing studies or completion of ongoing studies after marketing authorization to verify
the drug's clinical benefit in relationship to the surrogate endpoint or ultimate outcome in relationship to the clinical benefit. In addition, a sponsor may seek
FDA designation of its drug candidate as a breakthrough therapy if the drug can, alone or in combination with one or more other drugs, treat a serious or life-
threatening disease or condition and preliminary clinical evidence indicates that the drug may demonstrate substantial improvement over existing therapies on
one or more clinically significant endpoints, such as substantial treatment effects observed early in clinical development.

Post-approval Requirements

The FDA regulates drugs that we manufacture or distribute pursuant to FDA approvals and has specific requirements pertaining to recordkeeping,
periodic reporting, drug sampling and distribution, advertising and promotion and reporting of adverse experiences with the drug. After approval, the FDA
must provide review and approval for most changes to the approved drug, such as adding new indications or other labeling claims. There also are continuing,
annual program user fee requirements for any marketed drugs, as well as new application fees for supplemental applications with clinical data.

In  some  cases,  the  FDA  may  condition  approval  of  an  NDA  for  a  drug  on  the  sponsor's  agreement  to  conduct  additional  clinical  studies  after
approval. In other cases, a sponsor may voluntarily conduct additional clinical studies after approval to gain more information about the drug. We typically
refer to such post-approval studies as Phase 4 clinical studies.

21

 
Drug  manufacturers  are  subject  to  periodic  unannounced  inspections  by  the  FDA  and  state  agencies  for  compliance  with  cGMP  requirements.
There  are  strict  regulations  regarding  changes  to  the  manufacturing  process,  and  depending  on  the  significance  of  the  change,  it  may  require  prior  FDA
approval  before  we  can  implement  it.  FDA  regulations  also  require  investigation  and  correction  of  any  deviations  from  cGMP  and  impose  reporting  and
documentation requirements upon us and any third-party manufacturers that we may decide to use. Accordingly, manufacturers must continue to expend time,
money and effort in the area of production and quality control to maintain compliance with cGMP and other aspects of regulatory compliance.

We rely, and expect to continue to rely, on third parties for the production of clinical quantities of our drugs and we expect to rely in the future on
third parties for the production of commercial quantities. Future FDA and state inspections may identify compliance issues at our facilities or at the facilities
of  our  contract  manufacturers  that  may  disrupt  production  or  distribution,  or  require  substantial  resources  to  correct.  In  addition,  discovery  of  previously
unknown  problems  with  a  drug  or  the  failure  to  comply  with  applicable  requirements  may  result  in  restrictions  on  a  drug,  manufacturer  or  holder  of  an
approved NDA, including withdrawal or recall of the drug from the market or other voluntary, FDA-initiated or judicial actions that could delay or prohibit
further marketing.

The FDA may withdraw approval if a company does not comply with regulatory requirements and maintain standards or if problems occur after the
drug reaches the market. If a company or the FDA discovers previously unknown problems with a drug, including adverse events of unanticipated severity or
frequency,  issues  with  manufacturing  processes  or  the  company's  failure  to  comply  with  regulatory  requirements,  the  FDA  may  require  revisions  to  the
approved labeling to add new safety information; impose post-marketing studies or other clinical studies to assess new safety risks; or impose distribution or
other restrictions under a REMS program. Other potential consequences may include:

•

•

•

•

•

restrictions on the marketing or manufacturing of the drug, complete withdrawal of the drug from the market or drug recalls;

fines, warning letters or holds on post-approval clinical studies;

the FDA refusing to approve pending NDAs or supplements to approved NDAs, or suspending or revoking drug license approvals;

drug seizure or detention, or refusal to permit the import or export of drugs; or

injunctions or the imposition of civil or criminal penalties.

The FDA strictly regulates marketing, labeling, advertising and promotion of drugs that are placed on the market. Drugs may be promoted only for
the approved indications and in accordance with the provisions of the approved label. The FDA and other agencies actively enforce the laws and regulations
prohibiting the promotion of off-label uses. We could be subject to significant liability if we violated these laws and regulations.

Orphan Drug Designation

The FDA may grant orphan drug designation to drugs intended to treat a rare disease or condition that affects fewer than 200,000 individuals in the
United States, or if it affects more than 200,000 individuals in the United States and there is no reasonable expectation that the cost of developing and making
the drug for this type of disease or condition will be recovered from sales in the United States.

Orphan drug designation entitles a party to financial incentives such as opportunities for grant funding towards clinical study costs, tax advantages
and user-fee waivers. In addition, if a drug receives FDA approval for the indication for which it has orphan designation, the drug has orphan drug exclusivity,
which means the FDA may not approve any other application to market the same drug for the same indication for a period of seven years, except in limited
circumstances, such as a showing of clinical superiority over the drug with orphan exclusivity.

22

 
 
 
 
 
 
Pediatric Information

Under the Pediatric Research Equity Act, or PREA, NDAs or supplements to NDAs must contain data to assess the safety and effectiveness of the
drug for the claimed indications in all relevant pediatric subpopulations and to support dosing and administration for each pediatric subpopulation for which
the drug is safe and effective. The FDA may grant full or partial waivers, or deferrals, for submission of data. Unless otherwise required by regulation, PREA
does not apply to any drug for an indication for which the FDA has granted an orphan designation.

U.S. Patent Term Restoration

Patent term can also be extended based on the amount of time the patented drug spends in regulatory review for drug approval. The length of time
between drug launch and patent expiration is significantly less than the full 20-year patent term because companies often obtain the patents relating to a drug
early  in  development  and  the  development  path  for  regulatory  approval  is  long.  In  the  United  States,  The  Drug  Price  Competition  and  Patent  Term
Restoration  Act  of  1984  (commonly  known  as  the  Hatch-Waxman  Act)  permits  a  patent  holder  to  seek  a  patent  extension,  commonly  called  patent  term
restoration, for a patent on a drug governed by the FDCA. The length of patent term restoration is related to the length of time the drug is under regulatory
review. Patent term restoration can be a maximum of 5 years and cannot extend the remaining term of a patent beyond a total of 14 years from the date of
drug  approval.  Only  one  patent  applicable  to  an  approved  drug  may  be  extended.  Similar  provisions  are  available  in  Europe  and  certain  other  foreign
jurisdictions to extend the term of a patent that covers an approved drug in that jurisdiction.

Abbreviated New Drug Applications for Generic Drugs

In 1984, with passage of the Hatch-Waxman Act, Congress authorized the FDA to approve generic drugs that are the same as drugs previously
approved  by  the  FDA  under  the  NDA  provisions  of  the  statute.  To  obtain  approval  of  a  generic  drug,  an  applicant  must  submit  an  abbreviated  new  drug
application,  or  ANDA,  to  the  agency.  In  support  of  such  applications,  a  generic  manufacturer  may  rely  on  the  preclinical  and  clinical  testing  previously
conducted for a drug previously approved under an NDA, known as the reference listed drug, or RLD.

Specifically,  in  order  to  approve  an  ANDA,  the  FDA  must  find  that  the  generic  version  is  identical  to  the  RLD  with  respect  to  the  active
ingredients, the route of administration, the dosage form and the strength of the drug. At the same time, the FDA must also determine that the generic drug is
bioequivalent to the RLD. Under the statute, a generic drug is bioequivalent to an RLD if "the rate and extent of absorption of the generic drug do not show a
significant difference from the rate and extent of absorption of the listed drug…"

Upon  approval  of  an  ANDA,  the  FDA  indicates  that  the  generic  drug  is  "therapeutically  equivalent"  to  the  RLD  and  it  assigns  a  therapeutic
equivalence rating to the approved generic drug in its publication "Approved Drug Products with Therapeutic Equivalence Evaluations," also referred to as
the  "Orange  Book."  Physicians  and  pharmacists  consider  an  "AB"  therapeutic  equivalence  rating  to  mean  that  a  generic  drug  is  fully  substitutable  for  the
RLD.  In  addition,  by  operation  of  certain  state  laws  and  numerous  health  insurance  programs,  the  FDA's  designation  of  an  "AB"  rating  often  results  in
substitution of the generic drug without the knowledge or consent of either the prescribing physician or patient.

The  FDCA  provides  a  period  of  five  years  of  non-patent  exclusivity  for  a  new  drug  containing  a  new  chemical  entity.  In  cases  where  such
exclusivity  has  been  granted,  an  ANDA  may  not  be  filed  with  the  FDA  until  the  expiration  of  five  years  unless  the  submission  is  accompanied  by  a
Paragraph  IV  certification,  in  which  case  the  applicant  may  submit  its  application  four  years  following  the  original  product  approval.  The  FDCA  also
provides for a period of three years of exclusivity if the NDA includes reports of one or more new clinical investigations that were conducted by or for the
applicant and are essential to the approval of the application, and are not bioavailability or bioequivalence studies. This three-year exclusivity period often
protects changes to a previously approved drug, such as a new dosage form, route of administration, combination or indication.

23

 
Hatch-Waxman Patent Certification and the 30-month Stay

Upon approval of an NDA or a supplement thereto, NDA sponsors must list with the FDA each patent with claims that cover the applicant's drug or
a method of using the drug. Each of the patents listed by the NDA sponsor is published in the Orange Book. When an ANDA applicant files its application
with the FDA, the applicant is required to certify to the FDA concerning any patents listed for the reference drug in the Orange Book, except for patents
covering methods of use for which the ANDA applicant is not seeking approval. Specifically, the applicant must certify with respect to each patent that:

•

•

•

•

the required patent information has not been filed;

the listed patent has expired;

the listed patent has not expired, but will expire on a particular date and approval is sought after patent expiration; or

the listed patent is invalid, unenforceable or will not be infringed by the new drug.

A certification that the new drug will not infringe the already approved drug's listed patents or that such patents are invalid or unenforceable is
called a Paragraph IV certification. If the applicant does not challenge the listed patents or indicates that it is not seeking approval of a patented method of
use, the FDA will not approve the ANDA application until all the listed patents claiming the referenced drug have expired.

If the ANDA applicant has provided a Paragraph IV certification to the FDA, the applicant must also send notice of the Paragraph IV certification
to the NDA and patent holders once the ANDA has been accepted for filing by the FDA. The NDA and patent holders may then initiate a patent infringement
lawsuit  in  response  to  the  notice  of  the  Paragraph  IV  certification.  The  filing  of  a  patent  infringement  lawsuit  within  45  days  after  the  receipt  of  a
Paragraph IV certification automatically prevents the FDA from approving the ANDA until the earlier of 30 months after the receipt of the Paragraph IV
notice, expiration of the patent, or a decision in the infringement case that is favorable to the ANDA applicant.

Disclosure of Clinical Study Information

Sponsors of clinical studies of FDA-regulated products, including drugs, are required to register and disclose certain clinical study information.
Information related to the product, patient population, phase of investigation, trial sites and investigators, and other aspects of the clinical study is then made
public as part of the registration. Sponsors are also obligated to discuss the results of their clinical studies after completion. Disclosure of the results of these
studies can be delayed until the new drug or new indication being studied has been approved. Competitors may use this publicly available information to gain
knowledge regarding the progress of development programs.

Healthcare Reform

In the United States and foreign jurisdictions, the legislative landscape continues to evolve. There have been a number of legislative and regulatory
changes to the healthcare system that could affect our future results of operations. In particular, there have been and continue to be a number of initiatives at
the United States federal and state levels that seek to reduce healthcare costs. In March 2010, the Patient Protection and Affordable Care Act, or PPACA, was
enacted,  which  includes  measures  that  have  significantly  changed  health  care  financing  by  both  governmental  and  private  insurers.  The  provisions  of  the
PPACA of importance to the pharmaceutical and biotechnology industry are, among others, the following:

•

•

•

•

an annual, nondeductible fee on any entity that manufactures or imports certain branded prescription drugs agents, apportioned among these
entities according to their market share in certain government healthcare programs;

an increase in the rebates a manufacturer must pay under the Medicaid Drug Rebate Program to 23.1% and 13% of the average manufacturer
price for branded and generic drugs, respectively;

a new Medicare Part D coverage gap discount program, in which manufacturers must agree to offer 50% point-of-sale discounts to negotiated
prices  of  applicable  brand  drugs  to  eligible  beneficiaries  during  their  coverage  gap  period,  as  a  condition  for  the  manufacturer's  outpatient
drugs to be covered under Medicare Part D;

extension of manufacturers' Medicaid rebate liability to covered drugs dispensed to individuals who are enrolled in Medicaid managed care
organizations, unless the drug is subject to discounts under the 340B drug discount program;

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•

•

•

•

•

expansion  of  eligibility  criteria  for  Medicaid  programs  by,  among  other  things,  allowing  states  to  offer  Medicaid  coverage  to  additional
individuals and by adding new mandatory eligibility categories for certain individuals with income at or below 133% of the Federal Poverty
Level, thereby potentially increasing manufacturers' Medicaid rebate liability;

expansion of the entities eligible for discounts under the Public Health Service pharmaceutical pricing program;

expansion of healthcare fraud and abuse laws, including the False Claims Act and the Anti-Kickback Statute, new government investigative
powers and enhanced penalties for noncompliance;

new requirements under the federal Physician Payments Sunshine Act for drug manufacturers to report information related to payments and
other transfers of value made to physicians and teaching hospitals as well as ownership or investment interests held by physicians and their
immediate family members; and

a  new  requirement  to  annually  report  certain  drug  samples  that  manufacturers  and  distributors  provide  to  licensed  practitioners,  or  to
pharmacies of hospitals or other healthcare entities.

Since its enactment there have been judicial and Congressional challenges to or proposals to amend certain aspects of PPACA. We expect there will

be additional challenges and amendments to it in the future.

In addition, other health reform measures have been proposed and adopted in the United States since PPACA was enacted. For example, as a result
of the Budget Control Act of 2011, providers are subject to Medicare payment reductions of 2% per fiscal year through 2025 unless additional Congressional
action is taken. Further, the American Taxpayer Relief Act of 2012 reduced Medicare payments to several providers and increased the statute of limitations
period for the government to recover overpayments from providers from three to five years. More recently, there has been heightened governmental scrutiny
over the manner in which manufacturers set prices for their marketed products, which have resulted in several recent Congressional inquiries and proposed
bills designed to, among other things, bring more transparency to drug pricing, review the relationship between pricing and manufacturer patient programs,
and reform government program reimbursement methodologies for drugs.

European Union—EMA Process

In the European Union, drugs follow a similar demanding process as that we described above for the United States and the ICH Common Technical
Document is the basis for applications. Prior to submitting a European Marketing Authorization Application, or MAA, it is necessary to gain approval of a
detailed  Pediatric  Investigation  Plan,  or  PIP,  with  the  European  Medicines  Agency's  Pediatric  Committee,  or  PDCO.  After  gaining  PIP  approval,  EU
regulatory authorities can authorize the drug using either the centralized authorization procedure or national authorization procedures.

Centralized Procedure

Under the centralized procedure, after the EMA issues an opinion, the European Commission issues a single marketing authorization valid across
the  European  Union,  as  well  as  Iceland,  Liechtenstein  and  Norway.  The  centralized  procedure  is  compulsory  for  human  drugs  that:  are  derived  from
biotechnology  processes,  such  as  genetic  engineering;  contain  a  new  active  substance  indicated  for  the  treatment  of  certain  diseases,  such  as  HIV/AIDS,
cancer, diabetes, neurodegenerative disorders or autoimmune diseases and other immune dysfunctions; and are officially designated orphan drugs. For drugs
that do not fall within these categories, an applicant has the option of submitting an application for a centralized marketing authorization to the EMA, as long
as  the  drug  concerned  is  a  significant  therapeutic,  scientific  or  technical  innovation,  or  if  its  authorization  would  be  in  the  interest  of  public  health.
WAYLIVRA  has  been  granted  a  Promising  Innovative  Medicine,  or  PIM,  Designation  by  the  United  Kingdom's  Medicines  and  Healthcare  products
Regulatory  Agency,  or  MHRA,  for  the  treatment  of  people  with  FCS.  A  PIM  Designation  is  an  early  indication  that  a  medicinal  product  is  a  promising
candidate  for  the  Early  Access  to  Medicines  Scheme,  or  EAMS,  in  the  UK,  intended  for  the  treatment,  diagnosis  or  prevention  of  a  life-threatening  or
seriously debilitating condition, with the potential to address an unmet medical need.

25

 
 
 
 
 
 
National Authorization Procedures

There are also two other possible routes to authorize medicinal products in several countries, which are available for products that fall outside the

scope of the centralized procedure:

•

Decentralized  procedure.  Using  the  decentralized  procedure,  an  applicant  may  apply  for  simultaneous  authorization  in  more  than  one
European Union country of a medicinal product that has not yet been authorized in any European Union country and that does not fall within
the mandatory scope of the centralized procedure.

• Mutual recognition procedure. In the mutual recognition procedure, a medicine is first authorized in one European Union Member State, in
accordance  with  the  national  procedures  of  that  country.  Thereafter,  further  marketing  authorizations  can  be  sought  from  other  European
Union  countries  in  a  procedure  whereby  the  countries  concerned  agree  to  recognize  the  validity  of  the  original,  national  marketing
authorization.

Good Manufacturing Practices

Like  the  FDA,  the  EMA,  the  competent  authorities  of  the  European  Union  Member  States,  and  other  regulatory  agencies  regulate  and  inspect
equipment,  facilities  and  processes  used  in  the  manufacturing  of  drugs  prior  to  approving  a  drug.  If,  after  receiving  clearance  from  regulatory  agencies,  a
company makes a material change in manufacturing equipment, location or process, additional regulatory review and approval may be required. Once we or
our partners commercialize drugs, we will be required to comply with cGMP and drug-specific regulations enforced by the European Commission, the EMA
and the competent authorities of European Union Member States following drug approval. Also like the FDA, the EMA, the competent authorities of the
European Union Member States, and other regulatory agencies also conduct regular, periodic visits to re-inspect equipment, facilities and processes following
the initial approval of a drug. If, as a result of these inspections, the regulatory agencies determine that our or our partners' equipment, facilities, or processes
do not comply with applicable regulations and conditions of drug approval, they may seek civil, criminal or administrative sanctions and/or remedies against
us, including the suspension of our manufacturing operations or the withdrawal of our drug from the market.

Data and Market Exclusivity

Similar to the United States, there is a process to authorize generic versions of innovative drugs in the European Union. Generic competitors can
submit abridged applications to authorize generic versions of drugs authorized by EMA through a centralized procedure referencing the innovator's data and
demonstrating  bioequivalence  to  the  reference  drug,  among  other  things.  New  drugs  in  the  European  Union  can  receive  eight  years  of  data  exclusivity
coupled with two years of market exclusivity, and a potential one-year extension, if the marketing authorizations holder obtains an authorization for one or
more new therapeutic indications that demonstrates "significant clinical benefit" in comparison with existing therapies. This system is usually referred to as
"8+2." Abridged applications cannot rely on an innovator's data until after expiry of the eight-year date exclusivity term, meaning that a competitor can file an
application for a generic drug, but the drug cannot be marketed until the end of the market exclusivity term.

Other International Markets—Drug Approval Process

In some international markets (such as China or Japan), although data generated in United States or European Union studies may be submitted in
support of a marketing authorization application, regulators may require additional clinical studies conducted in the host territory, or studying people of the
ethnicity of the host territory, prior to the filing or approval of marketing applications within the country.

Pricing and Reimbursement

Significant uncertainty exists as to the coverage and reimbursement status of any drugs for which we may obtain regulatory approval. In the United
States  and  in  other  countries,  sales  of  any  drugs  for  which  we  receive  regulatory  approval  for  commercial  sale  will  depend  in  part  on  the  availability  of
coverage and reimbursement from third-party payors. Third-party payors include government authorities, managed care providers, private health insurers and
other  organizations.  The  process  for  determining  whether  a  payor  will  provide  coverage  for  a  drug  may  be  separate  from  the  process  for  setting  the
reimbursement rate that the payor will pay for the drug. Third-party payors may limit coverage to specific drugs on an approved list, or formulary, which
might not include all of the FDA-approved drugs for a particular indication. Moreover, a payor's decision to provide coverage for a drug does not imply that
an adequate reimbursement rate will be approved. Additionally, coverage and reimbursement for drugs can differ significantly from payor to payor. One third-
party payor's decision to cover a particular drug does not ensure that other payors will also provide coverage for the drug, or will provide coverage at an
adequate  reimbursement  rate.  Adequate  third-party  reimbursement  may  not  be  available  to  enable  us  to  maintain  price  levels  sufficient  to  realize  an
appropriate return on our investment in drug development.

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Third-party  payors  are  increasingly  challenging  the  price  and  examining  the  medical  necessity  and  cost-effectiveness  of  drugs  and  services,  in
addition to their safety and efficacy. To obtain coverage and reimbursement for any drug that might be approved for sale, we may need to conduct expensive
pharmacoeconomic studies to demonstrate the medical necessity and cost-effectiveness of our drug. These studies will be in addition to the studies required to
obtain regulatory approvals. If third-party payors do not consider a drug to be cost-effective compared to other available therapies, they may not cover the
drug after approval as a benefit under their plans or, if they do, the level of payment may not be sufficient to allow a company to sell its drugs at a profit.

The U.S. government, state legislatures and foreign governments have shown significant interest in implementing cost containment programs to
limit the growth of government-paid health care costs, including price controls, restrictions on reimbursement and requirements for substitution of generic
drugs for branded prescription drugs. By way of example, the PPACA contains provisions that may reduce the profitability of drugs, including, for example,
increased  rebates  for  drugs  sold  to  Medicaid  programs,  extension  of  Medicaid  rebates  to  Medicaid  managed  care  plans,  mandatory  discounts  for  certain
Medicare Part D beneficiaries and annual fees based on pharmaceutical companies' share of sales to federal health care programs. Adoption of government
controls and measures, and tightening of restrictive policies in jurisdictions with existing controls and measures, could limit payments for our drugs.

In the European community, governments influence the price of drugs through their pricing and reimbursement rules and control of national health
care systems that fund a large part of the cost of those drugs to consumers. Some jurisdictions operate positive and negative list systems under which drugs
may  only  be  marketed  once  a  reimbursement  price  has  been  agreed  to  by  the  government.  To  obtain  reimbursement  or  pricing  approval,  some  of  these
countries may require the completion of clinical studies that compare the cost effectiveness of a particular drug candidate to currently available therapies.
Other member states allow companies to fix their own prices for medicines, but monitor and control company profits. The downward pressure on health care
costs in general, particularly prescription drugs, has become very intense. As a result, increasingly high barriers are being erected to the entry of new drugs. In
addition, in some countries, cross border imports from low-priced markets exert a commercial pressure on pricing within a country.

The marketability of any drugs for which we receive regulatory approval for commercial sale may suffer if the government and third-party payors
fail  to  provide  adequate  coverage  and  reimbursement.  In  addition,  the  focus  on  cost  containment  measures  in  the  United  States  and  other  countries  has
increased and we expect will continue to increase the pressure on pharmaceutical pricing. Coverage policies and third-party reimbursement rates may change
at any time. Even if we attain favorable coverage and reimbursement status for one or more drugs for which we receive regulatory approval, less favorable
coverage policies and reimbursement rates may be implemented in the future.

Sales and Marketing

Numerous  regulatory  authorities  in  addition  to  the  FDA,  including,  in  the  United  States,  the  Centers  for  Medicare  &  Medicaid  Services,  other
divisions of the U.S. Department of Health and Human Services, the U.S. Department of Justice, and similar foreign, state and local government authorities,
regulate sales, promotion and other activities following drug approval. As described above, the FDA regulates all advertising and promotion activities for
drugs  under  its  jurisdiction  both  prior  to  and  after  approval.  Only  those  claims  relating  to  safety  and  efficacy  that  the  FDA  has  approved  may  be  used  in
labeling. Physicians may prescribe legally available drugs for uses that are not described in the drug's labeling and that differ from those we tested and the
FDA approved. Such off-label uses are common across medical specialties and often reflect a physician's belief that the off-label use is the best treatment for
the  patients.  The  FDA  does  not  regulate  the  behavior  of  physicians  in  their  choice  of  treatments,  but  FDA  regulations  do  impose  stringent  restrictions  on
manufacturers' communications regarding off-label uses. If we do not comply with applicable FDA requirements, we may face adverse publicity, enforcement
action by the FDA, corrective advertising, consent decrees and the full range of civil and criminal penalties available to the FDA. Promotion of off-label uses
of drugs can also implicate the false claims laws described below.

In  the  United  States  sales,  marketing  and  scientific/educational  programs  must  also  comply  with  various  federal  and  state  laws  pertaining  to
healthcare "fraud and abuse," including anti-kickback laws and false claims laws. Anti-kickback laws make it illegal for a prescription drug manufacturer to
solicit, offer, receive, or pay any remuneration in exchange for, or to induce, the referral of business, including the purchase or prescription of a particular
drug.  Due  to  the  breadth  of  the  statutory  provisions,  limited  statutory  exceptions  and  regulatory  safe  harbors,  and  the  absence  of  guidance  in  the  form  of
regulations and very few court decisions addressing industry practices, it is possible that our practices might be challenged under anti-kickback or similar
laws.  Moreover,  recent  healthcare  reform  legislation  has  strengthened  these  laws.  For  example,  the  PPACA  among  other  things,  amends  the  intent
requirement of the federal anti-kickback and criminal healthcare fraud statutes to clarify that a person or entity does not need to have

27

 
actual knowledge of this statute or specific intent to violate it. In addition, PPACA clarifies that the government may assert that a claim that includes items or
services resulting from a violation of the federal anti-kickback statute constitutes a false or fraudulent claim for purposes of the false claims statutes. False
claims laws prohibit anyone from knowingly and willingly presenting, or causing to be presented for payment, to third-party payors (including Medicare and
Medicaid) claims for reimbursed drugs or services that are false or fraudulent, claims for items or services not provided as claimed, or claims for medically
unnecessary items or services. Our activities relating to the sale and marketing of our drugs may be subject to scrutiny under these laws. Violations of fraud
and  abuse  laws  may  be  punishable  by  criminal  and  civil  sanctions,  including  fines  and  civil  monetary  penalties,  the  possibility  of  exclusion  from  federal
healthcare  programs  (including  Medicare  and  Medicaid)  and  corporate  integrity  agreements,  which  impose,  among  other  things,  rigorous  operational  and
monitoring  requirements  on  companies.  Similar  sanctions  and  penalties  also  can  be  imposed  upon  executive  officers  and  employees,  including  criminal
sanctions against executive officers under the so-called "responsible corporate officer" doctrine, even in situations where the executive officer did not intend
to violate the law and was unaware of any wrongdoing.

Given the significant penalties and fines that can be imposed on companies and individuals if convicted, allegations of such violations often result
in settlements even if the company or individual being investigated admits no wrongdoing. Settlements often include significant civil sanctions, including
fines and civil monetary penalties, and corporate integrity agreements. If the government were to allege or convict us or our executive officers of violating
these laws, our business could be harmed. In addition, private individuals can bring similar actions. Our activities could be subject to challenge for the reasons
discussed above and due to the broad scope of these laws and the increasing attention being given to them by law enforcement authorities. Other healthcare
laws that may affect our ability to operate include the federal Health Insurance Portability and Accountability Act of 1996, or HIPAA, as amended by the
Health Information Technology for Economic and Clinical Health Act, which governs the conduct of certain electronic healthcare transactions and protects
the security and privacy of protected health information; analogous state laws governing the privacy and security of health information, some of which are
more stringent than HIPAA and many of which differ from each other in significant ways and may not have the same effect, and the Physician Payments
Sunshine  Act,  which  requires  manufacturers  of  drugs,  devices,  biologics,  and  medical  supplies  to  report  annually  to  the  U.S.  Department  of  Health  and
Human Services information related to payments and other transfers of value to physicians and teaching hospitals, and ownership and investment interests
held by physicians and their immediate family members. Further, there are an increasing number of state laws that require manufacturers to make reports to
states on pricing and marketing information. Many of these laws contain ambiguities as to what is required to comply with the laws. Given the lack of clarity
in laws and their implementation, our reporting actions could be subject to the penalty provisions of the pertinent state authorities.

Similar rigid restrictions are imposed on the promotion and marketing of drugs in the European Union and other countries. Even in those countries
where  we  may  not  be  directly  responsible  for  the  promotion  and  marketing  of  our  drugs,  if  our  potential  international  distribution  partners  engage  in
inappropriate activity it can have adverse implications for us.

The Foreign Corrupt Practices Act

The Foreign Corrupt Practices Act, or FCPA, prohibits any U.S. individual or business from paying, offering, or authorizing payment or offering of
anything of value, directly or indirectly, to any foreign official, political party, or candidate for the purpose of influencing any act or decision of the foreign
entity in order to assist the individual or business in obtaining or retaining business. The FCPA also obligates companies whose securities are listed in the
United States to comply with accounting provisions requiring the company to maintain books and records that accurately and fairly reflect all transactions of
the  corporation,  including  international  subsidiaries,  and  to  devise  and  maintain  an  adequate  system  of  internal  accounting  controls  for  international
operations.  Activities  that  violate  the  FCPA,  even  if  they  occur  wholly  outside  the  United  States,  can  result  in  criminal  and  civil  fines,  imprisonment,
disgorgement, oversight, and debarment from government contracts.

Employees

As  of  February  20,  2019,  we  employed  248  people.  A  significant  number  of  our  management  and  professional  employees  have  had  prior
experience  with  pharmaceutical,  biotechnology  or  medical  product  companies.  Collective  bargaining  agreements  do  not  cover  any  of  our  employees  and
management considers relations with our employees to be good.

Corporate Information

We incorporated in Delaware in December 2014. Our principal offices are in Boston, Massachusetts. We make available, free of charge, on our
website, www.akceatx.com, our reports on Forms 10-K, 10-Q, 8-K and amendments thereto, as soon as reasonably practical after we file such materials with
the Securities and Exchange Commission. Any information that we include on or link to our website is not a part of this report or any registration statement
that incorporates this report by reference. The SEC also maintains a website that contains reports, proxy and information statements, and other information
regarding issuers that file electronically with the SEC. The address of that site is www.sec.gov.

28

 
Executive Officers of Akcea

The following sets forth certain information regarding our executive officers as of February 20, 2019:

Name

Paula Soteropoulos
Sarah Boyce
Michael MacLean
Jeffrey M. Goldberg
Louis St. L. O'Dea, MB BCh BAO, FRCP(C)

PAULA SOTEROPOLOUS

Chief Executive Officer

Position

Age
51
47
53
46
68

  Chief Executive Officer
  President
  Chief Financial Officer
  Chief Operating Officer
  Chief Medical Officer

Ms. Soteropoulos joined Akcea as Chief Executive Officer and as a member of our board of directors in January 2015. Prior to joining Akcea,
Ms.  Soteropoulos  was  a  member  of  the  executive  leadership  team  of  Moderna  Therapeutics  Inc.,  now  a  public  biotechnology  company,  serving  as  the
Cardiometabolic  Business  Unit  General  Manager  and  Senior  Vice  President  of  Strategic  Alliances  from  July  2013  to  December  2014.  Prior  to  Moderna,
Ms.  Soteropoulos  spent  21  years  at  Genzyme  Corporation  in  various  leadership  positions  driving  strategy,  sales  and  marketing,  business  development,
manufacturing  process  development,  strategic  capacity  planning,  and  supply  chain  development.  Since  July  2013,  Ms.  Soteropoulos  has  served  on  the
supervisory board of uniQure N.V., a public biotechnology company. Ms. Soteropoulos also serves on the advisory board of the Tufts University Chemical
and Biological Engineering Department. Our board of directors believes that Ms. Soteropoulos is uniquely suited to serve on our board of directors because of
her experience in the biotechnology industry and her daily insight into corporate matters as our Chief Executive Officer.

SARAH BOYCE

President

Ms. Boyce joined Akcea as a Board member and President in April 2018. Previously, she was the Chief Business Officer of Ionis Pharmaceuticals.
In this role Ms. Boyce was responsible for leading investor relations and corporate communications, business development, alliance management, competitive
intelligence and patient advocacy.  She led the effort to establish a global agreement with Ionis and Novartis to develop and commercialize AKCEA APO(a)-
LRx and AKCEA APOCIII-LRx. Ms. Boyce also served as Vice President, Head of International Business Strategy and Operations at Forest Laboratories, Inc.
where she led the establishment and expansion of their international pharmaceutical and consumer health businesses. Prior to Forest, she served as a global
business leader at Alexion and Novartis. Sarah  Boyce  is  an  experienced  life  sciences  industry  leader  who  has  built  out  and  overseen  divisions  and  global
commercial operations for a range of innovative therapies including Soliris®, Gleevec® and Tasigna®.

MICHAEL MACLEAN

Chief Financial Officer

Mr. MacLean has served as Chief Financial Officer of Akcea since September 2017. Prior to joining Akcea, from September 2015 to September
2017, Mr. MacLean was Chief Financial Officer and Executive Vice President for PureTech Health, an advanced, clinical-stage, public biopharmaceutical
company focusing on diseases caused by dysfunctions in the nervous, gastrointestinal and immune systems. Previously, Mr. MacLean served as Senior Vice
President of Finance and Chief Accounting Officer of Biogen Inc. where he led the Company's worldwide finance organization.

JEFFREY M. GOLDBERG

Chief Operating Officer

Mr.  Goldberg  joined  Akcea  as  Chief  Operating  Officer  in  January  2015.  Prior  to  joining  Akcea,  from  December  2012  to  September  2014,
Mr. Goldberg was a member of the executive leadership team at Proteostasis Therapeutics, Inc., now a public biotechnology company focusing on neurology
and orphan diseases, where he served as Vice President of Business Operations. Prior to that, Mr. Goldberg spent over 11 years in positions of increasing
responsibility with Genzyme and Sanofi S.A., most recently as Associate Vice President, Project Head, within Sanofi Oncology.

29

 
 
 
 
 
 
 
 
 
LOUIS ST. L. O'DEA

Chief Medical Officer

Dr.  O'Dea  joined  Akcea  as  Chief  Medical  Officer  in  January  2016.  Prior  to  joining  Akcea,  Dr.  O'Dea  was  Chief  Medical  Officer  at  Oxford
Immunotec Global PLC, now a public diagnostics company, from June 2014 to January 2016, overseeing medical affairs and clinical development. Prior to
Oxford, Dr. O'Dea was Chief Medical Officer and Head of Regulatory Affairs at Moderna from January 2012 to June 2014. Before Moderna, Dr. O'Dea held
positions  including  Chief  Medical  Officer  at  Radius  Health,  Inc.,  a  public  biopharmaceuticals  company,  an  academic  position  at  McGill  University,  and
worldwide Head of Clinical Development for Endocrine and Metabolic products at Serono.

ITEM 1A. RISK FACTORS

Investing in our securities involves a high degree of risk. You should consider carefully the following information about the risks described below,
together with the other information contained in this Report and in our other public filings in evaluating our business. If any of the following risks actually
occur, our business could be materially harmed, and our financial condition and results of operations could be materially and adversely affected. As a result,
the trading price of our securities could decline, and you might lose all or part of your investment. The risks and uncertainties described below are not the
only ones we face. Additional risks and uncertainties not presently known to us or that we currently believe to be immaterial may also adversely affect our
business.

Risks Related to Our Financial Condition and Need for Additional Capital

We have a limited operating history and may never become profitable.

Ionis Pharmaceuticals, Inc., or Ionis, incorporated us as a Delaware corporation in December 2014, and we have operated as an affiliate of Ionis
since that time. As such, we have limited experience as a company, and no experience operating independently from Ionis, and have not yet demonstrated that
we can successfully overcome many of the risks and uncertainties frequently encountered in new and rapidly evolving fields, particularly the biotechnology
and pharmaceutical fields.

As a company, we have limited experience commercializing products. Our ability to generate substantial revenue and achieve profitability depends
on  our  ability,  alone  or  with  strategic  partners,  to  successfully  develop  our  drugs,  obtain  the  regulatory  approvals  necessary  to  commercialize  our  drugs,
including WAYLIVRATM (volanesorsen), AKCEA-APO(a)-LRx, AKCEA-TTR-LRx and our other drugs in development, and continue the commercialization
of TEGSEDI TM (inotersen). Although we received our first revenue from product sales in the fourth quarter of 2018, if we are not successful in growing
revenue and controlling costs, we will not achieve profitable operations or positive cash flow, and even if we achieve profitability in the future, we may not
sustain profitability in subsequent periods. Our ability to generate revenue sufficient to achieve profitability from product sales depends heavily on our and
our current and future strategic partners' success in:

•

•

•

•

•

•

completing clinical development of WAYLIVRA for additional indications and nonclinical and clinical development of AKCEA-APO(a)-LRx,
AKCEA-TTR-LRx, AKCEA-ANGPTL3-LRx and AKCEA-APOCIII-LRx;

seeking  and  obtaining  regulatory  and  marketing  authorization  for  our  drugs,  including  TEGSEDI,  WAYLIVRA,  AKCEA-APO(a)-LRx  and
our other drugs in development;

managing supply and manufacturing relationships with third parties that can provide the amount and quality of products and services we need
to continue to commercialize TEGSEDI and to develop and, if approved, commercialize WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-TTR-
LRx and our other drugs in development;

launching  and  commercializing  WAYLIVRA,  AKCEA-ANGPTL3-LRx  and  AKCEA-TTR-LRx  and  continuing  the  commercialization  of
TEGSEDI by managing a sales, marketing and distribution infrastructure;

launching and co-commercializing AKCEA-APO(a)-LRx and AKCEA-APOCIII-LRx through our collaboration with Novartis Pharma AG, or
Novartis, under terms that we may negotiate with Novartis in the future;

educating physicians about our target patient populations, including the polyneuropathy of hereditary transthyretin-mediated amyloidosis in
adult patients in the United States, stage 1 or stage 2 polyneuropathy in adult patients with hereditary TTR Amyloidosis, or hATTR, in the EU
or Canada, patients with familial chylomicronemia syndrome, or FCS, and patients with familial partial lipodystrophy, or FPL;

30

 
 
 
 
 
 
 
•

•

•

•

•

•

•

obtaining market acceptance of TEGSEDI, WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-TTR-LRx  and  our  other  drugs  in  development  as
viable treatment options;

obtaining and maintaining adequate coverage and reimbursement from third-party payors for TEGSEDI, WAYLIVRA, AKCEA-APO(a)-LRx,
AKCEA-TTR-LRx and our other drugs in development;

addressing any competing technological and market developments;

negotiating favorable terms in any partnership, licensing or other arrangements into which we may enter;

maintaining, protecting and expanding our portfolio of intellectual property rights, including patents, product trademarks and know-how;

developing  and  commercializing  WAYLIVRA,  AKCEA-ANGPTL3-LRx,  AKCEA-TTR-LRx  and  our  other  drugs  in  development  and
continuing the commercialization of TEGSEDI without infringing others' intellectual property rights; and

attracting, hiring and retaining qualified personnel.

We  may  not  successfully  develop  our  products  or  generate  product  revenue  sufficient  to  cover  operating  expenses  or  become  profitable.  If  we
cannot  achieve  or  maintain  profitability,  it  would  depress  the  market  price  of  our  common  stock  and  could  impair  our  ability  to  raise  capital,  expand  our
business, diversify our product offerings or continue our operations. If the market price of our common stock declined, you could lose all or part of your
investment.

We have incurred losses since our inception.

Because  drug  development  requires  substantial  lead-time  and  funding  prior  to  commercialization,  we  have  incurred  expenses  while  generating
limited revenue from our operating activities since our formation. Our net losses were $225.8 million and $121.6 million for the years ended December 31,
2018 and December 31, 2017 (as revised), respectively. As of December 31, 2018, we had an accumulated deficit of approximately $522.0 million. Most of
the  losses  resulted  from  costs  incurred  in  connection  with  our  development  programs  and  from  general  and  administrative  costs  associated  with  our
operations. We expect to incur additional operating losses for the foreseeable future, and these losses may increase if we cannot generate substantial revenue.

We will require substantial additional funding to achieve our goals. If we fail to obtain timely funding, we may need to curtail or abandon some of our
programs.

All of our drugs are undergoing clinical studies. All of our drug programs, except TEGSEDI in the United States, EU, and Canada, will require
additional nonclinical and/or clinical testing and/or marketing authorization prior to commercialization. We will need to spend significant additional resources
to conduct these activities. Our expenses could increase beyond expectations if the U.S. Food and Drug Administration, or FDA, the European Medicines
Agency, or EMA, or other regulatory authorities require us to perform clinical studies and other studies in addition to those that we currently anticipate. As of
December 31, 2018, we had cash, cash equivalents and investments equal to $252.6 million. Our operating expenses were $295.7 million and $163.9 million
for the ended December 31, 2018 and December 31, 2017, respectively.

Prior to our IPO, we funded our operating activities through a $100.0 million cash contribution we received from Ionis in 2015, $75.0 million that
we received from initiating our collaboration with Novartis and $106.0 million in drawdowns under our line of credit with Ionis. The line of credit converted
to our common stock when we closed our IPO. We no longer have access to the line of credit following the closing of our IPO and we do not have any firm
commitment from Ionis to fund our cash flow deficits or provide other direct or indirect financial assistance to us. Additionally, in July 2017 we received
$182.3 million in net proceeds from our IPO including $25.0 million that Ionis invested in our IPO and the Novartis concurrent private placement of $50.0
million. In April 2018, we received $200.0 million from the common stock we issued in connection with the licensing transaction with Ionis discussed in
Note 7, License Agreements and Services Agreement with Ionis, to our consolidated financial statements included in this Form 10-K. We expect that we will
need  to  raise  additional  funding  to  continue  developing  the  drugs  in  our  pipeline  and  to  seek  regulatory  approval  for  and  to  commercialize  TEGSEDI,
WAYLIVRA and other drugs in our pipeline.

We  have  received  marketing  authorization  approval  for  TEGSEDI  from  the  FDA  for  the  treatment  of  the  polyneuropathy  of  hATTR  in  adult
patients in the United States, from the European Commission, or EC, and from Health Canada for the treatment of stage 1 or stage 2 polyneuropathy in adult
patients  with  hATTR,  and  we  will  continue  to  incur  significant  costs  commercializing  TEGSEDI.  Even  if  we  obtain  marketing  authorizations  to  sell
WAYLIVRA, AKCEA-APO(a)-LRx or AKCEA-TTR-LRx, we will incur

31

 
 
 
 
 
 
 
 
significant costs to commercialize the approved product. To date, only one of our product(s), TEGSEDI, has commercially launched, and even if we generate
substantial revenue from the sale of approved products, we may not become profitable and would need to obtain additional funding to continue operations.

Risks Related to Clinical Development, Regulatory Review and Approval of Our Drugs

If the results of clinical testing indicate that any of our drugs are not suitable for commercial use, we may need to abandon one or more of our drug
development programs.

Drug discovery and development has inherent risks and the historical failure rate for drugs is high. Antisense drugs are a relatively new approach to
therapeutics. If we cannot demonstrate that our drugs are safe and effective for human use in the intended indication, we may need to abandon one or more of
our drug development programs.

If any of our drugs in clinical studies, including WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-TTR-LRx and our other drugs in development, do
not show sufficient safety and efficacy in patients with the targeted indication, it would negatively affect our development and commercialization goals for the
drug and we would have expended significant resources with little or no benefit to us.

Even if our drugs are successful in preclinical and earlier-stage clinical studies, the drugs may not be successful in later-stage clinical studies.

Successful results in preclinical or initial clinical studies, including the results of earlier studies for our drugs in development, may not predict the
results of subsequent clinical studies, including the Phase 3 study of WAYLIVRA for the treatment of FPL and the Phase 3 study of AKCEA-APO(a)-LRx in
patients with established cardiovascular disease and elevated levels of lipoprotein(a). There are a number of factors that could cause a clinical study to fail or
be delayed, including:

•

•

•

•

•

•

•

•

•

•

•

•

•

the clinical study may produce negative or inconclusive results;

regulators may require that we hold, suspend or terminate clinical research for noncompliance with regulatory requirements;

we, our partners, the FDA or foreign regulatory authorities could suspend or terminate a clinical study due to adverse side effects of a drug on
people in the study;

we or our partners may decide, or regulators may require us, to conduct additional preclinical testing or clinical studies;

we or our partners may not identify, recruit and train suitable clinical investigators at a sufficient number of study sites;

the institutional review board for a prospective site might withhold or delay its approval for the study;

enrollment in our clinical studies may be slower than we anticipate;

patients who enroll in the clinical study may later drop out due to adverse events, a perception they are not benefiting from participating in the
study, fatigue with the clinical study process or personal issues;

a clinical study site may deviate from the protocol for the study;

the cost of our clinical studies may be greater than we anticipate;

we or our partners may require additional capital to fund the clinical study;

our partners may decide not to exercise any existing options to license and conduct additional clinical studies for our drugs; and

the supply or quality of our drugs or other materials necessary to conduct the clinical studies may be insufficient, inadequate or delayed.

In addition, WAYLIVRA and AKCEA-APOCIII-LRx have the same mechanism of action, TEGSEDI and AKCEA-TTR-LRx, also have the same
mechanism of action and all of our current drugs, including WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-ANGPTL3-LRx and AKCEA-APOCIII-LRx, are
chemically  similar  to  each  other  and  the  drugs  Ionis  and  other  companies  are  developing  separately.  As  a  result,  a  safety  observation  we,  Ionis  or  other
companies  encounter  with  one  of  our  or  their  drugs  could  have  or  be  perceived  by  a  regulatory  authority  to  have  an  impact  on  a  different  drug  we  are
developing. This could cause the FDA and other regulators to ask questions or take actions that could harm or delay our ability to develop and commercialize
our drugs or

32

 
 
 
 
 
 
 
 
 
 
 
 
 
 
increase our costs. For example, the FDA or other regulatory agencies could request, among other things, any of the following regarding one of our drugs:
additional information or commitments before we can start or continue a clinical study, protocol amendments, increased safety monitoring, additional product
labeling information, and post-approval commitments. Similarly, we have an ongoing Phase 3 study of WAYLIVRA in patients with FPL, an ongoing open
label  extension  study  of  WAYLIVRA  in  patients  with  FCS  and  an  open  label  extension  study  of  TEGSEDI  in  patients  with  hATTR,  and  an  early  access
program, or EAP, for both WAYLIVRA and TEGSEDI. Adverse events or results from these studies or the EAPs could negatively impact our pending or
future  marketing  approval  applications  for  WAYLIVRA  and  TEGSEDI  in  patients  with  FCS  or  hATTR  amyloidosis  or  the  commercial  opportunity  for
WAYLIVRA  or  TEGSEDI.  In  August  2018  we  received  a  Complete  Response  Letter,  or  CRL,  from  the  FDA  regarding  the  new  drug  application  for
WAYLIVRA  in  which  the  FDA  determined  that  the  safety  concerns  identified  with  WAYLIVRA  in  our  clinical  development  program  outweighed  the
expected  benefits  of  triglyceride  lowering  in  patients  with  FCS.  We  also  received  a  Notice  of  Noncompliance  withdrawal  letter,  or  Non-W,  from  Health
Canada for WAYLIVRA in November 2018. We and Ionis are engaged with the FDA and plan to work with Health Canada to confirm a path forward for
WAYLIVRA.  As  a  result,  we  will  need  to  submit  additional  data  to  FDA  and  may  need  to  conduct  additional  clinical  studies  before  obtaining  marketing
authorization, which in turn could delay or prevent us from generating any revenue or profit from the sale of WAYLIVRA. The regulatory authorities and
Europe could have a similar response to the pending marketing authorization application. Any failure or delay in the clinical studies for any of our drugs in
development could reduce the commercial potential or viability of our drugs.

We  may  not  have  appropriately  designed  the  planned  and  ongoing  clinical  studies  for  WAYLIVRA,  AKCEA-APO(a)-LRx, AKCEA-TTR-LRx  and  our
other  drugs  in  development  to  support  submission  of  a  marketing  application  to  the  FDA  and  foreign  regulatory  authorities  or  demonstrate  safety  or
efficacy at the level required by the FDA and foreign regulatory authorities for product approval.

We  completed  a  Phase  3  clinical  program  for  WAYLIVRA  for  the  treatment  of  FCS  in  2018  and  are  conducting  or  plan  to  conduct  additional
clinical  studies  for  WAYLIVRA  in  patients  with  FPL,  as  well  as  for  AKCEA-TTR-LRx,  AKCEA-APO(a)-LRx,  AKCEA-ANGPTL3-LRx  and  AKCEA-
APOCIII-LRx.

Even  if  we  achieve  positive  results  on  the  endpoints  for  these  clinical  studies  or  any  future  clinical  studies,  the  FDA  or  foreign  regulatory
authorities may believe the clinical studies do not show the appropriate balance of safety and efficacy in the indication being sought or may interpret the data
differently  than  we  do,  and  deem  the  results  insufficient  to  demonstrate  the  appropriate  balance  of  safety  and  efficacy  at  the  level  required  for  product
approval. For example, in August 2018 we received a CRL from the FDA regarding the new drug application for WAYLIVRA in which the FDA determined
that  the  safety  concerns  identified  with  WAYLIVRA  in  our  clinical  development  program  outweighed  the  expected  benefits  of  triglyceride  lowering  in
patients with FCS. We also received a Non-W from Health Canada for WAYLIVRA in November 2018. We and Ionis are engaged with the FDA and plan to
work with Health Canada to confirm a path forward for WAYLIVRA. As a result, we will need to submit additional data to the FDA and may need to conduct
additional clinical studies before obtaining marketing authorization, which in turn could delay or prevent us from generating any revenue or profit from the
sale  of  WAYLIVRA.  The  CHMP  of  the  EMA  has  adopted  a  positive  opinion  recommending  conditional  marketing  authorization  of  WAYLIVRA  as  an
adjunct  to  diet  in  adult  patients  with  genetically  confirmed  FCS  who  are  at  high  risk  for  pancreatitis,  in  whom  response  to  diet  and  triglyceride  lowering
therapy has been inadequate. The positive opinion will now be referred to the EC, which grants marketing authorization for medicines in the European Union,
as well as to European Economic Area members Iceland, Liechtenstein and Norway, however, the EC may decide not to adopt the CHMP’s positive opinion.
These risks are more likely to occur since we are developing our drugs against therapeutic targets or to treat diseases in which there is little or no clinical
experience. In addition, these risks may be more likely to occur for WAYLIVRA since there were some patients in the Phase 3 program that experienced
serious platelet events (grade 4 thrombocytopenia), a condition in which the patient has very low platelet levels, and additional patients experienced other
adverse events in the program, including patients who discontinued participation in the APPROACH study due to platelet count declines. We believe that the
enhanced monitoring we have implemented to support early detection and management of these issues can help manage these safety issues so that patients
can continue treatment. Since implementation of the enhanced monitoring, serious platelet events have been infrequent.

We may make modifications to the clinical study protocols or designs of our ongoing clinical studies that delay enrollment or completion of such
clinical studies and could delay regulatory approval of WAYLIVRA and our other drugs in development. Any failure to obtain approval for WAYLIVRA,
AKCEA-APO(a)-LRx, AKCEA-TTR-LRx and our other drugs in development on the timeline that we currently anticipate, or at all, would have a material and
adverse impact on our business, prospects, financial condition and results of operations and could cause our stock price to decline.

33

 
Clinical studies for WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-TTR-LRx, AKCEA-ANGPTL3-LRx, AKCEA-APOCIII-LRx or our other drugs may not
demonstrate safety or efficacy at the level required by the FDA and foreign regulatory authorities for product approval.

The EMA is currently reviewing our application for regulatory approval for WAYLIVRA. The CHMP of the EMA has adopted a positive opinion
recommending conditional marketing authorization of WAYLIVRA as an adjunct to diet in adult patients with genetically confirmed FCS who are at high risk
for pancreatitis, in whom response to diet and triglyceride lowering therapy has been inadequate. The positive opinion will now be referred to the EC, which
grants marketing authorization for medicines in the European Union, as well as to European Economic Area members Iceland, Liechtenstein and Norway,
however,  the  EC  may  decide  not  to  adopt  the  CHMP’s  positive  opinion. We  and  Ionis  are  conducting  or  intend  to  conduct  clinical  studies  for  AKCEA-
APO(a)-LRx, AKCEA-TTR-LRx, AKCEA-ANGPTL3-LRx and AKCEA-APOCIII-LRx.

Even if positive results on the endpoints for the clinical studies are achieved, the FDA or foreign regulatory authorities may believe the clinical
studies do not show the appropriate balance of safety and efficacy in the indication being sought or may interpret the data differently than we do, and may
deem the results insufficient to demonstrate the appropriate balance of safety and efficacy at the level required for product approval. For example, in August
2018 we received a CRL from the FDA regarding the new drug application for WAYLIVRA in which the FDA determined that the safety concerns identified
with WAYLIVRA in our clinical development program outweighed the expected benefits of triglyceride lowering in patients with FCS. We also received a
Non-W from Health Canada for WAYLIVRA in November 2018. We and Ionis are engaged with the FDA and plan to work with Health Canada to confirm a
path  forward  for  WAYLIVRA.  As  a  result,  we  will  need  to  submit  additional  data  to  FDA  and  may  need  to  conduct  additional  clinical  studies  before
obtaining  marketing  authorization,  which  in  turn  could  delay  or  prevent  us  from  generating  any  revenue  or  profit  from  the  sale  of  WAYLIVRA.  The
regulatory  authorities  in  Europe  could  have  a  similar  response  to  the  pending  marketing  authorization  application.  As  an  additional  example,  the  foreign
regulatory authorities could claim that we have not tested WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-TTR-LRx, AKCEA-ANGPTL3-LRx and AKCEA-
APOCIII-LRx in a sufficient number of patients to demonstrate that the drug is safe and effective in patients with other indications to support an application
for  marketing  authorization  for  the  applicable  indication.  In  such  a  case,  we  may  need  to  conduct  additional  clinical  studies  before  obtaining  marketing
authorization, which would be expensive and delay the development and commercialization of the drug.

Any  failure  to  obtain  approvals  for  WAYLIVRA  in  other  important  markets  outside  of  the  United  States  and  Canada,  including  the  EU,  on  the
timeline  that  we  currently  anticipate,  or  at  all,  would  have  a  material  and  adverse  impact  on  our  business,  prospects,  financial  condition  and  results  of
operations and could cause our stock price to decline.

If  we  or  our  partners  fail  to  obtain  regulatory  approval  for  our  drugs,  including  WAYLIVRA,  AKCEA-APO(a)-LRx, AKCEA-TTR-LRx  and  our  other
drugs in development, or additional approvals for TEGSEDI, we or our partners cannot sell them in the applicable markets.

We cannot guarantee that any of our drugs, including WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-TTR-LRx and our other drugs in development,
will  be  safe  and  effective,  or  will  be  approved  or  receive  additional  approvals  for  commercialization.  We  and  our  partners  must  conduct  time-consuming,
extensive  and  costly  clinical  studies  to  demonstrate  the  safety  and  efficacy  of  each  of  our  drugs,  including  WAYLIVRA,  AKCEA-APO(a)-LRx,  AKCEA-
TTR-LRx and our other drugs in development, before they can be approved, or receive additional approvals, for sale. We and our partners must conduct these
studies in compliance with FDA regulations and with comparable regulations in other countries.

We or our partners may not obtain necessary regulatory approvals on a timely basis, if at all, for any of our drugs. It is possible that regulatory
authorities will not approve TEGSEDI in additional markets or any of our other drugs, including WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-TTR-LRx and
our other drugs in development, for marketing. If the FDA or another regulatory authority believes that we or our partners have not sufficiently demonstrated
the  safety  or  efficacy  of  any  of  our  drugs,  including  WAYLIVRA,  AKCEA-APO(a)-LRx,  AKCEA-TTR-LRx  and  our  other  drugs  in  development,  the
authority will not approve the specific drug or will require additional studies, which can be time consuming and expensive and which will delay or harm our
ability  to  successfully  commercialize  the  drug.  For  example,  in  August  2018  we  received  a  CRL  from  the  FDA  regarding  the  new  drug  application  for
WAYLIVRA  in  which  the  FDA  determined  that  the  safety  concerns  identified  with  WAYLIVRA  in  our  clinical  development  program  outweighed  the
expected benefits of triglyceride lowering in patients with FCS. We also received a Non-W from Health Canada for WAYLIVRA in November 2018. We and
Ionis  are  engaged  with  the  FDA  and  plan  to  work  with  Health  Canada  to  confirm  a  path  forward  for  WAYLIVRA.  As  a  result,  we  will  need  to  submit
additional data to FDA and may need to conduct additional clinical studies before obtaining marketing authorization, which in turn could delay or prevent us
from  generating  any  revenue  or  profit  from  the  sale  of  WAYLIVRA.  The  regulatory  authority  in  Europe  could  have  a  similar  response  to  the  pending
marketing authorization.

34

 
The FDA or other comparable foreign regulatory authorities can delay, limit or deny approval of a drug for many reasons, including:

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•

such authorities may disagree with the design or implementation of our clinical studies;

we or our partners may be unable to demonstrate to the satisfaction of the FDA or other regulatory authorities that a drug is safe and effective
for any indication;

such authorities may not accept clinical data from studies conducted at clinical facilities that have deficient clinical practices or that are in
countries where the standard of care is potentially different from the United States;

we or our partners may be unable to demonstrate that our drug's clinical and other benefits outweigh its safety risks to support approval;

such authorities may disagree with the interpretation of data from preclinical or clinical studies;

such authorities may find deficiencies in the manufacturing processes or facilities of third-party manufacturers who manufacture clinical and
commercial supplies for our drugs; and

the  approval  policies  or  regulations  of  such  authorities  or  their  prior  guidance  to  us  or  our  partners  during  clinical  development  may
significantly change in a manner rendering our clinical data insufficient for approval.

Failure  to  successfully  develop  WAYLIVRA,  AKCEA-APO(a)-LRx,  AKCEA-TTR-LRx  and  our  other  drugs  in  development,  or  to  receive
marketing authorization for these drugs in important markets or delays in these authorizations would prevent or delay the commercial launch of the drug, and,
as a result, would negatively affect our ability to generate revenue.

We may not be able to benefit from orphan drug designation for WAYLIVRA, TEGSEDI or any of our other drugs.

The FDA and EMA have granted orphan drug designation to TEGSEDI and to WAYLIVRA for the treatment of patients with FCS. In addition, the
EMA has granted orphan drug designation to WAYLIVRA for the treatment of patients with FPL. The FDA, however, refused to grant our request for orphan
drug designation for WAYLIVRA for the treatment of patients with FPL in the United States in 2017.

In  the  United  States,  under  the  Orphan  Drug  Act,  the  FDA  may  designate  a  drug  as  an  orphan  drug  if  it  is  intended  to  treat  a  rare  disease  or
condition, which is generally defined as a patient population of fewer than 200,000 individuals in the United States. Orphan drug designation does not convey
any advantage in, or shorten the duration of, the regulatory review and approval process, but it can provide financial incentives, such as tax advantages and
user-fee waivers, as well as longer regulatory exclusivity periods.

Even if approval is obtained on a drug that has been designated as an orphan drug, we may lose orphan drug exclusivity if the FDA determines that
the request for designation was materially defective or if we cannot assure sufficient quantity of the applicable drug to meet the needs of patients with the rare
disease or condition, or if a competitor is able to gain approval for the same drug in a safer or more effective form or that makes a major contribution to
patient care.

Even  if  we  maintain  orphan  drug  exclusivity  for  TEGSEDI  or  WAYLIVRA  for  the  treatment  of  patients  with  FCS  or  obtain  orphan  drug
exclusivity  for  our  other  drugs,  the  exclusivity  may  not  effectively  protect  the  drug  from  competition  because  regulatory  authorities  still  may  authorize
different drugs for the same condition.

We may expend our limited resources to pursue a particular drug or indication and fail to capitalize on drugs or indications that may be more profitable
or for which there is a greater likelihood of success.

We  will  continue  to  dedicate  a  substantial  amount  of  our  resources  to  commercialize  TEGSEDI  and  support  the  continued  development  of
AKCEA-TTR-LRx.  In  addition,  we  may  dedicate  a  substantial  amount  of  our  resources  to  develop  and  seek  regulatory  approval  for  WAYLIVRA  to  treat
patients with FCS and FPL. As a result, we may forego or delay pursuit of opportunities with our other drugs or for other indications that later prove to have
greater  commercial  potential.  Our  resource  allocation  decisions  may  cause  us  to  fail  to  capitalize  on  viable  commercial  drugs  or  profitable  market
opportunities.  Our  spending  on  current  and  future  research  and  development  programs  and  drugs  for  specific  indications  may  not  yield  any  commercially
viable drugs.

35

 
 
 
 
 
 
 
 
Our  drugs,  including  TEGSEDI,  WAYLIVRA,  AKCEA-APO(a)-LRx,  AKCEA-TTR-LRx  and  our  other  drugs  in  development,  could  be  subject  to
regulatory limitations following approval.

Following approval of a drug, we and our partners must comply with comprehensive government regulations regarding the manufacture, marketing
and  distribution  of  drug  products.  Promotional  communications  regarding  prescription  drugs  must  be  consistent  with  the  information  in  the  product's
approved labeling. We and our partners may not obtain the labeling claims necessary or desirable to successfully commercialize our drug products, including
TEGSEDI, and if approved, WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-TTR-LRx and our other drugs in development.

The  FDA  and  foreign  regulatory  authorities  can  impose  significant  restrictions  on  an  approved  drug  product  through  the  product  label  and  on

advertising, promotional and distribution activities. For example:

•

•

•

In the United States, TEGSEDI’s label contains a boxed warning for thrombocytopenia and glomerulonephritis,

TEGSEDI requires periodic blood and urine monitoring, and

in the United States TEGSEDI is available only through a Risk Evaluation and Mitigation Strategy, or REMS, program.

In addition, when approved, the FDA or a foreign regulatory authority may condition approval on the performance of post-approval clinical studies
or patient monitoring, which could be time consuming and expensive. If the results of such post-marketing studies are not satisfactory, the FDA or a foreign
regulatory  authority  may  withdraw  marketing  authorization  or  may  condition  continued  marketing  on  commitments  from  us  or  our  partners  that  may  be
expensive and/or time consuming to fulfill.

In addition, if we or others identify side effects after any of our drug products are on the market, if manufacturing problems occur subsequent to

regulatory approval, or if we, our manufacturers or our partners fail to comply with regulatory requirements, we or our partners could be subject to:

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changes to the product label;

restrictions on the marketing of a product;

restrictions on product distribution;

restrictions on such products' manufacturing processes;

requirements to conduct post-marketing clinical studies;

Untitled or Warning Letters;

withdrawal of the products from the market;

refusal to approve pending applications or supplements to approved applications that we submit;

recall of products;

fines, restitution or disgorgement of profits or revenue;

suspension or withdrawal of regulatory approvals;

refusal to permit the import or export of our products;

product seizure;

injunctions;

restrictions on our ability to conduct clinical studies, including full or partial clinical holds on ongoing or planned clinical studies; or

imposition of civil or criminal penalties.

Any one or a combination of these events could prevent us from achieving or maintaining market acceptance of the affected drug product or could
substantially increase the costs and expenses of commercializing such drug product, which in turn could delay or prevent us from generating any revenue or
profit from the sale of the drug product.

36

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The development and commercialization of TEGSEDI and WAYLIVRA may place strain on our management team’s time and attention and may divert
our management team’s attention from our other existing products.

Although  we  have  personnel  with  experience  commercializing  drugs,  we  ourselves  have  limited  experience  commercializing  products.  We
commercially launched TEGSEDI during the fourth quarter of 2018 and, if regulatory approval is obtained, we plan to commercially launch WAYLIVRA
during 2019. The commercial launch of TEGSEDI will continue to and, if approved, the commercial launch of WAYLIVRA will, require significant efforts
and the devotion of substantial resources, as we finalize regulatory submissions, manage the manufacturing of sufficient quantities of product to support long-
term commercial sales and integrate, optimize or maintain, as applicable, the global sales, marketing, medical, for each of WAYLIVRA and TEGSEDI, and
patient  support  infrastructure,  which  may  place  pressure  on  the  management  team’s  time  and  attention.  These  efforts  may  also  divert  the  attention  of  the
management  team  from  our  other  business  operations,  such  as  the  development  or  commercialization  of  our  other  pipeline  products,  including  AKCEA-
APO(a)-LRx, AKCEA-TTR-LRx, AKCEA-ANGPTL3-LRx  and  AKCEA-APOCIII-LRx.  As  a  result,  our  business,  results  of  operations,  financial  condition
and prospects for future growth could be adversely impacted and the market price of our common stock may decline.

Risks Related to Commercialization of Our Drugs

If we cannot effectively manage our marketing and sales capabilities or enter into agreements with third parties to market and sell our drug products, we
may not generate product revenue.

We  commercially  launched  TEGSEDI  in  the  fourth  quarter  of  2018  and,  if  approved,  plan  to  commercialize  WAYLIVRA.    To  successfully
commercialize TEGSEDI and WAYLIVRA, we must effectively manage our marketing, sales and distribution capabilities or make arrangements with third
parties to perform these services. We may not be successful in doing so. To commercialize WAYLIVRA in the initial indications we plan to pursue and to
continue the commercialization of TEGSEDI, we will need to optimize and maintain specialty sales forces in the global regions where we currently market or
expect  to  market  TEGSEDI  and  WAYLIVRA,  supported  by  case  managers,  reimbursement  specialists,  partnerships  with  specialty  pharmacies,  injection
training, routine blood and urine monitoring and a medical affairs team. We may seek to further penetrate markets by expanding our sales forces or through
strategic partnerships with other pharmaceutical or biotechnology companies or third-party sales organizations.

Even  though  certain  members  of  our  management  team  and  other  employees  have  significant  experience  commercializing  drug  products,  as  a
company we have limited experience marketing, selling or distributing drug products, and there are significant risks involved in building and managing a
commercial infrastructure. It is expensive and time consuming for us to maintain our own sales forces and related compliance protocols to market TEGSEDI
and  it  will  be  increasingly  expensive  and  time  consuming  as  we  commercially  launch  additional  drug  products,  if  approved.  We  may  never  successfully
optimize or manage this capability and any failure could delay or preclude the commercial launch of WAYLIVRA or adversely affect TEGSEDI sales. We
and our partners, if any, will have to compete with other companies to recruit, hire, train, manage and retain marketing and sales personnel. As a result of our
receipt of a CRL from the FDA regarding the new drug application for WAYLIVRA, on September 6, 2018, we enacted a plan to reorganize our workforce to
better  align  with  the  immediate  needs  of  our  business.  In  connection  with  this  reorganization  plan,  we  reduced  our  workforce  by  approximately  12%.  If
WAYLIVRA is subsequently approved in the United States, we will again need to increase our operations and expand our use of third-party contractors.

We  have  incurred  expenses  launching  TEGSEDI  in  the  EU,  Canada  and  the  U.S.  and  integrating  and  managing  the  marketing  and  sales
infrastructure. If regulatory requirements or other factors cause the commercialization of TEGSEDI to be less successful than expected in important markets,
we  would  incur  additional  expenses  for  having  invested  in  these  capabilities  prior  to  realizing  any  significant  revenue  from  sales  of  TEGSEDI.  Our  sales
force and marketing teams may not successfully commercialize TEGSEDI.

We  will  incur  expenses  prior  to  the  launch  of  WAYLIVRA  to  integrate  and  manage  the  marketing  and  sales  infrastructure.  If  regulatory
requirements  or  other  factors  cause  a  delay  in  the  commercial  launch  of  WAYLIVRA,  we  would  incur  additional  expenses  for  having  invested  in  these
capabilities earlier than required and prior to realizing any revenue from sales of WAYLIVRA. Our sales force and marketing teams may not successfully
commercialize WAYLIVRA.

37

 
To the extent we decide to rely on third parties to commercialize TEGSEDI or WAYLIVRA in a particular geographic market, we may receive less
revenue  than  if  we  commercialized  TEGSEDI  or  WAYLIVRA  by  ourselves.  For  example,  in  August  2018,  we  granted  PTC  Therapeutics  International
Limited, or PTC Therapeutics, the exclusive right to commercialize TEGSEDI and WAYLIVRA in Latin America and certain Caribbean countries, and will
continue to rely on PTC Therapeutics to commercialize TEGSEDI and WAYLIVRA in those geographic markets. In addition, in August 2018 we entered into
an  agreement  with  Accredo  Health  Group,  Inc.,  or  Accredo,  a  subsidiary  of  Express  Scripts,  to  be  our  specialty  pharmacy  partner  for  distribution  of
TEGSEDI  in  the  U.S.  Further,  we  have  less  control  over  the  sales  efforts  of  other  third  parties,  including  PTC  Therapeutics  and  Accredo,  involved  in
commercializing TEGSEDI or WAYLIVRA.

If we cannot effectively build and manage our distribution, medical affairs, market access, marketing and sales infrastructure, or find a suitable
third party to perform such functions, the sales of TEGSEDI and commercial launch of WAYLIVRA may be adversely affected, which could have a material
adverse effect on our business, prospects, financial condition and results of operations.

If we are unable to rely on third-party specialty channels to distribute our drugs to patients we may be unable to generate adequate revenue

We and our strategic partners have contracted with, rely on and will continue to rely on third-party specialty pharmacies to distribute our drugs to
patients. A specialty pharmacy is a pharmacy that specializes in dispensing medications for complex or chronic conditions, a process that requires a high level
of patient education and ongoing management. Our management team will need to devote a significant amount of its attention to optimizing and managing
this distribution network. If we cannot effectively optimize and manage this distribution process, the commercial launch of WAYLIVRA, AKCEA-APO(a)-
LRx and AKCEA-TTR-LRx and the sales of TEGSEDI will be adversely affected.

In addition, the use of specialty pharmacies involves certain risks, including, but not limited to, risks that these organizations will:

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not provide us with accurate or timely information regarding their inventories, the number of patients who are using our drugs or complaints
regarding our drugs;

not effectively sell or support TEGSEDI, WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-TTR-LRx or our other drugs;

reduce or discontinue their efforts to sell or support TEGSEDI, WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-TTR-LRx or our other drugs;

not  devote  the  resources  necessary  to  sell  TEGSEDI,  WAYLIVRA,  AKCEA-APO(a)-LRx,  AKCEA-TTR-LRx  or  our  other  drugs  in  the
volumes and within the time frames that we expect;

not satisfy financial obligations to us or others; or

cease operations.

Any such events may result in decreased sales and lower revenue, which could have a material adverse effect on our business, prospects, financial

condition and results of operations.

If the market does not accept our drugs, including TEGSEDI, WAYLIVRA, AKCEA-TTR-LRx and our other drugs in development, we are not likely to
generate substantial product revenue or become profitable.

Even  though  we  have  obtained  marketing  authorization  approval  from  the  FDA,  the  EC  and  Health  Canada  for  TEGSEDI,  and  if  we  or  our
strategic partners obtain a marketing authorization for WAYLIVRA, AKCEA-TTR-LRx and our other drugs in development, our success will depend upon the
medical community, patients and third-party payors accepting our drugs as medically useful, cost-effective, safe and convenient. Even if the FDA or foreign
regulatory  authorities  authorize  our  drugs  for  commercialization,  doctors  may  not  prescribe  our  drugs  to  treat  patients.  We  and  our  partners  may  not
successfully commercialize additional drugs.

Additionally, in many of the markets where we or our partners may sell our drugs in the future, if we cannot agree with the government or other
third-party payors regarding the price we can charge for our drugs, then we may not be able to sell our drugs in that market. Similarly, cost control initiatives
by  governments  or  third-party  payors  could  decrease  the  price  received  for  our  drugs  or  increase  patient  coinsurance  to  a  level  that  makes  the  continued
commercializing  of  TEGSEDI  and  the  commercializing  of  WAYLIVRA,  AKCEA-APO(a)-LRx,  AKCEA-TTR-LRx  and  our  other  drugs  in  development
economically unviable.

38

 
 
 
 
 
 
 
The  degree  of  market  acceptance  for  TEGSEDI,  WAYLIVRA,  AKCEA-APO(a)-LRx,  AKCEA-TTR-LRx  and  our  other  drugs  in  development

depends upon a number of factors, including the:

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receipt and scope of marketing authorizations;

establishment and demonstration in the medical and patient community of the efficacy and safety of our drugs and their potential advantages
over competing products;

cost and effectiveness of our drugs compared to other available therapies;

patient convenience of the dosing regimen for our drugs; and

reimbursement by government and third-party payors.

Based on the profile of our drugs, physicians, patients, patient advocates, payors or the medical community in general may not accept and/or use

any drugs that we may develop.

For  example,  the  product  label  for  TEGSEDI  in  the  United  States  has  a  boxed  warning  for  thrombocytopenia  and  glomerulonephritis,  requires
periodic blood and urine monitoring, and TEGSEDI has a Risk Evaluation and Mitigation Strategy, or REMS, program. Our main competition in the U.S.
market for TEGSEDI is ONPATTRO (patisiran), marketed by Alnylam Pharmaceuticals, Inc. Although ONPATTRO requires intravenous administration and
pre-treatment with steroids, it does not have a boxed warning or REMS. Additionally, in the clinical studies with WAYLIVRA, declines in platelet counts
were observed in many patients and some patients discontinued the study because of platelet declines. Therefore, we expect the product label for WAYLIVRA
will require periodic blood monitoring. In each case, these label requirements could negatively affect our ability to attract and retain patients for these drugs.
We  believe  that  the  enhanced  monitoring  we  have  implemented  to  support  early  detection  and  management  of  these  issues  can  help  manage  these  safety
issues  so  that  patients  can  continue  treatment.  Since  implementation  of  the  enhanced  monitoring,  serious  platelet  events  have  been  infrequent.  While  we
believe  we  can  better  maintain  patients  on  TEGSEDI  and  WAYLIVRA  through  our  patient-centric  commercial  approach  where  we  plan  to  have  greater
involvement  with  physicians  and  patients,  if  we  cannot  effectively  maintain  patients  on  TEGSEDI  and  WAYLIVRA,  we  may  not  be  able  to  generate
substantial revenue from TEGSEDI and WAYLIVRA sales.

The patient populations suffering from FCS and FPL are small and have not been established with precision. If the actual number of patients is smaller
than we estimate, or if we cannot raise awareness of these diseases and diagnosis is not improved, our revenue and ability to achieve profitability from
WAYLIVRA may be adversely affected.

We estimate there are 3,000 to 5,000 FCS patients and an additional 3,000 to 5,000 FPL patients globally. Our estimates of the sizes of the patient
populations are based on published studies as well as internal analyses. If the results of these studies or our analyses of them do not accurately reflect the
number of patients with FCS and FPL, our assessment of the market potential for WAYLIVRA may be inaccurate, making it difficult or impossible for us to
meet our revenue goals, or to obtain and maintain profitability. In addition, as is the case with most orphan diseases, if we cannot successfully raise awareness
of these diseases and improve diagnosis, it will be more difficult or impossible to achieve profitability.

In addition, since the patient populations for FCS and FPL are small, the per-patient drug pricing must be priced appropriately in order to recover
our  development  and  manufacturing  costs,  fund  adequate  patient  support  programs  and  achieve  profitability.  For  these  initial  indications,  we  may  not
maintain or obtain sufficient sales volume at a price that justifies our product development efforts and our sales and marketing and manufacturing expenses.

The patient population suffering from hATTR amyloidosis is small and has not been established with precision. If the actual number of patients is smaller
than we estimate, or if we cannot raise awareness of the disease and diagnosis is not improved, our revenue and ability to achieve profitability from either
TEGSEDI or AKCEA-TTR-LRx may be adversely affected.

Our estimate of the sizes of the patient populations are based on published studies as well as internal analyses. If the results of these studies or our
analyses of them do not accurately reflect the number of patients with hATTR amyloidosis, our assessment of the market potential for either TEGSEDI or
AKCEA-TTR-LRx may be inaccurate, making it difficult or impossible for us to meet our revenue goals, or to obtain and maintain profitability. In addition, as
is  the  case  with  most  orphan  diseases,  if  we  cannot  successfully  raise  awareness  of  these  diseases  and  improve  diagnosis,  it  will  be  more  difficult  or
impossible to achieve profitability. For these initial indications, we may not maintain or obtain sufficient sales volume at a price that justifies our product
development efforts and our sales and marketing and manufacturing expenses.

39

 
 
 
 
 
 
If we or our partners fail to compete effectively, WAYLIVRA, TEGSEDI and our other drugs in development will not contribute significant revenue.

Our competitors engage in drug discovery throughout the world, are numerous and include, among others, major pharmaceutical companies and

specialized biopharmaceutical firms. Our competitors may succeed in developing drugs that are:

•

•

•

•

•

safer than our drugs;

more effective than our drugs;

priced lower than our drugs;

reimbursed more favorably by government and other third-party payors than our drugs; or

more convenient to use than our drugs.

These  competitive  developments  could  make  our  drugs,  including  WAYLIVRA,  TEGSEDI,  AKCEA-APO(a)-LRx,  AKCEA-TTR-LRx  and  our
other drugs in development, obsolete or non-competitive. Further, all of our drugs are delivered by injection, which may render them less attractive to patients
than non-injectable products offered by our current or future competitors.

Many of our competitors have substantially greater financial, technical and human resources than we do. In addition, many of these competitors
have  significantly  greater  experience  than  we  do  in  conducting  preclinical  testing  and  human  clinical  studies,  in  obtaining  FDA  and  other  regulatory
authorizations and in commercializing pharmaceutical products. Accordingly, our competitors may succeed in obtaining regulatory authorization for products
earlier than we do. Marketing and sales capability is another factor relevant to the competitive position of our drugs, and many of our competitors will have
greater marketing and sales capabilities than our capabilities.

There are several pharmaceutical and biotechnology companies engaged in the development or commercialization of products against targets that
are  also  targets  of  drugs  in  our  development  pipeline.  For  example,  if  approved,  WAYLIVRA  could  face  competition  from  drugs  like  metreleptin  and
gemcabene. Metreleptin, produced by Novelion Therapeutics, Inc., is currently approved in the U.S. and E.U. for use in generalized lipodystrophy patients.
WAYLIVRA  may  also  compete  with  gemcabene,  an  oral  small  molecule  that  reduces  apoC-III,  that  Gemphire  Therapeutics,  Inc.  is  developing  to  treat
patients with triglycerides above 500 mg/dL.

As  an  additional  example,  TEGSEDI  could  face  competition  from  drugs  like  ONPATTRO,  marketed  by  Alnylam  for  hATTR  amyloidosis  with
polyneuropathy in the U.S. and E.U., tafamidis, available in the E.U. for stage 1 hATTR amyloidosis with polyneuropathy and under review in the U.S. for
ATTR  with  cardiomyopathy,  and  AG10,  which  is  being  developed  by  Eidos  for  patients  with  ATTR  with  cardiomyopathy.  For  example,  ONPATTRO  is
approved in the United States and Europe for a similar and broader indication as TEGSEDI. AG10, which recently completed its Phase 2 dose-finding study,
is  an  orally  administered  TTR  tetramer  stabilizer  for  ATTR  amyloidosis.  If  WAYLIVRA,  TEGSEDI  or  the  other  drugs  in  our  pipeline  cannot  compete
effectively with these and other products with common or similar indications to the drugs in our pipeline, we may not be able to generate substantial revenue
from our product sales.

If  government  or  other  third-party  payors  fail  to  provide  adequate  coverage  and  payment  rates  for  TEGSEDI,  WAYLIVRA,  AKCEA-APO(a)-LRx,
AKCEA-TTR-LRx and our other drugs in development, our revenue and prospects for profitability will be limited.

In both domestic and foreign markets, sales of our future products will depend in part upon the availability of coverage and reimbursement from
third-party  payors.  The  majority  of  patients  in  the  United  States  who  would  fit  within  our  target  patient  populations  for  our  drugs  have  their  healthcare
supported by a combination of Medicare coverage, other government health programs such as Medicaid, managed care providers, private health insurers and
other organizations. Coverage decisions may depend upon clinical and economic standards that disfavor new drug products when more established or lower
cost therapeutic alternatives are already available or subsequently become available. Assuming coverage is approved, the resulting reimbursement payment
rates might not be enough to make our drugs affordable. Accordingly, TEGSEDI and, if approved, WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-TTR-LRx
and  our  other  drugs  in  development,  will  face  competition  from  other  therapies  and  drugs  for  limited  financial  resources.  We  may  need  to  conduct  post-
marketing  studies  to  demonstrate  the  cost-effectiveness  of  any  future  products  to  satisfy  third-party  payors.  These  studies  might  require  us  to  commit  a
significant  amount  of  management  time  and  financial  and  other  resources.  Third-party  payors  may  never  consider  our  future  products  as  cost-effective.
Adequate third-party coverage and reimbursement might not be available to enable us to maintain price levels sufficient to realize an appropriate return on
investment in product development.

40

 
 
 
 
 
 
Third-party payors, whether foreign or domestic, or governmental or commercial, are developing increasingly sophisticated methods of controlling
healthcare  costs.  In  addition,  in  the  United  States,  no  uniform  policy  of  coverage  and  reimbursement  for  drug  products  exists  among  third-party  payors.
Therefore,  coverage  and  reimbursement  for  drug  products  can  differ  significantly  from  payor  to  payor.  Further,  we  believe  that  future  coverage  and
reimbursement will likely be subject to increased restrictions both in the United States and in international markets. For example, in the United States, recent
health reform measures have resulted in reductions in Medicare and other healthcare funding, and there have been several recent U.S. Congressional inquiries
and  proposed  federal  legislation  designed  to,  among  other  things,  reform  government  program  reimbursement  methodologies  for  drug  products  and  bring
more transparency to drug pricing. Third-party coverage and reimbursement for our products or drugs may not be available or adequate in either the United
States or international markets, which would negatively affect the potential commercial success of our products, our revenue and our profits.

If we are found in violation of federal or state "fraud and abuse" laws or other healthcare laws and regulations, we may be required to pay a penalty
and/or be suspended from participation in federal or state healthcare programs, which may adversely affect our business, financial condition and results
of operation.

We may be subject to various federal and state laws pertaining to healthcare "fraud and abuse," including anti-kickback laws and false claims laws.
Anti-kickback laws, among other things, make it illegal for a prescription drug manufacturer to pay, or offer to pay, a healthcare provider to refer, purchase or
prescribe a particular drug. Due to the breadth of the statutory and regulatory provisions, it is possible that government authorities and others might challenge
our practices under anti-kickback or other fraud and abuse laws. Moreover, recent healthcare reform legislation has strengthened these laws. In addition, false
claims laws prohibit anyone from knowingly and willingly presenting, or causing to be presented for payment, to government third-party payors, including
Medicare and Medicaid claims for reimbursed drugs that are false or fraudulent, claims for items or services not provided as claimed, or claims for medically
unnecessary items or services. Our activities relating to the sale and marketing of our products may be subject to scrutiny under these laws. If we violated
fraud and abuse laws, we could face a combination of:

•

•

•

criminal and civil sanctions, including fines and civil monetary penalties;

the possibility of exclusion from federal healthcare programs, including Medicare and Medicaid; and

corporate integrity agreements, which could impose rigorous operational and monitoring requirements on us.

Given the significant penalties and fines that the government can impose on companies and individuals if convicted, allegations of violations often
result  in  settlements  even  if  the  company  or  individual  being  investigated  admits  no  wrongdoing.  Settlements  often  include  significant  civil  sanctions,
including fines and civil monetary penalties, and corporate integrity agreements. If the government were to allege or convict us or our executive officers of
violating these laws, our business could be harmed. In addition, private individuals may bring similar actions under the False Claims Act. Our activities could
be subject to challenge for the reasons discussed above and due to the broad scope of these laws and the increasing focus on these laws by law enforcement
authorities. To the extent we have access to protected health information we could be subject to federal and state health information privacy and security laws,
including without limitation, the Health Insurance Portability and Accountability Act of 1996, or HIPAA, as amended by the Health Information Technology
for  Economic  and  Clinical  Health  Act,  which  governs  the  conduct  of  certain  electronic  healthcare  transactions  and  protects  the  security  and  privacy  of
protected health information. State health information privacy and security laws in certain circumstances are more stringent than HIPAA and many of the
state laws differ from each other in significant ways and may not have the same effect, thus complicating compliance. Our failure to comply with applicable
federal  and  state  health  information  privacy  and  security  laws  could  subject  us  to  significant  fines  and  multi-year  corrective  action  plans.  TEGSEDI
commercially launched in the U.S. in the fourth quarter of 2018 and as such we are now required to report annually to Centers for Medicare and Medicaid
Services  certain  information  related  to  payments  and  other  transfers  of  value  we  may  provide  to  physicians  and  teaching  hospitals.  Further,  an  increasing
number  of  state  laws  require  manufacturers  to  make  reports  to  states  on  pricing  and  marketing  information.  Many  of  these  laws  are  unclear  as  to  what  is
required to comply with the laws. Given the lack of clarity in laws and their implementation, our reporting actions could be subject to the penalty provisions
of the pertinent state authorities.

Similar  rigid  restrictions  related  to  anti-kickbacks  and  promoting  and  marketing  medicinal  products  apply  in  the  European  Union  and  other
countries. Authorities in these countries strictly enforce these restrictions. Even in those countries where we will not be directly responsible for promoting and
marketing our products, inappropriate activity by any of our international commercialization partners we may have could harm us.

41

 
 
 
 
Risks Related to Dependence on Third Parties

We plan to substantially depend on our collaboration with Novartis to develop and commercialize AKCEA-APO(a)-LRx and AKCEA-APOCIII-LRx.

We  have  granted  Novartis  an  exclusive  option  to  exclusively  license  each  of  AKCEA-APO(a)-LRx  and  AKCEA-APOCIII-LRx  pursuant  to  our
strategic collaboration, option and license agreement with Novartis. In February 2019, Novartis exercised its option to license AKCEA-APO(a)-LRx. We plan
to  substantially  depend  on  Novartis  to  further  develop  and  commercialize  AKCEA-APO(a)-LRx  and  potentially  AKCEA-APOCIII-LRx.  We  initiated  this
collaboration primarily to have Novartis:

•

•

•

conduct the cardiovascular outcome studies that are likely to be required for approval of AKCEA-APO(a)-LRx and AKCEA-APOCIII-LRx;

seek and obtain regulatory approvals for AKCEA-APO(a)-LRx and AKCEA-APOCIII-LRx; and

globally commercialize AKCEA-APO(a)-LRx and AKCEA-APOCIII-LRx.

Since Novartis has exercised its option to license AKCEA-APO(a)-LRx, we will rely on Novartis to further develop, obtain regulatory approvals
for, and commercialize it. In general, we cannot control the amount and timing of resources that Novartis devotes to our strategic collaboration. If Novartis
fails to use commercially reasonable efforts to further develop, obtain regulatory approvals for, or commercialize AKCEA-APO(a)-LRx, or if Novartis' efforts
are  not  effective,  our  business  may  be  negatively  affected.  Novartis  could  pursue  other  technologies  or  develop  other  drugs  either  on  its  own  or  in
collaboration with others to treat the same diseases as we and Novartis plan to treat with AKCEA-APO(a)-LRx. Novartis could pursue these technologies and
develop these other drugs at the same time as it is developing or commercializing AKCEA-APO(a)-LRx, and Novartis is not required to inform us of such
activities.

If Novartis exercises its option to license AKCEA-APOCIII-LRx, we would rely on Novartis to further develop, obtain regulatory approvals for,
and commercialize it. In general, we cannot control the amount and timing of resources that Novartis devotes to our strategic collaboration. If Novartis fails to
use commercially reasonable efforts to further develop, obtain regulatory approvals for, or commercialize AKCEA-APOCIII-LRx, or if Novartis' efforts are
not effective, our business may be negatively affected. Novartis could pursue other technologies or develop other drugs either on its own or in collaboration
with others to treat the same disease as we and Novartis plan to treat with AKCEA-APOCIII-LRx. Novartis could pursue these technologies and develop these
other drugs at the same time as it is developing or commercializing AKCEA-APOCIII-LRx and Novartis is not required to inform us of such activities.

Our strategic collaboration with Novartis may not continue for various reasons. Novartis can terminate our agreement at any time and is under no
obligation to exercise the options we granted them. If Novartis stops developing or commercializing AKCEA-APO(a)-LRx, or does not exercise its option to
license AKCEA-APOCIII-LRx, we will have to seek additional sources for funding and may have to delay or reduce our development and commercialization
plans for these drugs.

In  addition,  following  Novartis’  exercise  of  its  option  to  license  AKCEA-APO(a)-LRx in February 2019,  and  if  Novartis  exercises  its  option  to

license AKCEA-APOCIII-LRx, Novartis will be responsible for the long-term supply of drug substance and finished drug product for the licensed drug.

Our strategic collaboration with Novartis may not result in the successful commercialization of AKCEA-APO(a)-LRx or AKCEA-APOCIII-LRx. If
Novartis  does  not  successfully  develop,  manufacture  or  commercialize  AKCEA-APO(a)-LRx  or  AKCEA-APOCIII-LRx,  we  may  receive  limited  or  no
revenues for these drugs.

We plan to substantially depend on our collaboration with PTC Therapeutics to commercialize TEGSEDI and WAYLIVRA in Latin America and certain
Caribbean countries.

In  August  2018,  we  granted  PTC  Therapeutics  International  Limited  the  exclusive  right  to  commercialize  TEGSEDI  and  WAYLIVRA  in  Latin

America and certain Caribbean countries. We plan to substantially depend on PTC to commercialize these drugs in those geographic markets.

42

 
 
 
 
In general, we cannot control the amount and timing of resources that PTC devotes to our strategic collaboration. If PTC fails to use commercially
reasonable  efforts  to  obtain  regulatory  approvals  for,  or  commercialize  these  drugs,  or  if  PTC’s  efforts  are  not  effective,  our  business  may  be  negatively
affected. PTC could pursue other technologies or develop other drugs either on its own or in collaboration with others to treat the same diseases as we and
PTC plan to treat with TEGSEDI and WAYLIVRA. PTC could pursue these technologies and develop these other drugs at the same time as it is developing or
commercializing TEGSEDI and WAYLIVRA, and PTC is not required to inform us of such activities.

Our strategic collaboration with PTC may not continue for various reasons. If PTC stops commercializing a drug, we will have to seek additional
sources for funding and may have to delay or reduce our commercialization plans for TEGSEDI and WAYLIVRA in Latin America or certain Caribbean
countries.

Our strategic collaboration with PTC may not result in the successful commercialization of TEGSEDI or WAYLIVRA in Latin America or certain
Caribbean countries. If PTC does not successfully commercialize TEGSEDI or WAYLIVRA, we may receive limited revenue for TEGSEDI or no revenue
for WAYLIVRA in Latin America or certain Caribbean countries.

AKCEA-APOCIII-LRx and AKCEA-ANGPTL3-LRx may compete with WAYLIVRA, which could reduce our expected revenues for WAYLIVRA.

WAYLIVRA  and  AKCEA-APOCIII-LRx  both  inhibit  the  production  of  the  same  protein.  We  believe  the  enhancements  we  incorporated  into
AKCEA-APOCIII-LRx  can  provide  greater  patient  convenience  by  allowing  for  significantly  lower  doses  and  less  frequent  administration  compared  to
WAYLIVRA. As such, if Novartis exercises its option and successfully commercializes AKCEA-APOCIII-LRx while we are commercializing WAYLIVRA,
to the extent physicians and patients elect to use AKCEA-APOCIII-LRx instead of WAYLIVRA, it will reduce the revenue we derive from WAYLIVRA. In
addition, while AKCEA-ANGPTL3-LRx and WAYLIVRA use different mechanisms of action, if AKCEA-ANGPTL3-LRx can effectively lower triglyceride
levels in FCS patients, it may likewise reduce the revenue we derive from WAYLIVRA.

If we cannot manufacture our drugs or contract with a third party to manufacture our drugs at costs that allow us to charge competitive prices to buyers,
we will not be able to operate profitably.

To  successfully  commercialize  TEGSEDI  and,  if  approved,  WAYLIVRA,  AKCEA-APO(a)-LRx,  AKCEA-TTR-LRx  and  our  other  drugs  in
development,  we  will  need  to  optimize  and  manage  large-scale  commercial  manufacturing  capabilities  either  on  our  own  or  through  a  third-party
manufacturer. In addition, as our drug development pipeline matures, we will have a greater need for clinical study and commercial manufacturing capacity.
We  have  no  direct  experience  manufacturing  pharmaceutical  products  of  the  chemical  class  represented  by  our  drugs,  called  oligonucleotides,  on  a
commercial scale for the systemic administration of a drug. We currently rely and expect to rely for the foreseeable future on Ionis' manufacturing capacity
and efficiency and the capacity and efficiency of third parties to produce our oligonucleotide drugs, and our business could be negatively affected if Ionis and
these third parties ceased to provide us with this capability for any reason. In addition, there are a small number of suppliers for certain raw materials that we
use  to  manufacture  our  drugs,  and  some  of  these  suppliers  will  need  to  increase  their  scale  of  production  to  meet  our  projected  needs  for  commercial
manufacturing. Further, if we cannot continue to acquire raw materials from these suppliers on commercially reasonable terms or at all, we may be required to
find alternative suppliers, which could be expensive and time consuming and negatively affect our ability to develop or commercialize our drugs in a timely
manner or at all. We may not be able to manufacture our drugs at a cost or in quantities necessary to make commercially successful products.

We do not have long-term supply agreements for our drugs. We cannot guarantee that we will have a steady supply of drug to complete clinical
studies, make registration batches for approval or satisfy market demand if commercialized at prices that are commercially acceptable. In addition, if we need
to  change  manufacturers  for  any  reason,  we  will  need  to  verify  that  the  new  manufacturer  maintains  facilities  and  procedures  that  comply  with  quality
standards and with all applicable regulations and guidelines. The delays associated with verifying a new manufacturer could negatively affect our ability to
develop drugs in a timely manner or within budget.

Also,  manufacturers  must  adhere  to  the  FDA's  current  Good  Manufacturing  Practices  regulations  and  similar  regulations  in  foreign  countries,
which  the  applicable  regulatory  authorities  enforce  through  facilities  inspection  programs.  Our  contract  manufacturers  may  not  comply  or  maintain
compliance  with  Good  Manufacturing  Practices,  or  similar  foreign  regulations.  Non-compliance  could  significantly  delay  or  prevent  receipt  of  marketing
authorization  for  our  drugs,  including  authorizations  for  WAYLIVRA,  AKCEA-APO(a)-LRx,  AKCEA-TTR-LRx  and  our  other  drugs  in  development,  or
result in enforcement action after authorization that could limit the commercial success of our drugs, including WAYLIVRA, TEGSEDI, AKCEA-APO(a)-
LRx, AKCEA-TTR-LRx and our other drugs in development.

43

 
We  depend  on  Ionis  and  third  parties  to  conduct  our  clinical  studies  for  our  drugs  and  any  failure  of  those  parties  to  fulfill  their  obligations  could
adversely affect our development and commercialization plans.

We depend on Ionis and independent clinical investigators, contract research organizations and other third-party service providers to conduct the
clinical studies for our drugs and expect to continue to do so in the future. For example, we use clinical research organizations for the clinical studies for
WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-TTR-LRx and our other drugs in development. We rely heavily on these parties for successful execution of our
clinical studies, but do not control many aspects of their activities. For example, the investigators are not our employees. However, we are responsible for
ensuring that these third parties conduct each of our clinical studies in accordance with the general investigational plan, approved protocols for the study and
applicable regulations. Ionis and third parties may not complete activities on schedule or may not conduct our clinical studies in accordance with regulatory
requirements or our stated protocols. The failure of these parties to carry out their obligations or a termination of our relationship with these third parties
could delay or prevent the development, marketing authorization and commercialization of our drugs, including authorizations for WAYLIVRA, AKCEA-
APO(a)-LRx, AKCEA-TTR-LRx and our other drugs in development.

We may seek to form additional partnerships in the future with respect to WAYLIVRA, and our other drugs in development, and we may not realize the
benefits of such partnerships.

Although we intend to develop and commercialize WAYLIVRA for patients with FCS and FPL ourselves, we may form partnerships, create joint
ventures or collaborations or enter into licensing arrangements with third parties for the development and commercialization of our drugs in development. For
example, we have granted PTC an exclusive license to commercialize WAYLIVRA in Latin America and certain Caribbean countries. We face significant
competition in seeking appropriate strategic partners and the negotiation process is time-consuming and complex. Any delays in entering into new strategic
partnership agreements related to our drugs could delay the development and commercialization of our drugs and reduce their competitiveness even if they
reach  the  market.  Moreover,  we  may  not  be  successful  in  our  efforts  to  establish  other  strategic  partnerships  or  other  collaborative  arrangements  for  any
additional drugs because the potential partner may consider that our development pipeline is not advanced enough to justify a collaborative effort, or that
WAYLIVRA  and  our  other  drugs  in  development  do  not  have  the  requisite  potential  to  demonstrate  safety  and  efficacy  in  the  target  populations  in  other
geographic markets. In addition, we will need to mutually agree with Ionis on the terms of any additional sublicenses to a third party for WAYLIVRA and our
other drugs in development. If we cannot mutually agree on terms for a sublicense to a third party or if Ionis does not agree to a sublicense at all, it could
delay our ability to develop and commercialize WAYLIVRA and our other drugs in development. Even if we are successful in establishing such a strategic
partnership or collaboration, we cannot be certain that, following such a strategic transaction or collaboration, we will be able to progress the development
and commercialization of the applicable drugs as envisioned, or that we will achieve the revenue that would justify such transaction. If we do not accurately
evaluate the commercial potential or target market for a particular drug, we may relinquish valuable rights to that drug through future collaboration, licensing
or other arrangements in cases in which it would have been more advantageous for us to retain sole development and commercialization rights.

Risks Related to Our Relationship with Ionis

Ionis  controls  the  direction  of  our  business,  and  the  concentrated  ownership  of  our  common  stock  will  prevent  you  and  other  stockholders  from
influencing significant decisions.

Ionis owns 67,383,965 shares of our common stock, or approximately 75 percent, of the economic interest and voting power of our outstanding
common stock as of February 20, 2019, which ownership will be expected to increase further if we achieve certain milestone events and pay the associated
milestone payment in shares of common stock pursuant to the payment election. As long as Ionis beneficially controls a majority of the voting power of our
outstanding common stock, it will generally be able to determine the outcome of all corporate actions requiring stockholder approval, including the election
and  removal  of  directors.  Even  if  Ionis  were  to  control  less  than  a  majority  of  the  voting  power  of  our  outstanding  common  stock,  it  may  influence  the
outcome of such corporate actions so long as it owns a significant portion of our common stock. If Ionis continues to hold its shares of our common stock, it
could remain our controlling stockholder for an extended period of time or indefinitely.

The licensing transaction with Ionis and the common stock issuances in connection with the achievement of the TEGSEDI regulatory milestones
has increased Ionis’ ownership percentage, and this increase, along with Ionis’ increased reliance on Akcea as a commercialization partner, given that Akcea
could now be commercializing at least two Ionis-developed products (WAYLIVRA and TEGSEDI), may increase the length of time during which Ionis will
control  us.  As  a  general  matter,  the  TEGSEDI  license  agreement  and  the  related  Investor  Rights  Agreement  increased  Ionis’  control  over  our  affairs.  In
addition, our TEGSEDI licensing agreement requires Ionis’ consent to the budget related to the commercialization of TEGSEDI and AKCEA-TTR-LRx.

44

 
Ionis' interests may not be the same as, or may conflict with, the interests of our other stockholders. You will not be able to affect the outcome of
any  stockholder  vote  while  Ionis  controls  the  majority  of  the  voting  power  of  our  outstanding  common  stock.  As  a  result,  Ionis  can  control,  directly  or
indirectly and subject to applicable law, all matters affecting us, including:

•

•

•

•

•

•

•

any determination with respect to our business strategy and policies, including the appointment and removal of officers and directors;

any determinations with respect to mergers, business combinations or disposition of assets;

our financing and dividend policy;

compensation and benefit programs and other human resources policy decisions;

termination of, changes to or determinations under our existing license agreements and services agreement with Ionis;

changes to any other agreements that may adversely affect us; and

determinations with respect to our tax returns.

Because  Ionis'  interests  may  differ  from  ours  or  yours,  actions  that  Ionis  takes  with  respect  to  us,  as  our  controlling  stockholder,  may  not  be

favorable to us or you.

As  a  “controlled  company”  under  the  marketplace  rules  of  the  Nasdaq  Stock  Market,  we  may  rely  on  exemptions  from  certain  corporate  governance
requirements that provide protection to stockholders of companies that are subject to such requirements.

Ionis beneficially owns more than 50% of the voting power of our outstanding common stock. As a result, we are a “controlled company” under
the marketplace rules of the Nasdaq Stock Market, or Nasdaq, and eligible to rely on exemptions from Nasdaq corporate governance requirements generally
obligating listed companies to maintain:

•

•

•

A board of directors having a majority of independent directors;

A  compensation  committee  composed  entirely  of  independent  directors  that  approves  the  compensation  payable  to  the  company’s  chief
executive officer and other executive officers; and

A nominating committee composed entirely of independent directors that nominates candidates for election to the board of directors, or that
recommends such candidates for nomination by the board of directors (or obligating the listed company to cause a majority of the board’s
independent directors to exercise this oversight of director nominations).

Currently, a majority of our board is made up of independent directors. As a controlled company, we have and in the future may avail ourselves of
some of these exemptions. Accordingly, our stockholders may not have the same protections afforded to stockholders of companies that are subject to the
Nasdaq corporate governance requirements described above.

If Ionis sells a controlling interest in our company to a third party in a private transaction, you may not realize a change of control premium on shares of
our common stock, and we may become subject to the control of a presently unknown third party.

Ionis owns a significant equity interest in our company. This means that Ionis could choose to sell some or all of its shares of our common stock in

a privately negotiated transaction, which, if sufficient in size, could result in a change of control of our company.

Ionis' ability to privately sell its shares of our common stock, with no requirement for a concurrent offer to be made to acquire your shares of our
common stock, could prevent you from realizing any change of control premium on your shares of our common stock that may otherwise accrue to Ionis on
its private sale of our common stock. Additionally, if Ionis privately sells its significant equity interest in our company, we may become subject to the control
of a presently unknown third party. Such third party may have conflicts of interest with those of other stockholders. In addition, if Ionis sells a controlling
interest in our company to a third party, such a sale could negatively impact or accelerate any future indebtedness we may incur, and negatively impact any
other commercial agreements and relationships, all of which may adversely affect our ability to run our business as described herein and may have a material
adverse effect on our operating results and financial condition.

45

 
 
 
 
 
 
 
 
 
 
 
Certain of our directors and officers may have actual or potential conflicts of interest because of their positions with Ionis.

Damien McDevitt, Chief Business Officer for Ionis, and B. Lynne Parshall, Senior Strategic Advisor and board member for Ionis, serve on our
board of directors and retain their positions or engagements with Ionis. In addition, these individuals own Ionis equity and Ionis equity awards. Ionis common
stock, options to purchase Ionis common stock and other Ionis equity awards represent a significant portion of these individuals' net worth. Their position at
Ionis and the ownership of any Ionis equity or equity awards creates, or may create the appearance of, conflicts of interest when we ask these individuals to
make decisions that could have different implications for Ionis than the decisions have for us. In addition, our certificate of incorporation provides for the
allocation  of  certain  corporate  opportunities  between  us  and  Ionis.  Under  these  provisions,  neither  Ionis  or  its  other  affiliates,  nor  any  of  their  officers,
directors, agents or stockholders, will have any obligation to present to us certain corporate opportunities. For example, a director of our company who also
serves  as  a  director,  officer  or  employee  of  Ionis  or  any  of  its  other  affiliates  may  present  to  Ionis  certain  acquisitions,  in-licenses,  potential  development
programs  or  other  opportunities  that  may  be  complementary  to  our  business  and,  as  a  result,  such  opportunities  may  not  be  available  to  us.  To  the  extent
attractive corporate opportunities are allocated to Ionis or its other affiliates instead of to us, we may not be able to benefit from these opportunities.

The  resources  Ionis  provides  us  under  the  license  agreements  and  the  services  agreement  may  not  be  sufficient  for  us  to  operate  as  a  standalone
company, and we may experience difficulty in separating our resources from Ionis.

Because we have not operated separately from Ionis in the past, we may have difficulty doing so. We will need to acquire resources in addition to,
and  eventually  in  lieu  of,  those  provided  by  Ionis  to  our  company,  and  may  also  face  difficulty  in  separating  our  resources  from  Ionis'  resources  and
integrating newly acquired resources into our business. In addition, Ionis may prioritize its own research, development, manufacturing and other needs ahead
of the services Ionis has agreed to provide us, or Ionis employees who conduct services for us may prioritize Ionis' interests over our interests. Our business,
financial condition and results of operations could be harmed if we have difficulty operating as a standalone company, fail to acquire resources that prove to
be important to our operations or incur unexpected costs in separating our resources from Ionis' resources or integrating newly acquired resources.

We may not realize the benefits of the licensing transaction with Ionis if we are unable to successfully transition, integrate and support the development
and commercialization of TEGSEDI and AKCEA-TTR-LRx.

As a result of the licensing transaction with Ionis, we need to successfully transition, integrate and support the assets we acquired related to the
commercialization and development of TEGSEDI and AKCEA-TTR-LRx if we are to realize any of the potential benefits of the licensing transaction. The
failure to meet these integration challenges, including the addition of TEGSEDI commercial team and other employees from Ionis and the coordination across
geographies between our headquarters in Massachusetts and our commercialization team in other locations, including major global markets, could seriously
harm our results of operations. Our failure to implement an orderly integration could result in failure of, or delays in, the development or commercialization
of TEGSEDI and AKCEA-TTR-LRx. Such failure or delay could adversely impact our business, results of operations, financial condition and prospects for
future growth.

We will incur incremental costs as a standalone company.

Ionis currently performs or supports many important corporate functions for our company. Our consolidated financial statements reflect charges for
these services on an allocation basis. Under our services agreement with Ionis we can use these Ionis services for a fixed term established on a service-by-
service  basis.  However,  we  generally  will  have  the  right  to  terminate  a  service  earlier  if  we  give  notice  to  Ionis.  Partial  reduction  in  the  provision  of  any
service requires Ionis' consent. In addition, either party will be able to terminate the agreement due to a material breach of the other party, upon prior written
notice, subject to limited cure periods.

46

 
We will pay Ionis mutually agreed upon fees for these services, based on Ionis' costs of providing the services. Since we negotiated the services
agreement in the context of a parent subsidiary relationship, the terms of the agreement, including the fees charged for the services, may be higher or lower
than  those  that  would  be  agreed  to  by  parties  bargaining  at  arm's  length  for  similar  services  and  may  be  higher  or  lower  than  the  costs  reflected  in  the
allocations in our historical consolidated financial statements. Ionis will pass third party costs through to us at Ionis' cost. In addition, while Ionis provides us
these services, our operational flexibility to modify or implement changes with respect to such services or the amounts we pay for them will be limited.

We may not be able to replace these services or enter into appropriate third-party agreements on terms and conditions, including cost, comparable
to those that we will receive from Ionis under our services agreement. Additionally, after the agreement terminates, we may not sustain the services at the
same  levels  or  obtain  the  same  benefits  as  when  we  were  receiving  such  services  and  benefits  from  Ionis.  When  we  begin  to  operate  these  functions
separately, if we do not have our own adequate systems and business functions in place, or cannot obtain them from other providers, we may not operate our
business effectively or at comparable costs, and our business may suffer. In addition, we have historically received informal support from Ionis, which may
not be addressed in our services agreement. The level of this informal support will diminish and could end in the future.

We may not be able to fully realize the expected benefits of our license agreements with Ionis.

We have development, commercialization and license agreements with Ionis pursuant to which, subject to certain restrictions, we and Ionis will
share  development  responsibilities  for  WAYLIVRA,  TEGSEDI,  AKCEA-APO(a)-LRx,  AKCEA-TTR-LRx  and  our  other  drugs  in  development.  We  are
paying for research and development costs and reimbursing Ionis for Ionis' employees supporting our development activities. Until we build or acquire our
own capabilities to replace those Ionis is providing to us, particularly development, regulatory and manufacturing services, we will be heavily dependent on
Ionis.

While we and Ionis intend the license agreements, on the whole, to bolster our capabilities, certain terms of the license agreements and the other

related agreements with Ionis may limit our ability to achieve the expected benefits of these transactions, including:

•

•

•

•

a  Joint  Steering  Committee,  or  JSC,  having  equal  membership  from  us  and  Ionis,  sets  the  development  strategy  for  our  drugs  by  mutual
agreement.  A  Regulatory  Sub-committee,  established  by  the  JSC  and  having  equal  membership  from  our  company  and  Ionis,  will  set  the
regulatory  strategy  for  each  of  our  drugs  by  mutual  agreement.  If  the  JSC  or  the  Regulatory  Sub-committee  cannot  come  to  a  mutual
agreement, then this could delay our ability to develop and commercialize TEGSEDI, AKCEA-APO(a)-LRx, AKCEA-TTR-LRx and our other
drugs in development. In the event of a disagreement at the JSC related to TEGSEDI or AKCEA-TTR-LRx, Ionis has final decision-making
authority on decisions relating to development matters, Akcea has final decision making authority on decision relating to commercial matters,
and the holder of the regulatory approvals for a product in a country has final decision making authority for regulatory affairs;

we will need to mutually agree with Ionis on the terms of any additional sublicense to a third party for WAYLIVRA and AKCEA-ANGPTL-
LRx, and will need to obtain Ionis’ consent prior to granting any sublicense to a third party for TEGSEDI or AKCEA-TTR-LRx. If we cannot
mutually agree on terms for a sublicense to a third party or if Ionis does not consent to a sublicense at all, it could delay or prevent our ability
to develop and commercialize our drugs;

we will need to obtain Ionis’ approval to in-license a product, acquire a product or acquire another company, until the time Ionis ceases to
hold at least 50% of our outstanding capital stock; and

there is nothing in our agreements with Ionis to prevent Ionis from developing and commercializing drugs targeting RNAs that are not apoC-
III, Apo(a) or ANGPTL3 to pursue the same indications we are pursuing with our drugs.

Each  of  the  foregoing  terms  and  Ionis'  other  rights  under  the  license  agreements,  could  limit  our  ability  to  realize  the  expected  benefits  of  the
license agreements or otherwise limit our ability to pursue transactions or development efforts other stockholders may view as beneficial. Further, if Ionis
does not continue to own a significant portion of our equity, Ionis' incentive to help us would be diminished. If we fail to achieve the expected benefits of our
agreements  with  Ionis,  it  may  be  more  difficult,  time  consuming  or  expensive  for  us  to  develop  and  commercialize  WAYLIVRA,  AKCEA-APO(a)-LRx,
AKCEA-TTR-LRx and our other drugs in development and continue the commercialization of TEGSEDI, or may result in our drugs being later to market
than those of our competitors or prevent them from ever getting to market. If these events cause delays in new product development we could lose the first in
class products in a given therapeutic area.

47

 
 
 
 
 
Risks Related to Our Intellectual Property

If we breach our obligations under any of our license agreements with Ionis, we could lose our rights to WAYLIVRA, TEGSEDI, AKCEA-TTR-LRx and
our other drugs in development.

We  obtained  our  rights  to  WAYLIVRA,  TEGSEDI,  AKCEA-TTR-LRx  and  our  other  drugs  in  development  under  our  license  agreements  with
Ionis. If we breach our obligations under these license agreements and, as a result, Ionis subsequently exercises its right to terminate it, we generally would
not be able to continue to develop or commercialize TEGSEDI, WAYLIVRA, AKCEA-TTR-LRx and our other drugs in development that incorporate Ionis'
intellectual  property,  and  Ionis  would  receive  a  royalty-free,  nonexclusive  license  to  our  improvements  to  those  programs,  meaning  we  would  lose  the
benefits of our investment in these programs. If we breach our obligations under the license agreement with respect to AKCEA-APO(a)-LRx  or  AKCEA-
APOCIII-LRx  and,  as  a  result,  Ionis  exercises  its  right  to  terminate  it,  then  our  strategic  collaboration  with  Novartis  would  convert  into  a  direct  strategic
collaboration between Novartis and Ionis, and Ionis would receive all of the revenue and other benefits associated with that strategic collaboration. Similarly,
if we breach our obligations under the license agreement with respect to TEGSEDI or AKCEA-TTR-LRx and, as a result, Ionis exercises its right to terminate
it, then our strategic collaboration with PTC in Latin America and certain Caribbean countries would convert into a direct strategic collaboration between
PTC and Ionis, and Ionis would receive all of the revenue and other benefits associated with that strategic collaboration.

If we cannot protect our patent rights or our other proprietary rights, others may compete more effectively against us.

Our  success  depends  to  a  significant  degree  upon  whether  we  can  continue  to  secure  and  maintain  intellectual  property  rights  that  protect
TEGSEDI, WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-TTR-LRx  and  our  other  drugs  in  development.  However,  patents  may  not  issue  from  any  of  our
pending patent applications in the United States or in other countries and we may not be able to obtain, maintain or enforce our owned or licensed patents and
other intellectual property rights which could impact our ability to compete effectively. In addition, the scope of any of our owned or licensed patents may not
be sufficiently broad to provide us with a competitive advantage. Furthermore, other parties may successfully challenge, invalidate or circumvent our issued
patents or patents licensed to us so that our patent rights do not create an effective competitive barrier or revenue source.

Composition of matter patents on the active pharmaceutical ingredient for a product are generally considered to be the strongest form of intellectual
property protection for pharmaceutical products, as such patents provide protection without regard to any method of use. Our WAYLIVRA patent portfolio
currently includes:

•

•

•

•

issued patent claims to the specific antisense sequence and chemical composition of WAYLIVRA in the United States, Australia, and Europe;

issued patent claims in the United States and Australia drawn to the use of antisense compounds complementary to an active region of human
apoC-III messenger ribonucleic acid, including the site targeted by WAYLIVRA;

additional patent applications designed to protect the WAYLIVRA composition in Canada; and

additional methods of use in jurisdictions worldwide for WAYLIVRA.

The natural term of the issued U.S. patent covering the WAYLIVRA composition of matter will expire in 2023, but we plan to seek to extend the
U.S. patent expiration beyond 2023 based upon the development and regulatory review period in the United States. The natural term of the granted European
and  Australian  patents  covering  WAYLIVRA  will  expire  in  2024,  but  we  plan  to  seek  to  extend  each  of  these  patents  beyond  2024  based  upon  the
development and regulatory review periods in Europe and Australia.

The natural term of the last expiring issued U.S. patent covering the composition of matter of TEGSEDI will expire in 2031. Patents issued in other
countries  will  have  the  same  natural  term.  We  plan  to  seek  to  extend  the  term  of  one  patent  covering  TEGSEDI  in  the  U.S.,  if  approved,  and  any  other
jurisdictions where such extension is available, based upon the development and regulatory review periods for TEGSEDI and in accordance with applicable
laws.

We cannot be certain that the U.S. Patent and Trademark Office, or U.S. PTO, and courts in the United States or the patent offices and courts in
foreign  countries  will  consider  the  claims  in  our  owned  or  licensed  patents  and  applications  covering  WAYLIVRA,  TEGSEDI,  AKCEA-APO(a)-LRx,
AKCEA-TTR-LRx and our other drugs in development as patentable. Method-of-use patents protect the use of a product for the specified method. This type
of patent does not prevent a competitor from making and marketing a product that is identical to our product for an indication that is outside the scope of the
patented method. Moreover, even if competitors do not actively promote their product for our targeted indications, physicians may prescribe these products
off-label.  Although  off-label  prescriptions  may  infringe  or  contribute  to  the  infringement  of  method-of-use  patents,  the  practice  is  common  and  such
infringement is difficult to prevent, including through legal action.

48

 
 
 
 
 
If we or any licensor partner loses or cannot obtain patent protection for TEGSEDI, WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-TTR-LRx or our

other drugs in development it could have a material adverse impact on our business.

Intellectual property litigation could cause us to spend substantial resources and prevent us from pursuing our programs.

From time to time we may have to defend our intellectual property rights. If we are involved in an intellectual property dispute, we may need to
litigate  to  defend  our  rights  or  assert  them  against  others.  Disputes  can  involve  arbitration,  litigation  or  proceedings  declared  by  the  U.S.  PTO  or  the
International  Trade  Commission  or  foreign  patent  authorities.  Even  if  resolved  in  our  favor,  litigation  or  other  legal  proceedings  relating  to  intellectual
property claims may cause us to incur significant expenses, and could distract our technical and management personnel from their normal responsibilities. In
addition, there could be public announcements of the results of hearings, motions or other interim proceedings or developments and if securities analysts or
investors perceive these results to be negative, it could have a substantial adverse effect on the price of our common stock. Such litigation or proceedings
could substantially increase our operating losses and reduce the resources available for development activities or any future sales, marketing or distribution
activities. We may not have sufficient financial or other resources to adequately conduct such litigation or proceedings. Some of our competitors may be able
to sustain the costs of such litigation or proceedings more effectively than we can because of their greater financial resources and more mature and developed
intellectual property portfolios.

Third parties may initiate legal proceedings alleging that we are infringing their intellectual property rights, the outcome of which would be uncertain
and could have a material adverse effect on the success of our business.

Our commercial success depends upon our ability and the ability of our strategic partners to develop, manufacture, market and sell our drugs and
use our proprietary technologies without infringing the proprietary rights and intellectual property of third parties. Extensive litigation regarding patents and
other intellectual property rights is common in the biotechnology and pharmaceutical industries. We may in the future become party to, or threatened with,
adversarial  proceedings  or  litigation  regarding  intellectual  property  rights  with  respect  to  our  drugs  and  technology,  including  interference,  derivation,
reexamination, post-grant review, opposition, cancellation or similar proceedings before the U.S. PTO or its foreign counterparts.

Third  parties  may  assert  infringement  claims  against  us  based  on  existing  patents  or  patents  that  may  be  granted  in  the  future.  For  example,  a
potential competitor was issued a patent which they have broadly characterized in their annual report on Form 10-K for the year ended December 31, 2017 as
being  directed  to  single-stranded  antisense  polynucleotide  molecules  capable  of  inhibiting  expression  of  the  human  transthyretin  gene,  and  having  certain
combinations of structural features. This third party has also attempted to broadly characterize certain other patents that they hold. While we believe that we
would have substantial defenses in the event this competitor brought a claim against us with respect to TEGSEDI or AKCEA-TTR-LRx, patent litigation is
inherently  uncertain,  involves  substantial  cost  and  is  a  distraction  to  management.  Moreover,  our  stock  price  may  be  impacted  by  the  existence  of  or
developments during a litigation, even developments that are preliminary in nature.

We  may  not  be  aware  of  all  such  intellectual  property  rights  potentially  relating  to  our  drugs  and  their  uses.  If  a  third  party  claims  that
WAYLIVRA,  TEGSEDI,  AKCEA-APO(a)-LRx,  AKCEA-TTR-LRx,  our  other  drugs  in  development  or  our  technology  infringe  its  patents  or  other
intellectual property rights, we or our partners may have to discontinue an important product or product line, alter our products and processes, pay license fees
or cease certain activities. We may not be able to obtain a license to needed intellectual property on favorable terms, if at all. There are many patents issued or
applied  for  in  the  biotechnology  industry,  and  we  may  not  be  aware  of  patents  or  patent  applications  held  by  others  that  relate  to  our  business.  This  is
especially  true  since  patent  applications  in  the  United  States  are  filed  confidentially  for  the  first  18  months.  Moreover,  the  validity  and  breadth  of
biotechnology patents involve complex legal and factual questions for which important legal issues remain. Thus, we do not know with certainty that our
drugs or our intended commercialization thereof, does and will not infringe or otherwise violate any third party's intellectual property.

We will not seek to protect our intellectual property rights in all jurisdictions throughout the world and we may not be able to adequately enforce our
intellectual property rights even in the jurisdictions where we seek protection.

Filing, prosecuting and defending patents on our drugs in all countries and jurisdictions throughout the world would be prohibitively expensive,
and our intellectual property rights in some countries outside the United States could be less extensive than those we could obtain in the United States. In
addition, the laws of some foreign countries do not protect intellectual property rights to the same extent as laws in the United States. Consequently, we may
not be able to prevent third parties from practicing our inventions in all countries outside the United States, or from selling or importing products made using
our inventions in and into the United States or other jurisdictions.

49

 
Competitors  may  use  our  technologies  in  jurisdictions  where  we  do  not  pursue  and  obtain  patent  protection  to  develop  their  own  products.  In
addition, competitors may export otherwise infringing products to territories where we have patent protection, but enforcement is not as strong as that in the
United States. These products may compete with our products and our patent rights or other intellectual property rights may not be effective or sufficient to
prevent them from competing. Even if we pursue and obtain issued patents in particular jurisdictions, our patent claims or other intellectual property rights
may not be effective or sufficient to prevent third parties from so competing.

The laws of some foreign countries do not protect intellectual property rights to the same extent as the laws of the United States. Many companies
have  encountered  significant  problems  in  protecting  and  defending  intellectual  property  rights  in  certain  foreign  jurisdictions.  The  legal  systems  of  some
countries, particularly developing countries, do not favor the enforcement of patents and other intellectual property protection, especially those relating to
biotechnology.  This  could  make  it  difficult  for  us  to  stop  competitors  from  infringing  our  patent  rights  or  misappropriating  our  other  intellectual  property
rights.  For  example,  many  foreign  countries  have  compulsory  licensing  laws  under  which  a  patent  owner  must  grant  licenses  to  third  parties.  In  addition,
many countries limit our right to enforce our patent rights against third parties, including government agencies or government contractors. In these countries,
patents  may  provide  limited  or  no  benefit.  We  must  ultimately  seek  patent  protection  on  a  country-by-country  basis,  which  is  an  expensive  and  time-
consuming process with uncertain outcomes. Accordingly, we may choose not to seek patent protection in certain countries, and we will not have the benefit
of patent protection in such countries.

In addition, proceedings to enforce our patent rights in foreign jurisdictions could result in substantial costs and divert our efforts and attention
from other aspects of our business, could put our patent rights at risk of being invalidated or interpreted narrowly, could put our owned or licensed patent
applications  at  risk  of  not  issuing  and  could  provoke  third  parties  to  assert  claims  against  us.  We  may  not  prevail  in  any  lawsuits  that  we  initiate  and  the
damages or other remedies awarded, if any, may not be commercially meaningful. Accordingly, our efforts to enforce our intellectual property rights around
the world may be inadequate to obtain a significant commercial advantage from the intellectual property that we develop or license.

If we do not obtain additional protection under the Hatch-Waxman Amendments and similar foreign legislation by extending the patent protection for
TEGSEDI, WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-TTR-LRx, and our other drugs in development, our business may be materially harmed.

Depending  upon  the  timing,  duration  and  specifics  of  the  first  FDA  marketing  authorization  of  TEGSEDI,  WAYLIVRA,  AKCEA-APO(a)-LRx,
AKCEA-TTR-LRx,  and  our  other  drugs  in  development,  a  United  States  patent  that  we  own  or  license  may  be  eligible  for  limited  patent  term  restoration
under  the  Drug  Price  Competition  and  Patent  Term  Restoration  Act  of  1984,  referred  to  as  the  Hatch-Waxman  Amendments.  The  Hatch-Waxman
Amendments allow the owner of an approved product to extend patent protection for up to five years as compensation for patent term lost during product
development and the FDA regulatory review process. During this period of extension, the scope of protection is limited to the approved product and approved
uses.

In 2018 we applied for patent term extensions to U.S. patents covering the TEGSEDI compound, composition and uses to recapture a portion of the
term lost during regulatory review. Although we have applied for patent term extension for TEGSEDI, and plan on seeking patent term restoration for our
other  products,  we  may  not  succeed  if,  for  example,  we  fail  to  apply  within  applicable  deadlines,  fail  to  apply  prior  to  expiration  of  relevant  patents  or
otherwise  fail  to  satisfy  applicable  requirements.  Moreover,  the  applicable  time  period  or  the  scope  of  patent  protection  afforded  could  be  less  than  we
request. If we cannot obtain patent term restoration or the term of any such patent restoration is less than we request, our competitors may enter the market
and compete against us sooner than we anticipate, and our ability to generate revenue could be materially adversely affected.

Changes in United States patent law could diminish the value of patents in general, thereby impairing our ability to protect our products.

Recent  United  States  Supreme  Court  rulings  have  narrowed  the  scope  of  patent  protection  available  in  certain  circumstances  and  weakened  the
rights of patent owners in certain situations. In addition to increasing uncertainty with regard to our ability to obtain patents in the future, this combination of
events has created uncertainty with respect to the value of patents, once obtained. Depending on decisions by the United States Congress, the federal courts,
and the U.S. PTO, the laws and regulations governing patents could change in unpredictable ways that would weaken our ability to obtain new patents or to
enforce our existing patents and patents that we might obtain in the future.

50

 
If we and our partners do not adequately protect the trademarks and trade names for our products, then we and our partners may not be able to build
name recognition in our markets of interest and our business may be adversely affected.

Our competitors or other third parties may challenge, infringe or circumvent the trademarks or trade names for our products. We and our partners
may not be able to protect these trademarks and trade names. In addition, if the trademarks or trade names for one of our products infringe the rights of others,
we or our partners may be forced to stop using the trademarks or trade names, which we need for name recognition in our markets of interest. If we cannot
establish name recognition based on our trademarks and trade names, we and our partners may not be able to compete effectively and our business may be
adversely affected.

Intellectual property rights do not necessarily address all potential threats to our competitive advantage.

The degree of future protection afforded by our intellectual property rights is uncertain because intellectual property rights have limitations, and

may not adequately protect our business, or permit us to maintain our competitive advantage. The following examples are illustrative:

•

•

•

•

•

•

•

•

•

others may make compounds that are similar to our drugs but that are not covered by the claims of the patents that we own or have exclusively
licensed;

we, or our license partners or current or future strategic partners, might not have been the first to make the inventions covered by the issued
patent or pending patent application that we own or have exclusively licensed;

we,  or  our  license  partners  or  current  or  future  strategic  partners,  might  not  have  been  the  first  to  file  patent  applications  covering  our
inventions;

others may independently develop similar or alternative technologies or duplicate any of our technologies without infringing our intellectual
property rights;

our pending licensed patent applications or those that we own in the future may not lead to issued patents;

issued patents that we hold rights to may be held invalid or unenforceable, including as a result of legal challenges by our competitors;

our  competitors  might  conduct  research  and  development  activities  in  countries  where  we  do  not  have  patent  rights  and  then  use  the
information learned from such activities to develop competitive products for sale in our major commercial markets;

we may not develop additional proprietary technologies that are patentable; and

the patents of others may have an adverse effect on our business.

Should any of these events occur, they could significantly harm our business, results of operations and prospects.

Risks Related to Our Business and Industry

We will need to significantly increase the size of our organization, and we may experience difficulties in managing growth.

We  are  currently  a  small  company.  To  continue  the  commercialization  of  TEGSEDI  and  commercialize  our  drugs  in  development  that  we  are
responsible  for  commercializing,  we  will  need  to  increase  our  operations  and  expand  our  use  of  third-party  contractors.  We  plan  to  continue  to  build  our
compliance,  financial  and  operating  infrastructure  to  ensure  the  maintenance  of  a  well-managed  company  including  hiring  additional  staff  within  our
regulatory,  clinical  and  medical  affairs  groups  and  an  in-house  commercial  organization  initially  focused  on  marketing  and  selling  TEGSEDI  and,  if
approved, WAYLIVRA. We have added a significant number of new employees to our sales and marketing capability to commercialize TEGSEDI.

We may also anticipate needs for growth that do not materialize. For example, in anticipation of WAYLIVRA’s potential approval, we added a
significant number of new employees to our sales and marketing capability to develop WAYLIVRA in the second half of 2017. However, as a result of our
receipt of a complete response letter, or CRL, from the FDA regarding the new drug application for WAYLIVRA, on September 6, 2018, we enacted a plan to
reorganize our workforce to better align with the immediate needs of our business. In connection with this reorganization plan, we reduced our workforce by
approximately 12%. If WAYLIVRA is subsequently approved in the United States, we will again need to increase our operations and expand our use of third-
party contractors. We cannot assure you that we will not build out our compliance, financial or operating infrastructure again in anticipation of developments
that do not occur or that occur later than we anticipate.

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The  current  and  future  growth  will  impose  significant  added  responsibilities  on  our  management,  including  the  need  to  maintain,  integrate,
optimize and manage additional employees. In addition, to meet our obligations as a public company, we will need to increase our general and administrative
capabilities. Our current management, personnel and systems may not be adequate to support this growth. Our future financial performance and our ability to
commercialize our drugs and to compete effectively will depend, in part, on our ability to manage any future growth effectively. To that end, we must be able
to:

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manage the manufacturing of our drugs for clinical and commercial use;

integrate current and additional management, administrative, financial and sales and marketing personnel;

optimize and manage a marketing and sales infrastructure;

maintain personnel necessary to effectively commercialize TEGSEDI and, if approved, WAYLIVRA and our other drugs in development;

manage our clinical studies and the regulatory process effectively;

develop our administrative, accounting and management information systems and controls; and

hire and train additional qualified personnel.

Our staff, financial resources, systems, procedures or controls may be inadequate to support our operations and our management may be unable to

successfully manage future market opportunities or our relationships with customers and other third parties.

If we do not progress in our programs as anticipated, the price of our securities could decrease.

For  planning  purposes,  we  estimate  and  may  disclose  the  timing  of  a  variety  of  clinical,  regulatory  and  other  milestones,  such  as  when  we
anticipate a certain drug will enter into clinical trials, when we anticipate completing a clinical study, when we anticipate filing an application for marketing
authorization, or when we or our partners plan to commercially launch a drug. We base our estimates on present facts and a variety of assumptions. Many
underlying  assumptions  are  outside  of  our  control.  If  we  do  not  achieve  milestones  in  accordance  with  our  or  our  investors'  or  securities  analysts'
expectations,  including  milestones  related  to  WAYLIVRA,  TEGSEDI,  AKCEA-APO(a)-LRx, AKCEA-TTR-LRx  and  our  other  drugs  in  development,  the
price of our securities could decrease.

The loss of key personnel, or if we cannot attract and retain highly skilled personnel, could make it more difficult to run our business and reduce our
likelihood of success.

We  are  dependent  on  the  principal  members  of  our  management  and  scientific  staff.  We  do  not  have  employment  agreements  with  any  of  our
executive officers that would prevent them from leaving us. The loss of management and key scientific employees might slow the achievement of important
research and development goals. It is also critical to our success that we recruit and retain qualified scientific personnel to perform development work and
marketing, sales and commercial support personnel to perform commercialization activities. We may not be able to attract and retain skilled and experienced
scientific and commercial personnel on acceptable terms because of intense competition for experienced personnel among many pharmaceutical and health
care companies, universities and non-profit research institutions. In addition, failure to successfully complete clinical studies, obtain regulatory approvals or
effectively commercialize drugs may make it more challenging to recruit and retain qualified personnel.

We are exposed to potential product liability claims, and insurance against these claims may not be available to us at a reasonable rate in the future or at
all.

Our  business  exposes  us  to  potential  product  liability  risks  that  are  inherent  in  the  testing,  manufacturing,  marketing  and  sale  of  therapeutic
products,  including  potential  product  liability  claims  related  to  TEGSEDI,  WAYLIVRA,  AKCEA-APO(a)-LRx, AKCEA-TTR-LRx  and  our  other  drugs  in
development. We have clinical study insurance coverage and commercial product liability insurance coverage. In addition, Novartis has agreed to indemnify
us  against  specific  claims  arising  from  Novartis'  development  and  commercialization  of  AKCEA-APO(a)-LRx  and  AKCEA-APOCIII-LRx,  and  PTC  has
agreed to indemnify us against specific claims arising from PTC’s commercialization of TEGSEDI and WAYLIVRA in Latin America and certain Caribbean
countries.  However,  this  insurance  coverage  and  indemnities  may  not  be  adequate  to  cover  claims  against  us.  Insurance  may  not  be  available  to  us  at  an
acceptable cost, if at all. Regardless of their merit or eventual outcome, products liability claims may result in decreased demand for our drug products, injury
to our reputation, withdrawal of clinical study volunteers and loss of revenue. Thus, whether or not we are insured or indemnified, a product liability claim or
product recall may result in losses that could be material.

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Because we use biological materials, hazardous materials, chemicals and radioactive compounds, if we do not comply with laws regulating the protection
of the environment and health and human safety, our business could be adversely affected.

Our  development  and  manufacturing  activities  involve  the  use  of  potentially  harmful  biological  materials  as  well  as  materials,  chemicals  and
various  radioactive  compounds  that  could  be  hazardous  to  human  health  and  safety  or  the  environment.  We  cannot  completely  eliminate  the  risk  of
contamination, which could cause:

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interruption of our development, manufacturing and distribution efforts;

injury to our employees and others;

environmental damage resulting in costly clean up; and

liabilities  under  federal,  state  and  local  laws  and  regulations  governing  health  and  human  safety,  as  well  as  the  use,  storage,  handling  and
disposal of these materials and resultant waste products.

In such an event, we may be held liable for any resulting damages, and any liability could exceed our resources. Although we carry insurance in
amounts and types that we consider commercially reasonable, we do not have insurance coverage for losses relating to an interruption of our development,
manufacturing or commercialization efforts caused by contamination, and the coverage or coverage limits of our insurance policies may not be adequate. If
our losses exceed our insurance coverage, our financial condition would be adversely affected.

A variety of risks associated with operating our business and marketing our drugs internationally could materially adversely affect our business.

In addition to our U.S. operations, we are commercializing TEGSEDI in Europe and Canada and, following approval, plan to establish operations
to commercialize our products in other countries globally. We face risks associated with our current and planned international operations, including possible
unfavorable  regulatory,  pricing  and  reimbursement,  political,  tax  and  labor  conditions,  which  could  harm  our  business.  Because  we  have  international
operations we are subject to numerous risks associated with international business activities, including:

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compliance with differing or unexpected regulatory requirements for our drugs and foreign employees;

complexities associated with managing multiple payor reimbursement regimes, government payors or patient self-pay systems;

difficulties in staffing and managing foreign operations;

in  certain  circumstances,  increased  dependence  on  the  commercialization  efforts  and  regulatory  compliance  of  third-party  distributors  or
strategic partners;

foreign government taxes, regulations and permit requirements;

U.S. and foreign government tariffs, trade restrictions, price and exchange controls and other regulatory requirements;

anti-corruption laws, including the Foreign Corrupt Practices Act, or the FCPA, and its equivalent in foreign jurisdictions;

economic weakness, including inflation, natural disasters, war, events of terrorism or political instability in particular foreign countries;

fluctuations in currency exchange rates, which could result in increased operating expenses and reduced revenue, and other obligations related
to doing business in another country;

compliance with tax, employment, privacy, immigration and labor laws, regulations and restrictions for employees living or traveling abroad;

workforce uncertainty in countries where labor unrest is more common than in the United States; and

changes in diplomatic and trade relationships.

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The United Kingdom’s anticipated exit from the EU could increase these risks.

Our business activities outside of the United States are subject to the FCPA and similar anti-bribery or anti-corruption laws, regulations or rules of
other  countries  in  which  we  operate,  including  the  United  Kingdom's  Bribery  Act  2010.  In  many  other  countries,  the  healthcare  providers  who  prescribe
pharmaceuticals  are  employed  by  their  government,  and  the  purchasers  of  pharmaceuticals  are  government  entities;  therefore,  any  dealings  with  these
prescribers and purchasers may be subject to regulation under the FCPA. There is no certainty that all employees and third-party business partners (including
our  distributors,  wholesalers,  agents,  contractors  and  other  partners)  will  comply  with  anti-bribery  laws.  In  particular,  we  do  not  control  the  actions  of
manufacturers  and  other  third-party  agents,  although  we  may  be  liable  for  their  actions.  Violation  of  these  laws  may  result  in  civil  or  criminal  sanctions,
which could include monetary fines, criminal penalties, and disgorgement of past profits, which could have a material adverse impact on our business and
financial condition.

The impact on us of the vote by the United Kingdom to leave the European Union cannot be predicted.

On June 23, 2016, the United Kingdom, or the UK, voted to leave the EU in an advisory referendum, which is generally referred to as Brexit. On
March 29, 2017, the UK delivered notice under Article 50 of the Lisbon Treaty of its intent to leave the EU, beginning a two year negotiation period for the
UK and the 27 remaining members of the EU to reach agreement on the terms of Brexit. The UK is a significant pharmaceutical market, and Brexit may lead
to legal uncertainty and potentially divergent laws and regulations between the UK and the EU as the UK determines which EU laws to replicate or replace.
We cannot predict whether or not the UK will significantly alter its current laws and regulations in respect of the pharmaceutical industry and, if so, what
impact any such alteration would have on us or our business.

As part of Brexit, the EMA, currently situated in London, is expected to relocate to Amsterdam. There is a risk that the relocation process will
interrupt current administrative routines and occupy resources, which may lead to delays in the EMA’s handling of our WAYLIVRA application and generally
adversely affect our dealings with the EMA. Further, there is considerable uncertainty resulting from a lack of precedent and the complexity of the UK and
EU’s intertwined legal regimes as to how Brexit will impact the life sciences industry in Europe, including our company, including with respect to ongoing or
future  clinical  trials.  The  impact  will  largely  depend  on  the  model  and  means  by  which  the  UK’s  relationship  with  the  EU  is  governed  post‑Brexit.  For
example, following Brexit, the UK will no longer be covered by the centralized procedures for obtaining EU-wide marketing authorization from the EMA
and, unless a specific agreement is entered into, a separate process for authorization of drug products, including our product candidates, will be required in the
UK,  the  potential  process  for  which  is  currently  unclear.  Brexit  may  adversely  affect  and  delay  our  ability  to  commercialize,  market  and  sell  our  product
candidates in the UK.  Brexit may also result in a reduction of funding to the EMA if the UK no longer makes financial contributions to European institutions,
such as the EMA. If UK funding is so reduced, it could create delays in the EMA issuing regulatory approvals for our product candidates and, accordingly,
have a material adverse effect on our business, financial condition, results or prospects.

If  a  natural  or  man-made  disaster  strikes  our  development  or  manufacturing  facilities  or  otherwise  affects  our  business,  it  could  delay  our  progress
developing and commercializing our drugs.

We currently rely on Ionis to manufacture our clinical supplies in a manufacturing facility located in Carlsbad, California and third party contract
manufacturing  organizations  to  manufacture  active  pharmaceutical  ingredient  and  finished  drug  product  for  TEGSEDI.  The  facilities  and  the  equipment
required to develop and manufacture our drugs would be costly to replace and could require substantial lead time to repair or replace. Natural or man-made
disasters, including, without limitation, earthquakes, floods, fires and acts of terrorism may harm these facilities. If a disaster affects these facilities, our and
our partners' development and commercialization efforts would be delayed. Although we possess insurance for damage to our property and the disruption of
our business from casualties, this insurance may not be sufficient to cover all of our potential losses and may not continue to be available to us on acceptable
terms, or at all. In addition, a shutdown of the U.S. government, including the FDA could harm or delay our development and commercialization activities.

Our business and operations would suffer in the event of computer system failures.

We are dependent upon our own or third-party information technology systems, infrastructure and data, including mobile technologies, to operate
our  business.  The  multitude  and  complexity  of  our  computer  systems  may  make  them  vulnerable  to  service  interruption  or  destruction,  disruption  of  data
integrity,  malicious  intrusion,  or  random  attacks.  Likewise,  data  privacy  or  security  incidents  or  breaches  by  employees  or  others  may  pose  a  risk  that
sensitive data, including our intellectual property, trade secrets or personal information of our employees, patients, customers or other business partners may
be exposed to unauthorized persons or to the public. Cyber-attacks are increasing in their frequency, sophistication and intensity. Cyber-attacks could include
the deployment of

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harmful malware, denial-of-service, social engineering and other means to affect service reliability and threaten data confidentiality, integrity and availability.
Our business partners face similar risks and any security breach of their systems could adversely affect our security posture. A security breach or privacy
violation that leads to disclosure or modification of or prevents access to patient information, including personally identifiable information or protected health
information,  could  harm  our  reputation,  compel  us  to  comply  with  federal  and/or  state  breach  notification  laws  and  foreign  law  equivalents,  subject  us  to
mandatory corrective action, require us to verify the correctness of database contents and otherwise subject us to litigation or other liability under laws and
regulations that protect personal data, any of which could disrupt our business and/or result in increased costs or loss of revenue. Moreover, the prevalent use
of mobile devices that access confidential information increases the risk of data security breaches, which could lead to the loss of confidential information,
trade  secrets  or  other  intellectual  property.  While  we  have  invested,  and  continue  to  invest,  in  the  protection  of  our  data  and  information  technology
infrastructure, there can be no assurance that our efforts will prevent service interruptions, or identify breaches in our systems, that could adversely affect our
business and operations and/or result in the loss of critical or sensitive information, which could result in financial, legal, business or reputational harm to us.
In addition, our liability insurance may not be sufficient in type or amount to cover us against claims related to security breaches, cyber-attacks and other
related breaches.

Risks Related to Our Common Stock

We  are  an  "emerging  growth  company"  and  as  a  result  of  the  reduced  disclosure  and  governance  requirements  applicable  to  emerging  growth
companies, our common stock may be less attractive to investors.

We  are  an  "emerging  growth  company,"  as  defined  in  the  JOBS  Act,  and  we  may  take  advantage  of  certain  exemptions  from  various  reporting
requirements  that  are  applicable  to  other  public  companies  that  are  not  "emerging  growth  companies"  including,  but  not  limited  to,  the  auditor  attestation
requirements of Section 404 of the Sarbanes-Oxley Act, reduced disclosure obligations regarding executive compensation in our periodic reports and proxy
statements, and exemptions from the requirements of holding a nonbinding advisory vote on executive compensation and stockholder approval of any golden
parachute  payments  not  previously  approved.  We  cannot  predict  if  investors  will  find  our  common  stock  less  attractive  if  we  choose  to  rely  on  these
exemptions. If some investors find our common stock less attractive as a result, there may be a less active trading market for our common stock and our stock
price may be more volatile.

An active public trading market for our common stock may not be sustained.

Prior to the completion of our IPO in July 2017, no public market for our common stock existed. An active public trading market for our common
stock may not be sustained. The lack of an active market may impair your ability to sell your shares at the time you wish to sell them or at a price that you
consider reasonable. The lack of an active market may also reduce the fair value of your shares. An inactive market may also impair our ability to raise capital
to  continue  to  fund  operations  by  selling  shares.  Additionally,  as  of  February  20,  2019,  Ionis  owns  approximately  75  percent  of  our  outstanding  common
stock. Ionis intends to hold its shares of our common stock for the foreseeable future, which could reduce the public market for our stock.

The market price for our common stock may be volatile, which could contribute to the loss of your investment.

Fluctuations in the price of our common stock could contribute to the loss of all or part of your investment. There has been a public market for our
common stock for a limited period of time. The trading price of our common stock is likely to be highly volatile and could be subject to wide fluctuations in
response to various factors, some of which are beyond our control. Any of the factors listed below could have a material adverse effect on your investment in
our common stock and our common stock may trade at prices significantly below your purchase price. In such circumstances the trading price of our common
stock may not recover and may experience a further decline.

Factors affecting the trading price of our common stock may include:

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our failure to effectively develop and commercialize TEGSEDI, WAYLIVRA and our other drugs in development;

Novartis' failure to exercise its option and/or effectively develop and commercialize AKCEA-APO(a)-LRx and AKCEA-APOCIII-LRx to the
extent it exercises its option to license those drugs from us;

PTC’s failure to effectively commercialize TEGSEDI or WAYLIVRA in Latin America and certain Caribbean countries;

changes in the market's expectations about our operating results;

adverse results or delays in preclinical or clinical studies;

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our decision to initiate a clinical study, not to initiate a clinical study or to terminate an existing clinical study;

adverse  regulatory  decisions,  including  failure  to  receive  additional  regulatory  approvals  for  TEGSEDI,  or  regulatory  approval  for
WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-TTR-LRx and our other drugs in development;

success or failure of competitive products or antisense drugs more generally;

adverse developments concerning our manufacturers or our strategic partnerships;

inability to obtain adequate product supply for any drug for clinical studies or commercial sale or inability to do so at acceptable prices;

the termination of a strategic partnership or the inability to establish additional strategic partnerships;

unanticipated serious safety concerns related to the use of TEGSEDI, WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-TTR-LRx and our other
drugs in development;

adverse  safety  or  other  clinical  results,  such  as  those  that  have  occurred  in  the  past  or  that  may  occur  in  the  future,  related  to  drugs  being
developed by Ionis or other companies that are or may be perceived to be similar to our drugs;

our ability to effectively manage our growth;

the size and growth, if any, of the targeted market;

our operating results do not meet the expectation of securities analysts or investors in a particular period;

actual or anticipated fluctuations in our quarterly financial results or the quarterly financial results of companies perceived to be similar to us;

securities analysts do not publish reports about us or our business or publish negative reports;

changes  in  financial  estimates  and  recommendations  by  securities  analysts  concerning  our  company,  our  market  opportunity,  or  the
biotechnology and pharmaceutical industries in general;

operating and stock price performance of other companies that investors deem comparable to us;

overall performance of the equity markets;

announcements  by  us  or  our  competitors  of  acquisitions,  new  drugs  or  programs,  significant  contracts,  commercial  relationships  or  capital
commitments;

our and our strategic partners' ability to successfully market TEGSEDI, WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-TTR-LRx and our other
drugs in development;

changes in laws and regulations affecting our business, including but not limited to clinical study requirements for approvals;

disputes or other developments relating to proprietary rights, including patents, litigation matters and our ability to obtain and maintain patent
protection for TEGSEDI, WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-TTR-LRx and our other drugs in development;

commencement of, or involvement in, litigation involving our company, our general industry, or both;

changes in our capital structure, such as future issuances of securities or the incurrence of additional debt;

the volume of shares of our common stock available for public sale;

additions or departures of key scientific or management personnel;

any major change in our board or management;

changes in accounting practices;

ineffectiveness of our internal control over financial reporting;

significant changes in our relationship with Ionis;

sales of substantial amounts of common stock by our directors, executive officers or significant stockholders or the perception that such sales
could occur; and

general economic and political conditions such as recessions, interest rates, fuel prices, elections, drug pricing policies, international currency
fluctuations and acts of war or terrorism.

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Broad market and industry factors may materially harm the market price of our common stock irrespective of our operating performance. The stock
market in general, and NASDAQ and the market for biotechnology companies in particular, have experienced extreme price and volume fluctuations that
have often been unrelated or disproportionate to the operating performance of the particular companies affected. The trading prices and valuations of these
stocks, and of ours, may not be predictable. A loss of investor confidence in the market for biotechnology or pharmaceutical stocks or the stocks of other
companies  which  investors  perceive  to  be  similar  to  us,  the  opportunities  in  the  biotechnology  and  pharmaceutical  market  or  the  stock  market  in  general,
could depress our stock price regardless of our business, prospects, financial conditions or results of operations.

Sales of a substantial number of shares of our common stock by our existing stockholders in the public market may cause our stock price to decline.

Sales of our common stock in the public market, or the perception that these sales may occur, could cause the market price of our common stock to
decline. Novartis has agreed that it will not sell any of its shares until the earlier of January 5, 2020 or six months after we stop developing a drug under our
agreement with Novartis. Thereafter, Novartis may only sell a limited number of shares each day. In addition, as of February 20, 2019 Ionis owns 67,383,965
shares, or approximately 75 percent, of our common stock. While the shares of common stock held by Ionis are eligible for sale in the public market, any
sales  by  Ionis  will  be  subject  to  volume  limitations  under  Rule  144  under  the  Securities  Act  of  1933,  as  amended,  or  the  Securities  Act.  In  addition,
18,500,000 shares of common stock that are either subject to outstanding options or reserved for future issuance under our employee benefit plans are eligible
for sale in the public market to the extent permitted by the provisions of various vesting schedules, the lock-up agreements and Rule 144 and Rule 701 under
the Securities Act. To the extent the holders of these shares sell them into the market or our stockholders believe these sales might occur, the market price of
our common stock could decline.

We cannot predict with certainty whether or when Ionis will sell a substantial number of shares of our common stock. Ionis' sale of a substantial

number of shares, or a perception that such sales could occur, could significantly reduce the market price of our common stock.

We do not expect to pay any cash dividends for the foreseeable future.

You should not rely on an investment in our common stock to provide dividend income. We do not anticipate that we will pay any cash dividends
to  holders  of  our  common  stock  in  the  foreseeable  future.  Instead,  we  plan  to  retain  any  earnings  to  maintain  and  expand  our  operations.  Accordingly,
investors must rely on sales of their common stock after price appreciation, which may never occur, as the only way to realize any return on their investment.
As a result, investors seeking cash dividends should not purchase our common stock.

Changes in tax laws, regulations and treaties could affect our future taxable income.

A change in tax laws, treaties or regulations, or their interpretation, of any country in which we operate could materially affect us.  For Example, on
December 22, 2017, the United States enacted H.R.1., known as the Tax Cuts and Jobs Act, which represented a substantial change to tax laws in the United
States, but which did not have a material impact on our financial statements because we maintain a valuation allowance on all our net operating losses and
other deferred tax assets.  However, any future changes in tax laws in any U.S. or non-U.S jurisdictions could have a material effect on our business.

We could be subject to additional tax liabilities.

We are subject to U.S. federal, state, local and sales taxes in the United States and foreign income taxes, withholding taxes and transaction taxes in
foreign jurisdictions. Significant judgment is required in evaluating our tax positions and our worldwide provision for taxes. During the ordinary course of
business, there are many activities and transactions for which the ultimate tax determination is uncertain. In addition, our tax obligations and effective tax
rates could be adversely affected by changes in the relevant tax, accounting and other laws, regulations, principles and interpretations, including those relating
to  income  tax  nexus,  by  recognizing  tax  losses  or  lower  than  anticipated  earnings  in  jurisdictions  where  we  have  lower  statutory  rates  and  higher  than
anticipated earnings in jurisdictions where we have higher statutory rates, by changes in foreign currency exchange rates, or by changes in the valuation of
our deferred tax assets and liabilities. We may be audited in various jurisdictions, and such jurisdictions may assess additional taxes, sales taxes and value-
added  taxes  against  us.  Although  we  believe  our  tax  estimates  are  reasonable,  the  final  determination  of  any  tax  audits  or  litigation  could  be  materially
different from our historical tax provisions and accruals, which could have a material adverse effect on our operating results or cash flows in the period for
which a determination is made.

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We could be subject to securities class action litigation.

In the past, securities class action litigation has often been brought against a company following a decline in the market price of its securities. This
risk  is  especially  relevant  for  us  because  biotechnology  companies  have  experienced  significant  stock  price  volatility  in  recent  years.  If  we  face  such
litigation, it could result in substantial costs and a diversion of management's attention and resources, which could harm our business.

Provisions in our amended and restated certificate of incorporation, our amended and restated bylaws and Delaware law may have anti-takeover effects
that could discourage an acquisition of us by others, even if an acquisition would be beneficial to our stockholders, and may prevent attempts by our
stockholders to replace or remove our current management.

Our amended and restated certificate of incorporation, amended and restated bylaws and Delaware law contain provisions that may have the effect
of delaying or preventing a change in control of us or changes in our management. Our amended and restated certificate of incorporation and bylaws include
provisions that:

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authorize  "blank  check"  preferred  stock,  which  could  be  issued  by  our  board  of  directors  without  stockholder  approval  and  may  contain
voting, liquidation, dividend and other rights superior to our common stock;

specify that only board of directors or holders of greater than 10% of our common stock can call special meetings of our stockholders;

prohibit stockholder action by written consent once Ionis no longer holds a majority of our voting power;

establish  an  advance  notice  procedure  for  stockholder  approvals  to  be  brought  before  an  annual  meeting  of  our  stockholders,  including
proposed nominations of persons for election to our board of directors;

provide that a majority of directors then in office, even though less than a quorum, may fill vacancies on our board of directors;

specify that no stockholder is permitted to cumulate votes at any election of directors;

expressly authorize our board of directors to modify, alter or repeal our amended and restated bylaws; and

require  supermajority  votes  of  the  holders  of  our  common  stock  to  amend  specified  provisions  of  our  amended  and  restated  certificate  of
incorporation and amended and restated bylaws.

These  provisions,  alone  or  together,  could  delay  or  prevent  hostile  takeovers  and  changes  in  control  or  changes  in  our  management.  Further,
Novartis  has  agreed  that  until  Novartis  holds  less  than  7.5%  of  our  outstanding  common  stock,  Novartis  will  vote  the  Novartis  Private  Placement  Shares
consistent with the recommendation of our board of directors. Although Novartis has retained the right to vote the Novartis Private Placement Shares in its
sole discretion in connection with certain enumerated matters, including any transaction which would result in our change of control, our agreement with
Novartis may nevertheless delay or prevent changes in our management or board of directors.

In  addition,  because  we  are  incorporated  in  the  State  of  Delaware,  we  are  governed  by  the  provisions  of  Section  203  of  the  Delaware  General

Corporation Law, which limits the ability of stockholders owning in excess of 15% of our outstanding voting stock to merge or combine with us.

Any  provision  of  our  amended  and  restated  certificate  of  incorporation  or  amended  and  restated  bylaws  or  Delaware  law  that  has  the  effect  of
delaying or deterring a change in control could limit your opportunity to receive a premium for your shares of our common stock, and could also affect the
price that some investors are willing to pay for our common stock.

Our bylaws designate the Court of Chancery of the State of Delaware and federal court within the State of Delaware as the exclusive forum for
certain types of actions and proceedings that our stockholders may initiate, which could limit our stockholders' ability to obtain a favorable judicial forum for
disputes with us or our directors, officers or employees.

58

 
 
 
 
 
 
 
 
 
Our  bylaws  provide  that,  subject  to  limited  exceptions,  the  Court  of  Chancery  of  the  State  of  Delaware  and  federal  court  within  the  State  of

Delaware will be exclusive forums for any:

•

•

•

•

derivative action or proceeding brought on our behalf;

action asserting a claim of breach of a fiduciary duty owed by any of our directors, officers or other employees to us or our stockholders;

action  asserting  a  claim  against  us  arising  pursuant  to  any  provision  of  the  Delaware  General  Corporation  Law,  our  amended  and  restated
certificate of incorporation or our amended and restated bylaws; or

other action asserting a claim against us that is governed by the internal affairs doctrine.

Any person or entity purchasing or otherwise acquiring any interest in shares of our capital stock shall be deemed to have notice of and to have
consented to the provisions of our bylaws described above. This choice of forum provision may limit a stockholder's ability to bring a claim in a judicial
forum  that  it  finds  favorable  for  disputes  with  us  or  our  directors,  officers  or  other  employees,  which  may  discourage  such  lawsuits  against  us  and  our
directors, officers and employees. Alternatively, if a court were to find these provisions of our amended and restated certificate of incorporation inapplicable
to, or unenforceable in respect of, one or more of the specified types of actions or proceedings, we may incur additional costs associated with resolving such
matters in other jurisdictions, which could adversely affect our business and financial condition.

Item 1B. Unresolved Staff Comments

Not applicable.

Item 2. Properties

Our corporate headquarters is located in Boston, Massachusetts. We currently occupy approximately 30,175 square feet of office space. Our lease
expires in November 2028. We also lease approximately 4,723 square feet of office space located in Carlsbad, California, which lease is set to expire in June
2023.

Item 3. Legal Proceedings

From  time  to  time,  we  may  be  involved  in  various  claims  and  legal  proceedings  relating  to  claims  arising  out  of  our  operations.  We  are  not
currently a party to any legal proceedings that, in the opinion of our management, are likely to have a material adverse effect on our business. Regardless of
outcome, litigation can have an adverse impact on us because of defense and settlement costs, diversion of management resources and other factors.

Item 4. Mine Safety Disclosures

Not applicable.

59

 
 
 
 
 
 
PART II

Item 5. Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities

Our common stock is traded publicly through The Nasdaq Global Select Market under the symbol “AKCA.” Prior to our initial public offering, or
IPO, on July 19, 2017, there was no public trading market for our common stock. Our initial public offering was priced at $8.00 per share on July 17, 2017.
On February 20, 2019, the closing price of our common stock on The Nasdaq Global Select Market was $26.25 per share.

As of February 20, 2019, there were 8 stockholders of record of our common stock. Because many of our shares are held by brokers and other

institutions on behalf of stockholders, we are unable to estimate the total number of stockholders represented by these record holders.

Set forth below is a chart comparing the total return on an indexed basis of $100 invested on July 19, 2017, which is the date our shares began
trading, in our common stock, the NASDAQ Composite Index (total return) and the NASDAQ Biotechnology Index through December 31, 2018. The total
return assumes reinvestment of dividends. Historical stockholder return is not necessarily indicative of the performance to be expected for any future periods.

Performance Graph (1)

Comparison of 18 Month Cumulative Total Return*
Among Akcea Therapeutics, Inc., the NASDAQ Composite Index and the NASDAQ Biotechnology Index

*$100 invested on July 19, 2017 in stock or June 30, 2017 index, including reinvestment of dividends. Fiscal year ending December 31.

(1)

This section is not “soliciting material,” is not deemed “filed” with the SEC, is not subject to the liabilities of Section 18 of the Exchange Act and is
not to be incorporated by reference in any of our filings under the Securities Act or the Exchange Act, whether made before or after the date hereof
and irrespective of any general incorporation language in any such filing.

60

 
  
 
 
 
Recent Sale of Unregistered Securities

During the year ended December 31, 2018, we did not issue or sell any unregistered securities not previously disclosed in a Quarterly Report on

Form 10-Q or in a Current Report on Form 8-K.

Use of Proceeds from Public Offering of Our Common Stock

On July 19, 2017, we closed our IPO of 17,968,750 shares of common stock at an offering price of $8.00 per share, resulting in gross proceeds to
us of approximately $143.8 million. All of the shares issued and sold in our IPO were registered under the Securities Act pursuant to a registration statement
on Form S-1 (File No. 333-216949), which was declared effective by the SEC on July 13, 2017. Cowen and Company, LLC, Stifel, Nicolaus & Company,
Incorporated and Wells Fargo Securities, LLC acted as joint book-running managers for our initial public offering and BMO Capital Markets Corp. acted as
lead manager for our initial public offering. The offering commenced on June 20, 2017 and did not terminate before all of the securities registered in the
registration statement were sold.

As  of  December  31,  2018,  we  have  applied  all  of  the  offering  proceeds  in  accordance  with  the  planned  use  of  proceeds  from  our  offering  as
described in final prospectus for our IPO dated July 13, 2017 and filed with the SEC pursuant to Rule 424(b)(4). As of December 31, 2018, all expenses
incurred in connection with our initial public offering had been paid.

Purchase of Equity Securities by the Issuer and Affiliated Purchasers

None.

61

 
Item 6. Selected Financial Data

This  selected  financial  data  should  be  read  in  conjunction  with  our  audited  consolidated  financial  statements  and  accompanying  notes  and
Management’s  Discussion  and  Analysis  of  Financial  Condition  and  Results  of  Operations  included  elsewhere  in  this  Annual  Report  on  Form  10-K.  Our
consolidated  financial  information  may  not  be  indicative  of  our  future  performance.    Set  forth  below  are  our  selected  consolidated  financial  data  (in
thousands, except per share amounts):

Consolidated Statement of Operations Data:
Product revenue
Licensing revenue
Research and development revenue under collaborative
   agreements
Cost of sales - product
Cost of sales - intangible asset amortization
Cost of license
Research and development expenses
Selling, general and administrative expenses
Net loss
Net loss per share of preferred stock, basic and diluted
Weighted-average shares of preferred stock outstanding,
   basic and diluted
Net loss per share of common stock owned by Ionis, basic
   and diluted
Weighted-average shares of common stock outstanding
   owned by Ionis, basic and diluted
Net loss per share of common stock owned by others, basic
   and diluted
Weighted-average shares of common stock outstanding
   owned by others, basic and diluted

2018

2017 (1)
(as revised)

Years Ended December 31,
2016

2015

2014

  $
  $

  $
  $
  $
  $
  $
  $
  $
  $

2,237    $
12,000    $

—    $
—    $

—    $
—    $

—    $
—    $

— 
— 

50,630    $
1,820    $
2,713    $
7,200    $
130,340    $
153,610    $
(225,821)   $
—    $

43,401    $
—    $
—    $
—    $
126,890    $
36,981    $
(121,559)   $
(1.80)   $

—    $
—    $
—    $
—    $
68,459    $
15,053    $
(83,217)   $
(2.88)   $

—    $
—    $
—    $
—    $
50,885    $
10,553    $
(61,422)   $
(2.13)   $

— 
— 
— 
— 
29,028 
995 
(30,023)
(1.04)

—     

15,748     

28,885     

28,885     

28,885 

  $

(2.74)   $

(3.08)   $

—    $

—    $

    59,812,394      20,669,446     

—     

—     

  $

(2.87)   $

(3.08)   $

—    $

—    $

    21,553,407     

9,593,322     

—     

—     

— 

— 

— 

—

Consolidated Balance Sheet:
Cash, cash equivalents and short-term investments
Working capital
Total assets
Payable to Ionis
Series A convertible preferred stock
Common stock and additional paid-in capital
Accumulated deficit
Stockholders’ equity (deficit)

As of December 31,

2018

2017 (1)

(as revised)

252,609    $
186,574    $
365,261    $
18,901    $
—    $
799,090    $
(522,042)   $
276,724    $

260,130    $
178,379    $
268,804    $
14,365    $
—    $
464,497    $
(296,221)   $
167,825    $

  $
  $
  $
  $
  $
  $
  $
  $

2016

2015

7,857    $
(19,344)   $
10,684    $
24,355    $
100,000    $
—    $
(174,662)   $
(17,747)   $

64,310 
53,761 
66,067 
9,198 
100,000 
— 
(91,445)
55,267

(1)

Reflects the impact of our adoption of the new revenue recognition accounting standard in 2018 (Topic 606). For additional details about our adoption
of  Topic  606,  see  Note  2,  Summary  of  Significant  Accounting  Policies,  in  the  Notes  to  the  Consolidated  Financial  Statements.  This  change  is  not
reflected in our consolidated statement of operations data for 2015 or 2014 or in our consolidated balance sheet data for 2016 or 2015 as we did not
have any revenues during these periods.

62

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
      
      
      
      
  
   
 
 
 
 
 
 
 
   
   
   
 
 
 
 
   
   
 
 
   
 
 
 
 
 
Item 7. Management’s Discussion and Analysis of Financial Condition and Results of Operations

This financial review presents our operating results for each of the three years in the period ended December 31, 2018, and our financial condition
at December 31, 2018. Except for the historical information contained herein, the following discussion contains forward-looking statements which are subject
to known and unknown risks, uncertainties and other factors that may cause our actual results to differ materially from those expressed or implied by such
forward-looking  statements.  We  discuss  such  risks,  uncertainties  and  other  factors  throughout  this  report  and  specifically  under  Item  1A  of  Part  I  of  this
report, "Risk Factors." In addition, the following review should be read in connection with the information presented in our consolidated financial statements
and the related notes to our consolidated financial statements as indexed on page F-1.

Overview

We are a commercial stage biopharmaceutical company developing and marketing drugs globally to treat patients with rare and serious diseases.
We are bringing novel and transformative medicines to patients by driving clinical program execution, understanding patient and physician needs, preparing
the market, creating market access, and commercializing our products on a global basis. As an affiliate of Ionis Pharmaceuticals, Inc., or Ionis, we have a
robust portfolio of development-, registration- and commercial-stage drugs covering multiple targets and diseases using antisense therapeutics. Our immediate
focus is on the commercial launch of our first commercially approved therapy, TEGSEDI in the United States, or U.S., the European Union, or E.U., and
Canada. TEGSEDI treats the polyneuropathy caused by hereditary transthyretin-mediated amyloidosis, or hATTR amyloidosis, in adults. We are also focused
on  commercial  preparations  for  WAYLIVRA  in  the  E.U.  and  on  regulatory  discussions  for  WAYLIVRA  in  the  U.S.  and  Canada.  The  Committee  for
Medicinal  Products  for  Human  Use,  or  CHMP,  of  the  European  Medicines  Agency,  or  EMA,  has  adopted  a  positive  opinion  recommending  conditional
marketing authorization of WAYLIVRA as an adjunct to diet in adult patients with genetically confirmed familial chylomicronemia syndrome, or FCS, who
are at high risk for pancreatitis, in whom response to diet and triglyceride lowering therapy has been inadequate. The positive opinion will now be referred to
the EC, which grants marketing authorization for medicines in the European Union, as well as to European Economic Area members Iceland, Liechtenstein
and Norway. With this positive opinion, and, pending adoption of the positive opinion by the EC, we plan to leverage our existing commercial infrastructure
in  Europe  to  market  WAYLIVRA.  FCS  is  an  ultra-rare,  devastating  hereditary  disease  that  causes  unpredictable  and  potentially  fatal  acute  pancreatitis,
chronic complications due to permanent organ damage, and a severe impact on daily living. The hallmark of FCS is extremely elevated triglycerides. There
are  approximately  3,000  to  5,000  patients  with  FCS  worldwide.  We  are  advancing  a  mature  pipeline  of  novel  drugs  with  the  potential  to  treat  multiple
diseases. TEGSEDI, WAYLIVRA and our pipeline drugs, AKCEA-APO(a)-LRx, AKCEA-ANGPTL3-LRx, AKCEA-APOCIII-LRx and AKCEA-TTR-LRx,
are all based on Ionis’ antisense technology platform.

We are continuing to build our current commercial infrastructure to support TEGSEDI, and plan to use this infrastructure to support WAYLIVRA
in the E.U. and the other drugs in our pipeline, if approved, as we anticipate further commercialization in serious and rare diseases. A key element of our
commercial  strategy  is  to  provide  the  specialized,  patient-centric  support  required  to  successfully  address  rare  disease  patient  populations.  We  believe  our
focus  on  treating  patients  with  inadequately  addressed  rare  and  serious  diseases  will  allow  us  to  partner  efficiently  and  effectively  with  the  specialized
medical community that supports these underserved patient communities. Our supply chain is fully operational in both the U.S. and E.U. To further support
the  hATTR  amyloidosis  community,  Akcea  and  Ambry  Genetics  Corporation,  or  Ambry,  a  Konica  Minolta  company,  launched  hATTR  Compass™  in  the
U.S.  and  Canada,  a  no-cost,  confidential  genetic  testing  and  genetic  counseling  program  for  people  with  suspected  hATTR  amyloidosis.  This  program  is
intended to empower people with accurate genetic information, so they can make informed decisions about their healthcare.

In  2018,  we  obtained  TEGSEDI  and  AKCEA-TTR-LRx,  the  ligand  conjugated  antisense,  or  LICA,  drug  in  development  for  TTR,  under  an
exclusive license from Ionis. With the licensing agreement, we have expanded our efforts to treat people with serious and under-served rare diseases focusing
on transthyretin amyloidosis, or ATTR amyloidosis, and cardiometabolic diseases.

ATTR

TEGSEDI is an antisense drug designed to reduce the production of the TTR protein. In patients with hATTR amyloidosis, a severe, rare and fatal
genetic  disease,  both  the  hereditary  and  wild-type,  or  wt,  TTR  protein  builds  up  as  fibrils  in  tissues,  such  as  the  peripheral  nerves,  heart,  gastrointestinal
system, eyes, kidneys, central nervous system, thyroid and bone marrow. The presence of TTR fibrils interferes with the normal functions of these tissues.
The  progressive  accumulation  of  TTR  amyloid  deposits  in  these  tissues  and  organs  leads  to  sensory,  motor  and  autonomic  dysfunction  often  having
debilitating effects on multiple aspects of a patient’s life and eventually leads to death.

63

 
We  estimate  that  there  are  approximately  50,000  patients  globally  with  hATTR  amyloidosis,  the  majority  of  whom  have  symptoms  of

polyneuropathy.

TEGSEDI was discovered and developed by Ionis Pharmaceuticals and was licensed by us in April 2018. In addition to TEGSEDI, we and Ionis
are developing AKCEA-TTR-LRx for hereditary and wild-type forms of transthyretin amyloidosis, or ATTR amyloidosis. We initiated clinical development
of AKCEA-TTR-LRx in 2018.

Cardiometabolic

Our  lipid/cardiometabolic  drugs,  WAYLIVRA,  AKCEA-APO(a)-LRx,  AKCEA-ANGPTL3-LRx  and  AKCEA-APOCIII-LRx,  are  all  based  on
antisense  technology  developed  by  Ionis.  We  are  focused  on  commercial  preparations  for  WAYLIVRA  in  the  E.U.  and  on  regulatory  discussions  for
WAYLIVRA  the  U.S.  and  Canada.  The  Committee  for  Medicinal  Products  for  Human  Use,  or  CHMP,  of  the  European  Medicines  Agency,  or  EMA,  has
adopted  a  positive  opinion  recommending  conditional  marketing  authorization  of  WAYLIVRA  as  an  adjunct  to  diet  in  adult  patients  with  genetically
confirmed familial chylomicronemia syndrome, or FCS, who are at high risk for pancreatitis, in whom response to diet and triglyceride lowering therapy has
been inadequate. The positive opinion will now be referred to the EC, which grants marketing authorization for medicines in the European Union, as well as
to European Economic Area members Iceland, Liechtenstein and Norway. With this positive opinion, and, pending adoption of the positive opinion by the
EC, we plan to leverage our existing commercial infrastructure in Europe to market WAYLIVRA. On May 10, 2018, the FDA’s Endocrinologic and Metabolic
Drugs Advisory Committee voted to support approval of WAYLIVRA for the treatment of people with FCS. On August 27, 2018, we and Ionis announced
that we received a Complete Response Letter from the Division of Metabolism and Endocrinology Products of the FDA regarding the New Drug Application
for WAYLIVRA. The FDA did not cite any new concerns beyond those described in the advisory committee briefing book, in which the main areas of focus
were the dosing schedule and management of thrombocytopenia. We continue to feel strongly that WAYLIVRA demonstrates a favorable benefit/risk profile
in people with FCS, as was reflected in the positive outcome from the Advisory Committee meeting. We received a preliminary notification of a Notice of
Noncompliance withdrawal letter, or NON-W, from Health Canada for WAYLIVRA. We and Ionis are engaged with the FDA and plan to work with Health
Canada to confirm a path forward for WAYLIVRA.

FCS is a severe and rare lipid disorder characterized by extremely elevated levels of triglycerides. FCS has life-threatening consequences such as
acute  pancreatitis  and  the  lives  of  patients  with  this  disease  are  impacted  daily  by  the  associated  symptoms.  In  our  clinical  program,  we  have  observed
consistent and substantial (>70%) decreases in triglycerides and improvements in other manifestations of FCS, including pancreatitis attacks and abdominal
pain. We believe the safety and efficacy data from the WAYLIVRA program demonstrate a favorable risk-benefit profile for patients with FCS. WAYLIVRA
is also in Phase 3 clinical development for the treatment of familial partial lipodystrophy, or FPL. Our other three lipid/cardiometabolic drugs are currently in
Phase 2 clinical development.

Commercial Infrastructure

We are continuing to build our global infrastructure as we begin to commercialize TEGSEDI and prepare to commercialize WAYLIVRA in the
E.U., and we have commercial teams in place in the U.S., E.U. and Canada. In addition, in August 2018, we entered into a licensing agreement with PTC
Therapeutics International Limited, or PTC Therapeutics, to commercialize TEGSEDI and WAYLIVRA in Latin America and certain Caribbean countries. A
key element of our commercial strategy is to provide the specialized, patient-centric support required to successfully address rare disease patient populations.
We believe our focus on treating patients with inadequately addressed rare and serious diseases will allow us to partner efficiently and effectively with the
specialized medical community that supports these underserved patient communities.

To  maximize  the  commercial  potential  of  two  of  the  drugs  in  our  pipeline,  we  initiated  a  strategic  collaboration  with  Novartis  Pharma AG,  or
Novartis, for the development and commercialization of AKCEA-APO(a)-LRx and AKCEA-APOCIII-LRx. In February 2019, Novartis exercised its option to
license AKCEA-APO(a)-LRx. Novartis is currently preparing to initiate a Phase 3 study of AKCEA-APO(a)-LRx in patients with established cardiovascular
disease (CVD) and elevated levels of lipoprotein(a), or Lp(a). We believe Novartis brings significant resources and expertise to the collaboration that can
accelerate our ability to deliver these potential therapies to the large populations of patients who have high cardiovascular risk due to inadequately treated
lipid  disorders.  As  part  of  our  collaboration,  we  received  $75.0  million  in  an  upfront  option  payment,  of  which  we  retained  $60.0  million  and  paid
$15.0 million to Ionis as a sublicense fee. We also earned a $150.0 million license fee when Novartis exercised its option to license AKCEA-APO(a)-LRx of
which we will pay $75.0 million to Ionis as a sublicense fee. We will pay Ionis the sublicense fee in Akcea common stock. Novartis is now responsible for all
future development and commercialization activities for AKCEA-APO(a)-LRx. We are eligible to receive license fees, milestone payments and royalties on
sales of AKCEA-APO(a)-LRx from Novartis if and when it meets the development, regulatory and sales milestones specified in our agreement. In connection
with Novartis’ exercise of its option to

64

 
exclusively  license  AKCEA-APO(a)-LRx,  Akcea  and  Novartis  established  a  more  definitive  framework  under  which  they  would  negotiate  the  co-
commercialization of AKCEA-APO(a)-LRx between the two companies in selected markets. Included in this framework is an option by which Novartis could
solely commercialize AKCEA-APO(a)-LRx in exchange for Novartis paying Akcea increased commercial milestone payments based on sales of AKCEA-
APO(a)-LRx. We will share any license fees, milestone payments and royalties equally with Ionis.

For AKCEA-APOCIII-LRx,  under  our  agreement  with  Novartis,  after  we  complete  Phase  2  development  and  if  Novartis  exercises  its  option  to
license  AKCEA-APOCIII-LRx,  we  would  receive  an  additional  $150.0  million  license  fee  which  we  would  also  share  equally  with  Ionis.  If  exercised,
Novartis would conduct and pay for a Phase 3 cardiovascular outcome study in patients with hypertriglyceridemia and prior cardiovascular risk. If approved,
Novartis  would  commercialize  AKCEA-APOCIII-LRx worldwide.  Novartis  will  have  60  days  plus  additional  time  that  could  be  required  for  Hart-Scott-
Rodino, or HSR, filing and review following the end-of-Phase 2 meeting to exercise its option for AKCEA-APOCIII-LRx. As part of the collaboration, we
may  co-commercialize  AKCEA-APOCIII-LRx  in  selected  markets,  on  mutually  agreed  terms  and  conditions.  Similar  to  AKCEA-APO(a)-LRx,  we  are
eligible to receive license fees, milestone payments and royalties on sales of AKCEA-APOCIII-LRx from Novartis if and when it meets the development,
regulatory and sales milestones specified in our agreement. We will share any license fees, milestone payments and royalties equally with Ionis.

Our strategic collaboration with Novartis has a potential aggregate transaction value of over $1.0 billion, plus royalties, which we would generally
be required to share equally with Ionis. The calculation of potential aggregate transaction value assumes that Novartis licenses, successfully develops and
achieves regulatory approval for both AKCEA-APO(a)-LRx and AKCEA-APOCIII-LRx in the U.S., E.U. and Japan, and that Novartis achieves pre-specified
sales targets with respect to both drugs. In addition, to the upfront payment that we have received, for AKCEA-APO(a)-LRx we are eligible to receive up to
$675.0 million in milestone payments, including $25.0 million for the achievement of a development milestone, up to $290.0 million for the achievement of
regulatory milestones and up to $360.0 million for the achievement of commercialization milestones. In addition, for AKCEA-APOCIII-LRx we are eligible
to receive up to $530.0 million in milestone payments, including $25.0 million for the achievement of a development milestone, up to $240.0 million for the
achievement of regulatory milestones and up to $265.0 million for the achievement of commercialization milestones. We are also eligible to receive tiered
royalties  in  the  mid-teens  to  low  twenty  percent  range  on  net  sales  of  AKCEA-APO(a)-LRx  and  AKCEA-APOCIII-LRx,  and  Novartis  will  reduce  these
royalties  upon  the  expiration  of  certain  patents  or  if  a  generic  competitor  negatively  impacts  the  product  in  a  specific  country.  We  will  pay  50%  of  these
license fees, milestone payments and royalties to Ionis as a sublicense fee. See Note 6, Strategic Collaboration with Novartis, to our consolidated financial
statements for additional information.

We  began  recognizing  revenue  under  the  collaboration  with  Novartis  upon  its  initiation  in  2017.  Our  collaboration  revenue  for  2018  was  $50.6
million. In addition, we began to recognize TEGSEDI product revenue in 2018 and recognized licensing revenue in the third quarter of 2018 related to our
collaboration  and  license  agreement  with  PTC  Therapeutics.  Our  product  revenue  and  licensing  revenue  for  2018  was  $2.2  million  and  $12.0  million
respectively. Our total revenue for 2018 was $64.9 million. Our net losses have resulted from costs incurred in developing TEGSEDI, WAYLIVRA and the
other  drugs  in  our  pipeline,  preparing  to  commercialize  TEGSEDI  and  potentially  WAYLIVRA  upon  approval,  and  general  and  administrative  activities
associated with our operations. We expect to continue to generate operating losses and negative operating cash flows for the foreseeable future. The transition
to profitability is dependent upon the successful development, approval, and commercialization of our products and product candidates and the achievement
of a level of revenue adequate to support our cost structure. We incur meaningful expenses to support commercialization, including manufacturing, marketing,
sales and distribution functions. Further, we incur additional costs associated with operating as a public company.

As of December 31, 2018, we had cash, cash equivalents and investments of $252.6 million. We have funded our operating activities through a
$100.0 million cash contribution that we received from Ionis in 2015, $75.0 million from initiating our collaboration with Novartis that we received in the
first quarter of 2017 and $106.0 million in drawdowns under our line of credit with Ionis that we received in the first and second quarters of 2017. In July
2017, we completed our IPO and raised $182.3 million in net proceeds from the IPO including the $50.0 million Novartis concurrent private placement. In
April 2018, we completed a licensing transaction with Ionis to commercialize TEGSEDI. In conjunction with this transaction, Ionis purchased 10.7 million
shares of our common stock for $200.0 million. As a result of the MA approval for TEGSEDI in the EU, on August 3, 2018 we issued 1,597,571 shares of
our common stock to Ionis as payment of the $40.0 million regulatory milestone for TEGSEDI, and as a result of the regulatory approval for TEGSEDI in the
United  States,  on  October  17,  2018  we  issued  1,671,849  shares  of  our  common  stock  to  Ionis  as  payment  of  the  $50.0  million  regulatory  milestone  for
TEGSEDI. See Note 7, License Agreements and Services Agreement with Ionis, to our  consolidated financial statements included in this Form 10-K for more
information about our TTR licensing agreement with Ionis. We plan to use our cash, cash equivalents and investments on hand as of December 31, 2018 to
further our commercialization efforts of TEGSEDI and WAYLIVRA and continue the advancement of our pipeline drugs.

65

 
We  expect  that  our  cash,  cash  equivalents  and  investments  of  $252.6 million as of December 31, 2018, together  with  the  receipt  of  the  $150.0
million license fee payment expected in March 2019 as a result of Novartis opt in for the ACKEA-APO(a)-LRx, and cash expected to be generated from sales
of  TEGSEDI,  which  has  been  approved  in  the  U.S.,  the  EU  and  Canada,  will  be  sufficient  to  fund  our  operating  expenses  and  capital  expenditure
requirements  for  at  least  the  next  12  months  from  issuance  of  these  financial  statements.  However,  we  expect  to  raise  additional  funding  in  the  future  to
continue developing the drugs in our pipeline and to commercialize TEGSEDI, or any other approved drug, including WAYLIVRA. We may seek to obtain
additional financing in the future through the issuance of our common stock, through other equity or debt financings or through collaborations or partnerships
with other companies. We may not be able to raise additional capital on terms acceptable to us, or at all, and any failure to raise capital as and when needed
could compromise our ability to execute on our business plan.

Our Relationship with Ionis

Ionis formed Akcea as a wholly owned subsidiary to complete development of and commercialize Ionis’ drugs to treat lipid disorders. We began
business operations in January 2015. We licensed our cardiometabolic franchise from Ionis at the beginning of 2015. Prior to licensing these drugs, Ionis’
employees performed all of the development, regulatory and manufacturing activities for these drugs either themselves or through third-party providers. As
such, Ionis incurred all of the expenses associated with these activities and reported them in its consolidated financial statements. TEGSEDI and AKCEA-
TTR-LRx were licensed from Ionis in April 2018. Prior to then, Ionis had been advancing these drugs in development and incurring the expenses for those
activities. Under our license agreements with Ionis, Ionis continued and is continuing to conduct development, regulatory or manufacturing activities for our
drugs and to charge us for this work. As of December 31, 2018, Ionis owed approximately 75 percent of our outstanding stock.

Critical Accounting Policies

We prepare our consolidated financial statements in conformity with accounting principles generally accepted in the United States, or GAAP. As such,
we  make  certain  estimates,  judgments  and  assumptions  that  we  believe  are  reasonable,  based  upon  the  information  available  to  us.  These  judgments  involve
making estimates about the effect of matters that are inherently uncertain and may significantly impact our quarterly or annual results of operations and financial
condition. In the following paragraphs, we describe our most significant accounting policies, which we believe are the most critical to aid in fully understanding
and evaluating our reported financial results. As described below, there are specific risks associated with these critical accounting policies and we caution that
future events rarely develop exactly as one may expect, and that best estimates may require adjustment. The significant accounting policies, which we believe are
the most critical to aid in fully understanding and evaluating our reported financial results, are as follows:

Revenue Recognition

We began to record revenues from product sales in the fourth quarter of 2018 subsequent to the approval of TEGSEDI in the U.S., EU and Canada.
Prior to the fourth quarter of 2018, our revenues were derived from our collaboration agreement with Novartis and collaboration and license agreement with
PTC  Therapeutics.  The  terms  of  such  collaboration  agreements  may  include  consideration  such  as  nonrefundable  license  fees,  funding  of  research  and
development  services,  payments  due  upon  the  achievement  of  clinical  and  pre-clinical  performance-based  development  milestones,  regulatory  milestones,
manufacturing services, sales-based milestones and royalties on product sales.

Collaboration and License Revenue

On January 1, 2018, we adopted the new revenue standard, discussed below under Note 2, Summary of Significant Accounting Policies, which amended
revenue recognition principles and provides a single, comprehensive set of criteria for revenue recognition within and across all industries. Our adoption of the new
revenue standard had a material impact on our consolidated financial statements, as discussed below in Note 2. This new revenue standard applies to all contracts with
customers,  except  for  contracts  that  are  within  the  scope  of  other  standards,  such  as  leases,  insurance,  collaboration  arrangements  and  financial  instruments.  To
determine revenue recognition for arrangements that an entity determines are within the scope of Topic 606, the entity performs the following five steps: (i) identify
the contract(s) with a customer; (ii) identify the performance obligations in the contract; (iii) determine the transaction price; (iv) allocate the transaction price to the
performance obligations in the contract; and (v) recognize revenue when (or as) the entity satisfies a performance obligation. At contract inception, once the contract
is  determined  to  be  within  the  scope  of  Topic  606,  we  assess  the  goods  or  services  promised  within  each  contract  and  determine  those  that  are  performance
obligations, then assess whether each promised good or service is distinct. When we offer options for additional goods or services, such as an option to license a drug
in the future or for additional goods or services to be provided in the future, we evaluate whether such options are material rights that should be treated as additional
performance obligations. We typically have not concluded that the option to license a drug or the options for additional goods or services that may be requested in the
future  under  our  collaboration  agreement  are  material  rights  as  the  amounts  attributable  to  such  options  represent  standalone  selling  price,  and  therefore  no
consideration is allocated to these items at the inception of an agreement. When a partner exercises its option to

66

 
 
 
 
 
license a drug or requests the additional goods or services, a new performance obligation is created for that item. Once performance obligations are identified, we then
recognize as revenue the amount of the transaction price that we allocated to the respective performance obligation when (or as) each performance obligation is
satisfied, either at a point in time or over time. If the performance obligation is satisfied over time, we recognize revenue based on the use of an output or input
method.  As  of  December  31,  2018,  we  have  three  revenue  streams:  our  strategic  collaboration,  option  and  license  agreement,  or  collaboration  agreement,  with
Novartis Pharma AG, or Novartis, which we entered into in January 2017, our collaboration and license agreement with PTC Therapeutics International Limited, or
PTC Therapeutics, which we entered into in August 2018 and commercial product revenue related to sales of TEGESDI in the fourth quarter of 2018. For a complete
discussion of the accounting for our revenue streams, see Note 6, Strategic Collaboration with Novartis, Note 8, Collaboration and License Agreement with  PTC
Therapeutics, and Note 2, Summary of Significant Accounting Policies.

Effective January 1, 2018, we adopted Topic 606 using the full retrospective transition method. Under this method, we revised our consolidated
financial statements for prior period amounts including the periods included in this Report on Form 10-K, as if Topic 606 had been effective for such periods.
The references “as revised” used herein refer to revisions of amounts originally reported for the year ended December 31, 2017 and as of December 31, 2017
as a result of our adoption of Topic 606.

Impact of Adoption

As a result of adopting Topic 606 on January 1, 2018, we revised our comparative financial statements for the prior years as if Topic 606 had been
effective for that period. On September 18, 2018, we filed a Current Report on Form 8-K to present recast consolidated financial statements for each of the
three years ended December 31, 2015, 2016 and 2017, to reflect our adoption of the new accounting standard for revenue recognition set forth in Topic 606.
The financial information recast in the Form 8-K was originally filed with the SEC in our Annual Report on Form 10-K for the fiscal year ended December
31, 2017, which was filed with the SEC on February 28, 2018. Under Topic 605, we recognized revenue from our collaboration with Novartis over time on a
straight-line basis. Under Topic 606, we recognize revenue from our collaboration with Novartis using the input method based on the total cost of performing
services over time. As a result, the following financial statement line items for fiscal year 2017 were affected.

Consolidated Balance Sheets

Current portion of deferred revenue
Long-term portion of deferred revenue
Accumulated deficit

Consolidated Statement of Operations and Comprehensive Loss

December 31, 2017
(in thousands)
As Originally
Reported

As Revised

Under Topic 606    

Under Topic 605    

  $

  $

58,192    $
12,501     
(296,221)   $

50,579    $
8,306     
(284,413)   $

Effect
of Change

7,613 
4,195 
(11,808)

Year Ended December 31, 2017
(in thousands, except per share data)
As Originally
Reported

As Revised

Under Topic 606    

Under Topic 605    

Effect
of Change

Research and development revenue under collaborative
   Agreement
Loss from operations
Net loss
Net loss per share of preferred stock, basic and diluted
Net loss per share of common stock owned by Ionis, basic
   and diluted
Net loss per share of common stock owned by others, basic
   and diluted

  $

43,401    $
(120,470)    
(121,559)    
(1.80)    

55,209    $
(108,662)    
(109,751)    
(1.55)    

(11,808)
(11,808)
(11,808)
(0.25)

(3.08)    

(2.82)    

(0.26)

  $

(3.08)    

(2.82)   $

(0.26)

67

 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
   
   
   
 
Consolidated Statement of Cash Flows

Years Ended December 31, 2017
(in thousands)
As Originally
Reported

As Revised

Under Topic 606    

Under Topic 605    

Effect
of Change

Net loss
Adjustments to reconcile net loss to net cash used in
   operating activities:
Deferred revenue
Cash, cash equivalents and restricted cash at beginning of
   period
Cash, cash equivalents and restricted at end of period

  $

(121,559)   $

(109,751)   $

(11,808)

70,693     

58,885     

11,808 

  $

7,857     
58,367    $

7,857     
58,367    $

— 
—

Product Revenue, Net

Subsequent to regulatory approval in Europe on July 11, 2018 and FDA approval in the U.S. on October 5, 2018, in the fourth quarter of 2018 we
began  to  sell  TEGSEDI  in  the  U.S.  and  Germany.    In  the  U.S.,  the  product  is  distributed  through  an  exclusive  distribution  agreement  with  a  third-party
logistics (3PL) company that takes title to the product and represents our sole customer in the U.S.  Our U.S. customer distributes TEGSEDI to a specialty
pharmacy  and  a  specialty  distributor  (collectively  referred  to  as  “wholesalers”),  who  then  distribute  the  product  to  health  care  providers  and  patients.    In
Germany, the product is distributed through a non-exclusive distribution model with a 3PL that takes title to the product and currently represents our sole
customer in Germany.  Our customer in Germany then distributes TEGSEDI to hospitals and pharmacies in Germany.  

Revenue from product sales are recognized when the customer obtains control of our product, which occurs at a point in time, upon transfer of title
to  the  customer.   We  record  shipping  and  handling  costs  within  cost  of  goods  sold  on  our  consolidated  statement  of  operations.  We  classify  payments  to
customers or other parties in the distribution channel for services that are distinct and priced at fair value as selling, general and administrative expenses in
our consolidated statements of operations. Otherwise payments to customers or other parties in the distribution channel that do not meet those criteria are
classified  as  a  reduction  of  revenue,  as  discussed  further  below.    Taxes  collected  from  customers  relating  to  product  sales  and  remitted  to  governmental
authorities  are  excluded  from  revenue.  We  have  elected  not  to  adjust  consideration  for  the  effects  of  a  significant  financing  component  when  the  period
between the transfer of a promised good or service to the customer and when the customer pays for that good or service will be one year or less.  Our payment
terms are generally between thirty to ninety days.  We expense incremental costs of obtaining a contract as and when incurred since the expected amortization
period of the asset that we would have recognized is one year or less.

Reserves for Variable Consideration

Revenues from product sales are recorded at the net sales price (transaction price), which includes estimates of variable consideration for which
reserves  are  established  and  which  result  from  discounts,  returns,  chargebacks,  rebates,  co-pay  assistance  and  other  allowances  that  are  offered  within
contracts between us and our customers, wholesalers, health care providers and other indirect customers relating to the sale of TEGSEDI. These reserves are
based on the amounts earned or to be claimed on the related sales and are classified as reductions of accounts receivable (if the amount is payable to the
customer) or a current liability (if the amount is payable to a party other than a customer). Where appropriate, these estimates take into consideration a range
of  possible  outcomes  that  are  probability-weighted  for  relevant  factors  such  as  our  historical  experience,  current  contractual  and  statutory  requirements,
specific  known  market  events  and  trends,  industry  data  and  forecasted  customer  buying  and  payment  patterns.  Overall,  these  reserves  reflect  our  best
estimates of the amount of consideration to which we are entitled based on the terms of the contract. The amount of variable consideration that is included in
the transaction price may be constrained and is included in the net sales price only to the extent that it is considered probable that a significant reversal in the
amount  of  the  cumulative  revenue  recognized  will  not  occur  in  a  future  period.  Actual  amounts  of  consideration  ultimately  received  may  differ  from  our
estimates. If actual results in the future vary from our estimates, we will adjust these estimates, which would affect net product revenue and earnings in the
period such variances become known.

68

 
 
 
 
 
 
 
 
   
      
      
  
   
   
 
 
 
 
 
 
 
The following are the components of variable consideration related to product revenue:

Chargebacks:  In the U.S., we estimate obligations resulting from contractual commitments with the government and other entities to sell products
to qualified healthcare providers at prices lower than the list prices charged to our U.S. customer. Our U.S. customer charges us for the difference between
what they pay for the product and the selling price to the qualified healthcare providers. We record reserves for these chargebacks related to product sold to
our U.S. customer during the reporting period, as well as our estimate of product that remains in the distribution channel at the end of the reporting period that
we expect will be sold to qualified healthcare providers in future periods.

Government rebates: We are subject to discount obligations under government programs, including Medicaid programs and Medicare in the United
States.  We  estimate  Medicaid  and  Medicare  rebates  based  upon  a  range  of  possible  outcomes  that  are  probability-weighted  for  the  estimated  payer
mix.  These reserves are recorded in the same period the related revenue is recognized, resulting in a reduction of product revenue and the establishment of a
liability that is included in accrued expenses on our consolidated balance sheet.  For Medicare, we also estimate the number of patients in the prescription
drug coverage gap for whom we will owe an additional liability under the Medicare Part D program. On a quarterly basis, we update our estimates and record
any  adjustments  in  the  period  that  we  identify  the  adjustments.  In  Germany,  pharmaceutical  companies  must  grant  a  specified  rebate  percentage  to  the
German government. We have included this rebate as a reduction of revenue in the period the related product revenue is recognized.

Trade discounts and allowances: We provide customary invoice discounts on TEGSEDI sales to our U.S. customer for prompt payment that are
recorded as a reduction of revenue in the period the related product revenue is recognized.  In addition, we receive and pay for various distribution services
from our U.S. customer and wholesalers in the U.S. distribution channel.  For services that are either not distinct from the sale of our product or for which we
cannot reasonably estimate the fair value, such fees are classified as a reduction of product revenue.

Product Returns: Our U.S. customer has return rights and the wholesalers have limited return rights primarily related to the product’s expiration
date. We estimate the amount of product sales that may be returned and record the estimate as a reduction of revenue and a refund liability in the period the
related product revenue is recognized. Based on the distribution model for TEGSEDI, contractual inventory limits with our customer and wholesalers and the
price of TEGSEDI, we believe there will be minimal returns. Our customer in Germany only takes title to the product once it receives an order from a hospital
or pharmacy and therefore does not maintain any inventory of TEGSEDI. Therefore, there is limited return risk and the Company has not recorded any return
estimate in the transaction price for TEGSEDI sold in Germany.

Other incentives:  In the U.S., other incentives include co-payment assistance we provide to patients with commercial insurance that have coverage
and reside in states that allow co-payment assistance. The calculation of the accrual for co-pay assistance is based on an estimate of claims and the cost per
claim that we expect to receive associated with product that has been recognized as revenue. The estimate is recorded as a reduction of revenue in the same
period the related revenue is recognized.

During the year ended December 31, 2018, we recorded product revenue, net, of $2.2 million, which consist of $1.2 million of TEGSEDI sales in
the U.S., and $1.0 million of TEGSEDI sales in Germany. The following table summarizes balances and activity in each of the product revenue allowance and
reserve categories for the year ended December 31, 2018 (in thousands):

Balance at December 31, 2017
Provision related to current period sales
Adjustment related to prior period sales
Credit or payments made during the period
Balance at December 31, 2018

Inventory

Chargebacks,
discounts and
fees

Government
and other
rebates

Returns

Total

  $

  $

—    $
50     
—     
—     
50    $

—    $
293     
—     
—     
293    $

—    $
5     
—     
—     
5    $

— 
348 
— 
— 
348

Prior  to  the  regulatory  approval  of  our  product  candidates,  we  incur  expenses  for  the  manufacturing  of  drug  product  that  could  potentially  be
available  to  support  the  commercial  launch  of  our  products.  Until  the  first  reporting  period  when  regulatory  approval  has  been  received  or  is  otherwise
considered probable, we record all such costs as research and development expense.

69

 
 
 
 
 
 
 
 
 
   
   
   
 
   
   
   
 
For inventory related costs incurred subsequent to July 1, 2018, we reflected these amounts as inventory on our consolidated balance sheets at the
lower of cost or market value under the first-in, first-out, or FIFO, basis. We periodically analyze our inventory levels, and write down inventory that has
become obsolete, inventory that has a cost basis in excess of its estimated realizable value and inventory in excess of expected sales requirements as cost of
product sales. The determination of whether inventory costs will be realizable requires estimates by our management and if actual market conditions are less
favorable than projected by our management, additional write-downs of inventory may be required which would be recorded as a cost of product sales in the
consolidated statements of operations.

At  December  31,  2018  a  majority  of  our  physical  inventory  for  TEGSEDI  was  produced  prior  to  when  we  obtained  regulatory  approval  and
accordingly had no cost basis as we recorded the related costs as research and development expense in prior periods. At December 31, 2018 the amount of
finished goods recorded in our consolidated balance sheets in other current assets related to our approved product TEGSEDI was $85,000.

Intangible Assets

We obtained exclusive licenses from Ionis for specific patents that Ionis owns and maintains related to our drug pipeline. We recorded our licenses
from Ionis as a capital contribution using the carryover basis of Ionis' historical cost for the related patents. We are amortizing our capitalized licenses over
their estimated useful life, which is the term of the underlying individual patents owned by Ionis.

In addition, we maintain definite-lived intangible assets related to regulatory milestone payments made to Ionis that are recoverable through future
cash flows from approved products, which are capitalized as license intangible assets. These assets are amortized over their remaining useful lives, which are
generally estimated to be the remaining patent life. If our estimate of the product’s useful life is shorter than the remaining patent life, then the shorter period
is used. Intangible assets are amortized using the economic consumption method if anticipated future revenue can be reasonably estimated. The straight-line
method  is  used  when  future  revenue  cannot  be  reasonably  estimated.  Amortization  expense  is  recorded  as  a  component  of  cost  of  sales  to  the  extent  the
underlying license is commercialized or research and development prior to its commercialization in the consolidated statements of operations.

Cost of Product Sales

As a result of receiving marketing authorization, or MA, approval for TEGSEDI from the European Commission, or EC, in July 2018, we began
recording all TEGSEDI related expenses as cost of product sales starting in July 2018. Cost of product sales consists of manufacturing costs, transportation
and freight, and indirect overhead costs associated with the manufacturing and distribution of TEGSEDI. Cost of product sales may also include period costs
related  to  certain  manufacturing  services  and  inventory  adjustment  charges.  Additionally,  we  expensed  a  significant  portion  of  the  cost  of  producing
TEGSEDI that we will use in the commercial launch as research and development expense prior to the regulatory approval of TEGSEDI.

Estimated Liability for Research and Development Costs

We record accrued liabilities related to expenses for which vendors or service providers have not yet billed us. These liabilities are for products or
services that we have received and primarily relate to ongoing nonclinical and clinical studies. These costs primarily include third-party clinical management
costs, laboratory and analysis costs, toxicology studies and investigator grants. We have drugs in concurrent nonclinical and clinical studies at several sites
throughout the world. To ensure that we have adequately provided for ongoing nonclinical and clinical research and development costs during the period in
which we incur such costs, we maintain an accrual to cover these costs. We update our estimate for this accrual on at least a quarterly basis. The assessment of
these costs is a subjective process that requires judgment. Upon settlement, these costs may differ materially from the amounts accrued in our consolidated
financial statements. Our historical accrual estimates have not been materially different from our actual amounts.

Stock-Based Compensation Expense

We measure stock-based compensation expense for equity-classified awards, principally related to stock options, restricted stock units, or RSUs,
and stock purchase rights under our employee stock purchase plan, or ESPP, based on the estimated fair value of the award on the date of grant. We recognize
the  value  of  the  portion  of  the  award  that  we  ultimately  expect  to  vest  as  stock-based  compensation  expense  over  the  requisite  service  period  in  our
consolidated statements of operations. We reduce stock-based compensation expense for estimated forfeitures at the time of grant and revise the expense in
subsequent periods if actual forfeitures differ from those estimates.

70

 
We value our stock option awards and stock purchase rights under our ESPP using the Black-Scholes model. The determination of the grant date
fair value of options using an option pricing model is affected principally by our estimated common stock fair value and requires us to make a number of
other assumptions, including: the expected life of the option, the volatility of the underlying stock, the risk-free interest rate and expected dividends.

The fair value of RSUs is based on the market price of our common stock on the date of grant. The RSUs we have granted vest annually over a

four-year period.

Prior to December 2015, Ionis granted our employees options to purchase shares of Ionis' common stock, or Ionis options. In December 2015, we granted

our employees holding Ionis options additional options to purchase shares of our common stock, or Akcea options.

We  determined  the  stock-based  compensation  expense  for  the  Ionis  options  at  the  date  of  grant  and  recognized  compensation  expense  over  the
vesting period of the Ionis options. In December 2015, we accounted for the issuance of the Akcea options as a modification to the original grant of the Ionis
options  because  the  grant  of  the  Ionis  options  and  Akcea  options  essentially  represented  a  single  stock  award  as  the  exercisability  provisions  of  the  Ionis
options and Akcea options grants were interrelated and mutually exclusive. The total compensation expense measured on the modification date was the sum
of the grant date fair value of the Ionis options plus any incremental compensation cost resulting from the grant of the Akcea options.

In 2016, we began concurrently granting Ionis options and Akcea options to our employees. Because the exercisability provisions of the awards are
interrelated and mutually exclusive as described above, the fair values of the Ionis options and the Akcea options were determined on the date of grant and the
option with the greater fair value was recognized over the vesting period of the awards. In 2017, we no longer concurrently granted Ionis and Akcea options. Our
board of directors only receive grants under the Akcea option plan.

Following our IPO, we no longer grant Ionis options to our employees. Under the terms of the Ionis options, when we completed our IPO, the Ionis
options  our  employees  were  holding  were  terminated.  The  termination  of  the  Ionis  options  was  determined  not  to  be  a  modification,  as  the  options  were
terminated based upon the existing contractual terms of the option agreements. As such, we will continue to recognize expense based on the valuation that
was determined upon the grant date for options issued in 2016 or the modification date for options issued in 2015 and 2017.

The fair value of stock options granted under our 2015 Equity Incentive Plan is based on the fair value of our common stock on the date of grant.
The  fair  value  of  stock  options  granted  under  the  Ionis  2011  Equity  Incentive  Plan  is  based  on  the  fair  value  of  Ionis'  common  stock  on  the  date  of
grant. Options granted to employees vest over a four-year period, with 25 percent exercisable at the end of one year from the date of the grant and the balance
vesting ratably, on a monthly basis, thereafter and have a term of ten years. Options granted to directors vest annually over a four-year period and have a term
of ten years.

See Note 9, Equity and Stock-based Compensation, for additional information regarding our stock-based compensation plans.

Income Taxes

Prior  to  the  completion  of  our  IPO  we  filed  our  tax  returns  on  a  consolidated  and  combined  basis  with  Ionis  for  federal  and  state  income  tax
purposes,  respectively.  For  financial  statement  purposes  when  we  are  required  to  file  on  a  consolidated  or  combined  basis,  we  calculate  our  income  tax
amounts, including net operating losses and tax credit carryforwards, using a separate return methodology which determines income taxes as if we were a
separate taxpayer from Ionis.  Effective July 19, 2017, the date of our IPO, we are no longer included in the consolidated federal income tax return with Ionis.
We determined the amount of federal tax attributes, primarily net operating losses and tax credit carryforwards that transferred to us upon deconsolidation
from  Ionis.    We  are  still  required  to  file  most  of  our  state  tax  returns  on  a  consolidated  or  combined  basis  with  Ionis.    Therefore,  for  financial  statement
purposes we calculated our state income tax amounts using the separate return method. 

We  account  for  income  taxes  using  the  asset  and  liability  method,  which  requires  the  recognition  of  deferred  tax  assets  and  liabilities  for  the
expected future tax consequences of events that have been recognized in our financial statements or tax returns. In addition, deferred tax assets are recorded
for the future benefit of utilizing net operating losses and research and development credit carry forwards. Valuation allowances are provided when necessary
to reduce deferred tax assets to the amount expected to be realized.

71

 
We apply the authoritative accounting guidance prescribing a threshold and measurement attribute for the financial recognition and measurement of
a tax position taken or expected to be taken in a tax return. We recognize liabilities for uncertain tax positions based on a two-step process. The first step is to
evaluate the tax position for recognition by determining if the weight of available evidence indicates that it is more likely than not that the position will be
sustained on audit, including resolution of related appeals or litigation settlement. The second step is to estimate and measure the tax benefit as the largest
amount that is more than 50% likely to be realized upon ultimate settlement.

We  recognize  interest  and  penalties  related  to  unrecognized  tax  benefits  within  the  income  tax  expense  line  in  the  accompanying  consolidated

statements of operations. Accrued interest and penalties are included within other long-term liabilities in the consolidated balance sheets.

Significant judgment is required in evaluating our uncertain tax positions and determining our provision for income taxes. Although we believe our
reserves are reasonable, no assurance can be given that the final tax outcome of these matters will not be different from that which is reflected in our historical
income tax provisions and accruals. We adjust these reserves for changing facts and circumstances, such as the closing of a tax audit or the refinement of an
estimate.  To  the  extent  that  the  final  tax  outcome  of  these  matters  is  different  than  the  amounts  recorded,  such  differences  may  impact  the  provision  for
income taxes in the period in which such determination is made.

Significant  judgment  is  also  required  in  determining  any  valuation  allowance  recorded  against  deferred  tax  assets.  In  assessing  the  need  for  a
valuation allowance, we consider all available evidence, including scheduled reversal of deferred tax liabilities, past operating results, the feasibility of tax
planning strategies and estimates of future taxable income. Estimates of future taxable income are based on assumptions that are consistent with our plans.
Assumptions represent management's best estimates and involve inherent uncertainties and the application of management's judgment. Should actual amounts
differ from our estimates, the amount of our tax expense and liabilities could be materially impacted.

We  record  a  valuation  allowance  to  reduce  the  balance  of  our  net  deferred  tax  assets  to  the  amount  we  believe  is  more-likely-than-not  to  be
realized. We have incurred financial statement losses since inception and as a result we have a full valuation allowance recorded against our net deferred tax
assets.  We  regularly  assess  the  future  realization  of  our  net  deferred  tax  assets  and  will  reduce  the  valuation  allowance  in  any  such  period  in  which  we
determine that all, or a portion, of our deferred tax assets are more-likely-than-not to be realized.

We do not provide for a U.S. income tax liability and foreign withholding taxes on undistributed foreign earnings of our foreign subsidiaries. The

earnings of non-U.S. subsidiaries are currently expected to be indefinitely reinvested in non-U.S. operations.

Results of Operations

In order to analyze and compare our results of operations to other similar companies, we believe it is important to exclude non-cash stock-based
compensation expense related to equity awards from our expenses. We believe non-cash stock-based compensation expense is not indicative of our operating
results  or  cash  flows  from  our  operations.  Further,  we  internally  evaluate  the  performance  of  our  operations  excluding  it.  All  numbers  presented  below
exclude stock-based compensation expense unless otherwise indicated.

Comparison of the Years Ended December 31, 2018 and 2017 (as revised)

Revenue

The following table sets forth our revenue for the periods presented (in thousands):

Product revenue
Licensing revenue
Research and development revenue under collaboration agreement
Total revenue

72

Years Ended December 31,

2018

2017
(as revised)

  $

  $

2,237    $
12,000   
50,630   
64,867    $

— 
— 
43,401 
43,401

 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
Product revenue. Product  revenue  of  $2.2  million  for  2018  relates  to  sales  of  TEGSEDI  in  the  Unites  States  and  Germany.  For  the  year  ended

December 31, 2017, we did not generate any product revenue.

Licensing revenue. Licensing revenue of $12.0 million for 2018 relates to the upfront payment received from PTC Therapeutics related to our PTC

License Agreement entered into in August 2018. For the year ended December 31, 2017, we did not generate any licensing revenue.

Research  and  development  revenue.  In  2018,  we  recognized  $50.6  million  compared  to  $43.4  million  in  2017  (as  revised),  in  research  and
development revenue from our collaboration with Novartis. The increase in research and development revenue is primarily the result of level of efforts related
to activities for our AKCEA-APO(a)-LRx and AKCEA-APOCIII-LRx programs.

Cost of sales and license expense

The following table sets forth our cost of sales and license expense for the periods presented (in thousands):

Cost of sales - product
Cost of sales - intangible asset amortization
Cost of license
Total cost of sales and license expenses, excluding non-cash stock-based compensation
expense
Non-cash stock-based compensation expense
Total cost of sales and license expenses

  $

  $

1,660    $
2,713   
7,200   

11,573   
160   
11,733    $

— 
— 
— 

— 
— 
—

Years Ended December 31,

2018

2017

Cost  of  sales  –  product  expense  of  $1.7  million  for  2018  consists  of  period  costs  and  certain  fixed  costs  associated  with  the  manufacturing  of
TEGSEDI. We do not expect fixed costs will increase in direct correlation to sales. Based on our policy, we expense costs associated with the manufacture of
our products as research and development prior to regulatory approval. Certain product costs of TEGSEDI units recognized as revenue during the year ended
December 31, 2018 were incurred prior to the July 2018 EU approval, and therefore are not included in cost of sales during the year.  We expect cost of sales
to increase as we deplete these inventories. The cost of units sold during the period for which there was no cost basis was $0.1 million for the year ended
December 31, 2018.  No product cost of sales was recorded for the year ended December 31, 2017. All amounts exclude non-cash compensation expense
related to equity awards.

Cost of sales expense – intangible asset amortization of $2.7 million for 2018 consist of amortization of intangible assets recorded as a result of the

achievement of TEGSEDI regulatory milestones in the U.S. and E.U. All amounts exclude non-cash compensation expense related to equity awards.

Cost of license of $7.2 million for 2018 consists of TTR sub-license expense due to Ionis related to the payment received as part of the licensing
agreement entered into with PTC Therapeutics in August 2018. No license cost of sales was recorded for the year ended December 31, 2017. All amounts
exclude non-cash compensation expense related to equity awards.

73

 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Research and development expense

The following table sets forth our research and development expenses for the periods presented (in thousands):

External TEGSEDI expenses
External WAYLIVRA expenses
Other external research and development projects expenses
Research and development personnel and overhead expenses
Sublicensing expenses
Total research and development expenses, excluding non-cash stock-based compensation
expense
Non-cash stock-based compensation expense
Total research and development expenses

  $

Years Ended December 31,

2018

2017

26,044   
22,246   
40,560   
32,055   
—   

120,905   
9,435   
130,340    $

— 
26,505 
21,789 
21,572 
48,394 

118,260 
8,630 
126,890

Research and development expenses were $120.9 million for the year 2018 compared to $118.3 million for the same period in 2017. The slight
increase in research and development expenses was primarily due to development activities related to TEGSEDI, development activities related to our Phase
2b studies for AKCEA APOCIII-LRx and AKCEA-ANGPTL3-LRx which were initiated in the first quarter of 2018 and personnel and overhead expense to
support  our  development  efforts.  This  increase  was  offset  primarily  due  to  sublicensing  expenses  related  to  our  collaboration  with  Novartis,  which  we
incurred in the first quarter of 2017, the majority of which were non-cash, a decrease in development activities for AKCEA APO(a)-LRx as the clinical study
ended, finished data collection and reported topline results, as well as a decrease in development activities for WAYLIVRA. All amounts exclude non-cash
compensation expense related to equity awards.

Selling, general and administrative expense

The following table sets forth our selling, general and administrative expenses for the periods presented (in thousands):

Selling, general and administrative expenses
Non-cash compensation expense related to equity awards
Total Selling, general and administrative expenses

Years Ended December 31,

2018

2017

  $

  $

118,923    $
34,687   
153,610    $

28,072 
8,909 
36,981

Selling, general and administrative expenses were $118.9 million for 2018 compared to $28.1 million for the same period in 2017. Our selling,
general and administrative expenses increased due to the ongoing buildout of our commercial organization and advancement of pre-commercialization and
commercialization  activities  necessary  to  launch  TEGSEDI  in  the  U.S.,  the  EU  and  Canada,  and  WAYLIVRA,  if  approved  for  marketing  in  the  EU.  All
amounts exclude non-cash compensation expense related to equity awards.

Other income and other expense

Investment  income.  Investment  income  for  2018  totaled  $5.7  million  compared  to  $1.8  million  for  the  same  period  in  2017.  The  increase  in
investment income was primarily due to a higher average investment balance and an increase in the interest rates on high quality debt and U.S. government
agencies investments during 2018 compared to 2017.

Interest expense. Interest expense is comprised entirely of interest incurred under our line of credit agreement with Ionis. We incurred no interest
expense during 2018. Interest expense for 2017 totaled $1.7 million. The outstanding principal and accrued interest under our line of credit converted into
13,438,339 shares of our common stock in connection with the closing of our IPO in July 2017 and we no longer have access to this line of credit following
the closing of our IPO.

74

 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
Net Loss and Net Loss Per Share

Net loss for 2018 was $225.8 million compared to $121.6 million for the same period in 2017 (as revised). We incurred a higher net loss during
2018  compared  to  2017  primarily  due  to  the  development  and  pre-commercialization  and  commercial  activities  for  TEGSEDI,  the  increase  in  expenses
related to pre-commercialization and development activities for WAYLIVRA and our other drugs, and the ongoing global expansion of our company. Basic
and diluted net loss per preferred share for the year ended December 31, 2017 (as revised) was $1.80. We had no outstanding preferred shares at December
31, 2018. Basic and diluted net loss per common share owned by Ionis and owned by others for the year ended December 31, 2018 was $2.74 and $2.87,
respectively. Basic and diluted net loss per common share owned by Ionis and owned by others for the year ended December 31, 2017 (as revised) was $3.08.

Comparison of the Years Ended December 31, 2017 (as revised) and 2016

Revenue

For the year ended December 31, 2017, we recognized $43.4 million in research and development revenue (as revised) from our collaboration with

Novartis, which we initiated in January 2017. For the year ended December 31, 2016, we did not generate any revenue.

Research and development expense

The following table sets forth our research and development expenses for the periods presented (in thousands):

External WAYLIVRA expenses
Other external research and development projects expenses
Research and development personnel and overhead expenses
Sublicensing expenses
Total research and development expenses, excluding non-cash stock-based compensation
expense
Non-cash stock-based compensation expense
Total research and development expenses

  $

  $

26,505    $
21,789   
21,572   
48,394   

118,260   
8,630   
126,890    $

38,403 
11,567 
13,913 
— 

63,883 
4,576 
68,459

Years Ended December 31,

2017

2016

Research and development expenses were $118.3 million for 2017 and increased compared to $63.9 million for 2016. The increase in expenses was
primarily due to sublicensing expenses related to our collaboration with Novartis, which we incurred in the first quarter of 2017, the majority of which were
non-cash. The progression of our other drugs in development, including AKCEA-APO(a)-LRx, AKCEA-APOCIII-LRx and AKCEA-ANGPTL3-LRx, during
2017 also contributed to the increase in our expenses. In particular we commenced four Phase 2 trials in 2017. This increase in research and development
expenses was offset in part by a decrease in external WAYLIVRA expenses primarily related to the completion of the phase 3 program. All amounts exclude
non-cash compensation expense related to equity awards.

Selling, general and administrative expense

The following table sets forth our selling, general and administrative expenses for the periods presented (in thousands):

Selling, general and administrative expenses
Non-cash compensation expense related to equity awards
Total Selling, general and administrative expenses

Years Ended December 31,

2017

2016

  $

  $

28,072    $
8,909   
36,981    $

9,480 
5,573 
15,053

Selling,  general  and  administrative  expenses  were  $28.1  million  for  2017  and  increased  compared  to  $9.5  million  for  2016.  Our  general  and
administrative expenses increased due to the ongoing buildout of our commercial organization and advancement of pre-commercialization activities necessary
to launch WAYLIVRA, if approved for marketing in the US, Canada and certain EU countries. All amounts exclude non-cash compensation expense related
to equity awards.

75

 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
Other income and other expense

Investment income. Investment income for 2017 totaled $1.8 million compared to $0.3 million for 2016. The increase in investment income was
primarily  due  to  a  higher  average  short-term  investment  balance  and  an  increase  in  the  interest  rates  on  high  quality  debt  and  U.S.  government  agencies
investments during 2017 compared to 2016.

Interest expense. Interest expense is comprised entirely of interest incurred under our line of credit agreement with Ionis. Interest expense for 2017
totaled  $1.7  million.  We  incurred  no  interest  expense  for  2016.  The  outstanding  principal  and  accrued  interest  under  our  line  of  credit  converted  into
13,438,339 shares of our common stock in connection with the closing of our IPO in July 2017 and we no longer have access to this line of credit following
the closing of our IPO.

Net Loss and Net Loss Per Share

Net loss for 2017 (as revised) was $121.6 million compared to $83.2 million for 2016. Basic and diluted net loss per preferred share for the year
ended December 31, 2017 (as revised) was $1.80 compared to $2.88 for 2016. Basic and diluted net loss per common share owned by Ionis and owned by
others for the year ended December 31, 2017 (as revised) was $3.08. We had no outstanding common stock at December 31, 2016. We incurred a higher net
loss  in  2017  compared  to  2016  primarily  due  to  the  increase  in  expenses  related  to  pre-commercialization  and  development  activities  for  our  drugs,
sublicensing  expenses  related  to  our  collaboration  with  Novartis,  the  ongoing  global  expansion  of  our  company  and  becoming  and  operating  as  a  public
company.

Liquidity and Capital Resources

At December 31, 2018, we had cash, cash equivalents and investments of $252.6 million and accumulated deficit of $522.0 million.

We  have  funded  our  operating  activities  through  a  $100.0  million  cash  contribution  that  we  received  from  Ionis  in  2015,  $75.0  million  from
initiating our collaboration with Novartis that we received in the first quarter of 2017 and $106.0 million in drawdowns under our line of credit with Ionis that
we received in the first and second quarters of 2017. Our borrowings under our line of credit agreement with Ionis converted into shares of our common stock
at the IPO price in connection with the closing of our IPO in July 2017. We no longer have access to the line of credit. Additionally, in July 2017 we received
$182.3  million  in  net  proceeds  from  our  IPO,  including  $25.0  million  Ionis  invested  in  our  IPO  and  the  Novartis  concurrent  private  placement  of  $50.0
million.

In  April  2018,  the  stockholders  other  than  Ionis  and  its  affiliates  approved  the  development,  commercialization,  collaboration  and  license
agreement,  or  TTR  License  Agreement,  pursuant  to  which  we  acquired  an  exclusive  license  from  Ionis  to  TEGSEDI  and  AKCEA-TTR-LRx  and  a  stock
purchase  agreement,  or  Ionis  SPA,  with  Ionis,  our  majority  shareholder,  which  we  entered  into  on  March  14,  2018.  To  support  our  commercialization  of
TEGSEDI and AKCEA-TTR-LRx, Ionis purchased 10.7 million shares of our common stock for $200.0 million.

At December 31, 2018, we had working capital of $186.5 million compared to working capital of $178.4 million at December 31, 2017. Working
capital increased in 2018 primarily due to the increase in our cash, cash equivalents and investments as a result of our financing activities. This increase is
offset  by  activities  related  to  our  normal  course  of  business.  As  of  December  31,  2018,  our  outstanding  payable  to  Ionis  was  $18.9  million  under  our
Amended Services Agreement with Ionis

TEGSEDI is approved in the U.S., E.U. and Canada and we are now beginning our commercialization efforts in these three regions. We began to
generate  product  revenue  from  TEGSEDI  drug  sales  in  the  fourth  quarter  of  2018.  We  anticipate  that  we  will  continue  to  incur  losses  for  the  foreseeable
future, and losses may continue to increase as we develop, seek regulatory approval for, and begin to commercialize our other pipeline drugs. We are subject
to all of the risks incident in developing and commercializing new drugs and we may encounter unforeseen expenses, difficulties, complications, delays and
other unknown factors that may adversely affect our business.

On February 22, 2019, Novartis exercised its option to license AKCEA-APO(a)-LRx as part of our strategic collaboration with Novartis discussed
in Note 6, Strategic Collaboration with Novartis.  As  a  result  we  earned  a  license  fee  of  $150.0  million  of  which  we  will  pay  $75.0  million  to  Ionis  as  a
sublicense fee. We will issue 2,837,373 shares of our common stock to Ionis as payment of the $75.0 million sublicense fee.

76

 
Future Funding Requirements

We  expect  to  raise  additional  funding  in  the  future  to  continue  developing  the  drugs  in  our  pipeline  and  to  expand  our  commercial  efforts  for
TEGSEDI,  which  has  been  approved  in  the  U.S.,  E.U.  and  Canada,  and  WAYLIVRA,  for  which  we  are  in  on  going  regulatory  discussion  in  those  same
jurisdictions. We expect that our cash, cash equivalents and investments of $252.6 million as of December 31, 2018, together with the receipt of the $150.0
million license fee payment expected in March 2019 as a result of Novartis opt in for the ACKEA-APO(a)-LRx, and cash expected to be generated from sales
of  TEGSEDI,  which  has  been  approved  in  the  U.S.,  the  EU  and  Canada,  will  be  sufficient  to  fund  our  operating  expenses  and  capital  expenditure
requirements  for  at  least  the  next  12  months  from  issuance  of  these  financial  statements.  Until  such  time,  if  ever,  as  we  can  generate  substantial  product
revenue, we may finance our cash needs through additional financing in the future through the issuance of our common stock, through other equity or debt
financings or through collaborations or partnerships with other companies. In any event, we may not generate significant revenue from product sales prior to
the  use  of  our  existing  cash,  cash  equivalents  and  investments.  We  do  not  have  any  committed  external  source  of  funds.  Additional  capital  may  not  be
available on reasonable terms, if at all. To the extent that we raise additional capital through the sale of stock or convertible debt securities, the ownership
interest of our stockholders will be diluted and the terms of these securities may include liquidation or other preferences that adversely affect the rights of our
common  stockholders.  Debt  financing,  if  available,  may  involve  agreements  that  include  increased  fixed  payment  obligations  and  covenants  limiting  or
restricting  our  ability  to  take  specific  actions,  such  as  incurring  additional  debt,  making  capital  expenditures,  declaring  dividends,  selling  or  licensing
intellectual property rights and other operating restrictions that could adversely affect our ability to conduct our business. If we raise additional funds through
collaborations or licensing arrangements with third parties, we may have to relinquish valuable rights to our drugs or grant licenses on terms that may not be
favorable to us. If we cannot raise additional funds through stock offerings or debt financings when needed, we may be required to delay, limit, reduce or
terminate our product development or future commercialization efforts or grant rights to develop and commercialize our drugs even if we would otherwise
prefer to develop and commercialize the drugs ourselves.

Our forecast of the period of time through which our financial resources will be adequate to support our operations involves risks and uncertainties,
and actual results could vary as a result of a number of factors. We have based this estimate on assumptions that may prove to be wrong and we could use our
available capital resources sooner than we currently expect. The amount and timing of future funding requirements, both near- and long-term, will depend on
many factors, including, but not limited to:

•
•

•
•
•
•
•
•
•

the design, initiation, progress, size, timing, costs and results of our clinical and nonclinical studies;
the outcome, timing and cost of regulatory approvals by the FDA and comparable foreign regulatory authorities, including the potential for the
FDA  or  comparable  foreign  regulatory  authorities  to  require  that  we  perform  more  studies  than,  or  evaluate  clinical  endpoints  other  than,
those that we currently expect;
the number and characteristics of drugs that we may pursue;
our need to expand our development activities, including our need and ability to hire additional employees;
the effect of competing technological and market developments;
the cost of establishing sales, marketing, manufacturing and distribution capabilities for our drugs;
our strategic collaborators' success in developing and commercializing our drugs;
our need to add infrastructure, implement internal systems and hire additional employees to operate as a public company; and
the revenue, if any, generated from commercial sales of our drugs for which we receive marketing authorization, which may be affected by
market  conditions,  including  obtaining  coverage  and  adequate  reimbursement  of  our  drugs  from  third-party  payors,  including  government
programs and managed care organizations, and competition within the therapeutic class to which our drugs are assigned.

If we cannot expand our operations or otherwise capitalize on our business opportunities because we lack sufficient capital, our business, financial

condition and results of operations could be materially adversely affected.

Contractual Obligations and Commitments

Year Ending December 31,
Operating lease obligations
Purchase commitments
Total

Total

Less than 1 year

Payments due by period
1 to 3 years

3 to 5 years

  $

  $

23,688 
5,033 
28,721 

 $

 $

2,308 
5,033 
7,341 

 $

 $

4,711 
— 
4,711 

 $

 $

4,805 
— 
4,805 

77

  More than 5 years
 $

11,864 
— 
11,864

 $

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
  
  
  
 
Operating Lease

On April 5, 2018, we entered into an operating lease agreement with MEPT Seaport 13 Stillings LLC, or MEPT, for 30,175 square feet of office
space located in Boston, Massachusetts for our new corporate headquarters. The commencement date of the lease was August 2018 and the initial term of the
lease  is  123  months  with  one  five-year  renewal  option.  We  took  occupancy  of  the  office  space  in  Boston,  Massachusetts  in  September  2018.  MEPT  is
providing  us  with  a  three-month  free  rent  period,  which  commenced  on  August  15,  2018,  and  a  tenant  improvement  allowance  up  to  $3.8  million.  We
provided MEPT with a letter of credit to secure our obligations under the lease in the initial amount of $2.4 million, to be reduced to $1.8 million on the third
anniversary of the rent commencement date and to $1.2 million on the fifth anniversary of the rent commencement date if we meet certain conditions set forth
in the lease at each such time. This balance is included in deposits and other assets on the accompanying consolidated balance sheets.

On  November  12,  2018,  we  entered  into  an  operating  lease  agreement  with  Ionis  Pharmaceuticals  to  sublease  4,723  square  feet  of  office  space

located in Carlsbad, California.  The commencement date was March 2018 and the term of the lease is 64 months with a four-month free rent period.

Rent expense for the year ended December 31, 2018, 2017 and 2016 was $2.4 million, $0.7 million and $0.4 million, respectively.  We recognize
rent  expense  on  a  straight-line  basis  over  the  lease  term  for  the  lease  of  our  office  spaces,  which  resulted  in  a  deferred  rent  balance  of  $4.8  million  and
$39,000 at December 31, 2018 and 2017, respectively.

Purchase Commitments

Purchase  commitments  include  agreements  to  purchase  goods  or  services  that  are  enforceable  and  legally  binding  on  us  and  that  specify  all
significant terms, including, fixed or minimum quantities to be purchased; fixed, minimum or variable price provisions; and the approximate timing of the
transaction.  Such obligations are related principally to inventory purchase orders based on our current manufacturing needs and require significant lead times
to be fulfilled by our vendors.  Purchase commitments exclude agreements that are cancelable without penalty

License Fee Payment

On February 22, 2019, Novartis exercised its option to license AKCEA-APO(a)-LRx as part of our strategic collaboration with Novartis discussed
in Note 6, Strategic Collaboration with Novartis to our consolidated financial statements included in this Form 10-K. As a result we earned a license fee of
$150.0 million of which we will pay $75.0 million to Ionis as a sublicense fee. We will issue 2,837,373 shares of our common stock to Ionis as payment of
the $75.0 million sublicense fee.

Recently Issued Accounting Pronouncements

We  describe  the  recently  issued  accounting  pronouncements  that  apply  to  us  in  Note  2,  Summary  of  Significant  Accounting  Policies,  to  our

consolidated financial statements.

Off-balance Sheet Arrangements

We did not have any off-balance sheet arrangements during the period presented, as defined in the rules and regulations of the SEC.

Item 7A. Quantitative and Qualitative Disclosures About Market Risk

Interest Rate Risk

We are exposed to changes in interest rates primarily from our investments in certain short-term investments. We place our cash equivalents and
short-term  investments  with  reputable  financial  institutions.  We  primarily  invest  our  excess  cash  in  commercial  paper  and  debt  instruments  of  the  U.S.
Treasury, financial institutions, corporations, and U.S. government agencies with strong credit ratings and an investment grade rating at or above A-1, P-1 or
F-1  by  Moody's,  Standard  &  Poor's,  or  Fitch,  respectively.  We  have  established  guidelines  relative  to  diversification  and  maturities  that  are  designed  to
maintain safety and liquidity. We periodically review and modify these guidelines to maximize trends in yields and interest rates without compromising safety
and liquidity. We typically hold our investments for the duration of the term of the respective instrument. We do not utilize derivative financial instruments,
derivative  commodity  instruments  or  other  market  risk  sensitive  instruments,  positions  or  transactions  to  manage  exposure  to  interest  rate  changes.
Accordingly, we believe that, while the securities we hold are subject to changes in the financial standing of the issuer of such securities, we are not subject to
any material risks arising from changes in interest rates, foreign currency exchange rates, commodity prices, equity prices or other market changes that affect
market risk sensitive instruments.

78

 
 
 
 
Foreign Exchange Risk

Our results of operations are subject to foreign currency exchange rate fluctuations as we have foreign subsidiaries, Akcea Therapeutics UK Ltd.,
or Akcea UK, Akcea Therapeutics Canada, Inc., or Akcea Canada, Akcea Therapeutics France SAS, , or Akcea France, Akcea Therapeutics Germany GmbH,
or Akcea Germany, and Akcea Therapeutics Ireland Limited, or Akcea Ireland with functional currencies other than the U.S. dollar. We created these foreign
subsidiaries to support our initial pre-commercialization activities in North America and Europe and to serve as potential entities for future North American
and  European  operations.  We  translate  the  foreign  subsidiaries'  functional  currencies  to  our  reporting  currency,  the  U.S.  dollar.  As  a  result,  our  financial
position, results of operations and cash flows can be affected by market fluctuations in the foreign currencies to U.S. dollar exchange rate which are difficult
to  predict.  However,  because  the  Akcea  foreign  subsidiaries  currently  have  limited  operations,  the  effect  of  fluctuations  of  the  foreign  currencies  to  U.S.
dollar  exchange  rate  on  our  consolidated  results  is  immaterial  to  our  consolidated  financial  statements.    Our  business  strategy  incorporates  potentially
significant international expansion, particularly in anticipation of approval of WAYLIVRA, therefore we expect that the impact of foreign currency exchange
rate fluctuations may become more substantial in the future.

Item 8. Financial Statements and Supplementary Data

We filed our consolidated financial statements and supplementary data required by this item as exhibits hereto, and listed them under Item 15(a)

(1) and (2), and incorporate them herein by reference.

Item 9. Changes in and Disagreements with Accountants on Accounting and Financial Disclosure

None

Item 9A. Controls and Procedures

Disclosure Controls and Procedures

We  maintain  disclosure  controls  and  procedures  (as  defined  in  Rules  13a-15(e)  and  15d-15(e)  under  the  Securities  Exchange  Act  of  1934,  as
amended,  or  Exchange  Act)  that  are  designed  to  ensure  that  information  we  are  required  to  disclose  in  our  Exchange  Act  reports  is  recorded,  processed,
summarized and reported within the time periods specified in the SEC’s rules and forms, and that such information is accumulated and communicated to our
management, including our Chief Executive Officer and Chief Financial Officer, as appropriate, to allow timely decisions regarding required disclosure. We
designed and evaluate our disclosure controls and procedures recognizing that any controls and procedures, no matter how well designed and operated, can
provide only reasonable assurance and not absolute assurance of achieving the desired control objectives.

As of the end of the period covered by this report on Form 10-K, we carried out an evaluation of our disclosure controls and procedures under the
supervision of, and with the participation of our management, including our Chief Executive Officer and Chief Financial Officer. Based on our evaluation, our
Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls and procedures were effective as of December 31, 2018.

Management’s Report on Internal Control Over Financial Reporting

Our  management  is  responsible  for  establishing  and  maintaining  adequate  internal  control  over  financial  reporting  for  our  company.  Internal
control  over  financial  reporting  is  defined  in  Rule  13a-15(f)  or  15d-15(f)  promulgated  under  the  Exchange  Act  as  a  process  designed  by,  or  under  the
supervision of, the company's principal executive and principal financial officer and effected by the company's board of preparation of financial statements
for external purposes in accordance with GAAP and directors, management and other personnel, to provide reasonable assurance regarding the reliability of
financial reporting and the includes those policies and procedures that: (i) pertain to the maintenance of records that, in reasonable detail, accurately and fairly
reflect the transactions and dispositions of the assets of the company; (ii) provide reasonable assurance that transactions are recorded as necessary to permit
preparation of financial statements in accordance with generally accepted accounting principles, and that receipts and expenditures of our company are being
made only in accordance with authorizations of management and directors of the company; and (iii) provide reasonable assurance regarding prevention or
timely detection of unauthorized acquisition, use, or disposition of our company's assets that could have a material effect on the financial statements.

79

 
 
 
 
 
Internal  control  over  financial  reporting  is  designed  to  provide  reasonable  assurance  regarding  the  reliability  of  financial  reporting  and  the
preparation  of  financial  statements  prepared  for  external  purposes  in  accordance  with  generally  accepted  accounting  principles.  Because  of  its  inherent
limitations, internal control over financial reporting may not prevent or detect misstatements. Also, projections of any evaluation of effectiveness to future
periods are subject to the risk that controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies or
procedures may deteriorate.

Our management, with the participation of our principal executive and principal financial officer, assessed the effectiveness of our internal control
over financial reporting as of December 31, 2018, based on criteria for effective internal control over financial reporting established in Internal Control—
Integrated  Framework  (2013),  issued  by  the  Committee  of  Sponsoring  Organizations  of  the  Treadway  Commission,  or  COSO.  Based  on  its  assessment,
management concluded that our internal control over financial reporting was effective as of December 31, 2018, based on those criteria.

This Annual Report on Form 10-K does not include an attestation report of our independent registered public accounting firm due to the deferral

allowed under the JOBS Act for emerging growth companies

Changes in Internal Control Over Financial Reporting

The above assessment did not identify any change in our internal control over financial reporting that occurred during our latest fiscal quarter and

that has materially affected, or is reasonably likely to materially affect, our internal control over financial reporting.

Item 9B. Other Information

None.

80

 
Item 10. Directors, Executive Officers and Corporate Governance

PART III

We incorporate by reference the information required by this Item with respect to directors and the Audit Committee from the information under
the  caption  "ELECTION  OF  DIRECTORS,"  including  in  particular  the  information  under  "Nominating,  Governance  and  Review  Committee"  and  "Audit
Committee," contained in our definitive information statement (the "Information Statement"), to be filed with the SEC within 120 days after the end of the
fiscal year ended December 31, 2018.

We incorporate by reference the required information concerning our Code of Ethics from the information under the caption "Code of Ethics and
Business Conduct" contained in the Information Statement. Our Code of Ethics and Business Conduct is posted on our website at www.akceatx.com(1) and is
available  in  print  free  of  charge  to  any  stockholder  upon  request.  We  intend  to  disclose  future  amendments  to,  or  waivers  from,  our  Code  of  Ethics  and
Business Conduct on our website. No such waivers have been issued during fiscal 2017.

Item 1, Part I of this Report contains information concerning our executive officers. We incorporate by reference the information required by this
Item concerning compliance with Section 16(a) of the Exchange Act from the information under the caption "Section 16(a) Beneficial Ownership Reporting
Compliance" contained in the Information Statement to be filed within 120 days after the end of the fiscal year ended December 31, 2018.

(1)

Any information that is included on or linked to our website is not part of this Form 10-K.

Item 11. Executive Compensation

We  incorporate  by  reference  the  information  required  by  this  item  to  the  information  under  the  caption  "EXECUTIVE  COMPENSATION,"
"Compensation Committee Interlocks and Insider Participation" and "COMPENSATION COMMITTEE REPORT" contained in the Information Statement to
be filed with the SEC within 120 days after the end of the fiscal year ended December 31, 2018.

Item 12. Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters

We incorporate by reference the information required by this item to the information under the caption "SECURITY OWNERSHIP OF CERTAIN
BENEFICIAL OWNERS AND MANAGEMENT" contained in the Information Statement to be filed with the SEC within 120 days after the end of the fiscal
year ended December 31, 2018.

Securities Authorized for Issuance under Equity Compensation Plans

The following table sets forth information regarding outstanding options and shares reserved for future issuance under our equity compensation

plans as of December 31, 2018.

Plan Category
Equity compensation plans
   approved by stockholders (a)

Total

Number of Shares
to be Issued
Upon Exercise of

Weighted Average
Exercise Price of

Outstanding Options    

Outstanding Options    

Number of Shares
Remaining
Available for
Future Issuance

11,010,828    $

15.00     

2,578,939  (b)

11,010,828    $

15.00     

2,578,939 

(a)
(b)

Consists of two Akcea plans: 2015 Equity Incentive Plan and 2017 Employee Stock Purchase Plan, or ESPP.
Of these shares, 968,449 remained available for purchase under the ESPP as of December 31, 2018. The ESPP incorporates an evergreen formula
pursuant to which on January 1 of each year, we automatically increase the aggregate number of shares reserved for issuance under the plan by an
amount equal to the lesser of (i) 1% of the total number of shares of Common Stock outstanding on December 31st of the preceding calendar year,
and (ii) 500,000 shares of Common Stock shares.

81

 
 
 
 
 
 
   
 
   
      
      
  
 
   
 
 
Item 13. Certain Relationships and Related Transactions, and Director Independence

We incorporate by reference the information required by this item to the information under the captions "Independence of the Board of Directors"
and "Certain Relationships and Related Transactions" contained in the Information Statement to be filed with the SEC within 120 days after the end of the
fiscal year ended December 31, 2018.

Item 14. Principal Accounting Fees and Services

We incorporate by reference the information required by this item to the information under the caption "Ratification of Selection of Independent

Auditors" contained in the Information Statement to be filed with the SEC within 120 days after the end of the fiscal year ended December 31, 2018.

82

 
 
Item 15. Exhibits, Financial Statement Schedules

(a)(1) Index to Financial Statements

Part IV

We submitted the consolidated financial statements required by this item in a separate section beginning on page F-1 of this Report.

(a)(2) Index to Financial Statement Schedules

We omitted these schedules because they are not required, or are not applicable, or the required information is shown in the consolidated financial

statements or notes thereto.

(a)(3) Index to Exhibits

Item 16. Form 10-K Summary

Not Applicable.

83

 
 
Exhibit

Description

  Schedule / Form  

File Number

  Exhibit

File Date

Index to EXHIBITS

Incorporated by Reference

  Amended and Restated Certificate of Incorporation of the

Registrant

  First Amendment to Amended and Restated Certificate of

incorporation of the Registrant

8-K

8-K

001-38137

3.1

July 19, 2017

001-38137

3.1

  April 17, 2018

  Second Amendment to Amended and Restated Certificate of

10-Q

001-38137

3.1

  May 7, 2018

3.1

3.2

3.3

3.4

4.1

4.2

4.3

Incorporation of the Registrant

  Amended and Restated Bylaws of the Registrant

  Reference is made to Exhibits 3.1, 3.2, 3.3 and 3.4

  Form of Common Stock Certificate of the Registrant

  Amended and Restated Investor Rights Agreement by and

among the Registrant and Ionis Pharmaceuticals, Inc., dated
March 14, 2018

4.4

  Form of Indenture, between the Registrant and one or more

trustees to be named

10.1#

  Collaboration and License Agreement by and among the

Registrant and PTC Therapeutics International Limited, dated
August 1, 2018

8-K

S-1

8-K

S-3

10-Q

001-38137

333-216949

001-38137

3.2

4.1

4.1

July 19, 2017

June 20, 2017

  March 15, 2018

333-227403

4.4

September 18,
2018

001-38137

10.1

  November 6, 2018

10.2

  Operating  Lease Agreement by and among Registrant and

10-Q

001-38137

10.1

  August 7, 2018

MEPT Seaport 13 Stillings LLC, dated April 5, 2018

10.3*

  Operating  Sublease  Agreement  by  and  among  Registrant  and

Ionis Pharmaceuticals, Inc., dated November 12, 2018

10.4†

10.5†

10.6†

10.7#

  Form of Indemnity Agreement

  2015 Equity Incentive Plan, as amended, and Form of Award

Agreement

  2017 Employee Stock Purchase Plan

  Development, Commercialization and License Agreement by
and among Registrant and Ionis Pharmaceuticals, Inc., dated
December 18, 2015

10.8#

  Services Agreement by and among Registrant and Ionis

Pharmaceuticals, Inc., dated December 18, 2015

10.9

  Senior Unsecured Line of Credit by and among Registrant and

Ionis Pharmaceuticals, Inc., dated January 18, 2017

10.10#

  Strategic Collaboration, Option and License Agreement by and
among Registrant and Novartis Pharma AG, dated January 5,
2017

10.11

  Stock Purchase Agreement by and among Registrant, Ionis

Pharmaceuticals, Inc. and Novartis Pharma AG, dated January 5,
2017

    10.12*†

  Non-Employee Director Compensation Plan

84

S-1

8-K

S-1

S-1

S-1

S-1

S-1

S-1

333-216949

001-38137

333-216949

333-216949

10.1

10.1

10.3

10.4

  April 10, 2017

  November 23,

2018

June 20, 2017

  March 27, 2017

333-216949

10.5

  March 27, 2017

333-216949

10.6

  March 27, 2017

333-216949

10.7

  March 27, 2017

333-216949

10.8

  March 27, 2017

 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Description

  Schedule / Form  

File Number

  Exhibit

File Date

Incorporated by Reference

S-1

S-1

S-1

S-1

333-216949

10.12

  March 27, 2017

333-216949

10.13

  March 27, 2017

333-216949

10.14

  March 27, 2017

333-216949

10.15

  March 27, 2017

Exhibit

  10.13†

  10.14†

  Offer Letter Agreement between Registrant and Paula

Soteropoulos, dated November 17, 2014

  Offer Letter Agreement between Registrant and Jeffrey M.

Goldberg, dated January 5, 2015

  10.15†

  Offer Letter Agreement between Registrant and Louis St. L.

O’Dea, dated January 18, 2016

  10.16#

  Letter Agreement regarding Development, Commercialization

 21.1*

 23.1*

24.1*

 31.1*

and License Agreement between Registrant and Ionis
Pharmaceuticals, Inc., dated January 18, 2017

  Subsidiaries of the Registrant

  Consent of Independent Registered Public Accounting Firm

  Power of Attorney (included in the signature page to this

Report)

  Certification of Principal Executive Officer Pursuant to Rules
13a-14(a) and 15d-14(a) under the Securities Exchange Act of
1934, as Adopted Pursuant to Section 302 of the Sarbanes-
Oxley Act of 2002

 31.2*

  Certification of Principal Financial Officer Pursuant to Rules

  32.1**

13a-14(a) and 15d-14(a) under the Securities Exchange Act of
1934, as Adopted Pursuant to Section 302 of the Sarbanes-
Oxley Act of 2002

  Certification of Principal Executive Officer and Principal
Financial Officer Pursuant to 18 U.S.C. Section 1350, as
Adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of
2002

101

  The following financial statements from the Akcea

Therapeutics, Inc. Annual Report on Form 10-K for the year
ended December 31, 2018, formatted in Extensive Business
Reporting Language (XBRL): (i) consolidated balance sheets,
(ii) consolidated statements of operations, (iii) consolidated
statements of comprehensive loss, (iv) consolidated statements
of stockholders' equity, (v) consolidated statements of cash
flows and (vi) notes to consolidated financial statements (detail
tagged).

*
**
†
#

Filed herewith.
Furnished herewith.
Indicates management contract or compensatory plan.
Confidential  treatment  has  been  requested  with  respect  to  certain  portions  of  this  exhibit.  Omitted  portion  have  been  filed  separately  with  the
Securities and Exchange Commission

85

 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, the Registrant has duly caused this report to be signed

on its behalf by the undersigned, thereunto duly authorized on the 1st day of March, 2019.

SIGNATURES

AKCEA THERAPEUTICS, INC.

By: /s/ PAULA SOTEROPOULOS

Paula Soteropoulos
Chief Executive Officer and Director
(Principal executive officer)

86

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
POWER OF ATTORNEY

KNOW  ALL  MEN  BY  THESE  PRESENTS,  that  each  person  whose  signature  appears  below  constitutes  and  appoints  Paula  Soteropoulos  and
Michael  MacLean,  or  any  of  them,  his  or  her  attorney-in-fact,  each  with  the  power  of  substitution,  for  him  or  her  in  any  and  all  capacities,  to  sign  any
amendments  to  this  Report,  and  to  file  the  same,  with  exhibits  thereto  and  other  documents  in  connection  therewith,  with  the  Securities  and  Exchange
Commission, hereby ratifying and confirming all that each of said attorneys-in-fact, or his or her substitute or substitutes, may do or cause to be done by
virtue hereof.

Pursuant to the requirements of the Securities Exchange Act of 1934, this report has been signed below by the following persons on behalf of the

Registrant and in the capacities and on the dates indicated.

Signatures

Title

/s/ PAULA SOTEROPOULOS
Paula Soteropoulos

  Chief Executive Officer and Director

(Principal executive officer)

/s/ MICHAEL MACLEAN
Michael MacLean

  Chief Financial Officer

(Principal financial and accounting officer)

/s/ SARAH BOYCE
Sarah Boyce

  President and Director

/s/ CHRISTOPHER GABRIELI
Christopher Gabrieli

  Chairman of the Board

/s/ EDWARD M. FITZGERALD
Edward M. Fitzgerald

  Director

/s/ ELAINE HOCHBERG
Elaine Hochberg

  Director

/s/ B. LYNNE PARSHALL
B. Lynne Parshall, J.D.

  Director

/s/ SANDFORD D. SMITH
Sandford D. Smith

  Director

/s/ RICHARD A. MOSCICKI
Richard A. Moscicki

  Director

/s/ DAMIEN MCDEVITT
Damien McDevitt

  Director

87

Date

March 1, 2019

March 1, 2019

March 1, 2019

March 1, 2019

March 1, 2019

March 1, 2019

March 1, 2019

March 1, 2019

March 1, 2019

March 1, 2019

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INDEX TO CONSOLIDATED FINANCIAL STATEMENTS

Report of Independent Registered Public Accounting Firm

Consolidated Balance Sheets

Consolidated Statements of Operations

Consolidated Statements of Comprehensive Loss

Consolidated Statements of Convertible Preferred Stock and Stockholders’ Equity (Deficit)

Consolidated Statements of Cash Flows

Notes to Consolidated Financial Statements

F-2

F-3

F-4

F-5

F-6

F-7

F-9

F-1

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The Board of Directors and Stockholders of Akcea Therapeutics, Inc.

REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM

Opinion on the Financial Statements
We  have  audited  the  accompanying  consolidated  balance  sheets  of  Akcea  Therapeutics,  Inc.  (the  Company)  as  of  December  31,  2018  and  2017,  and  the
related consolidated statements of operations, comprehensive loss, convertible preferred stock and stockholders’ equity (deficit) and cash flows for each of
the  three  years  in  the  period  ended  December  31,  2018,  and  the  related  notes  (collectively  referred  to  as  the  “consolidated  financial  statements”).  In  our
opinion, the consolidated financial statements present fairly, in all material respects, the financial position of the Company at December 31, 2018 and 2017,
and  the  results  of  its  operations  and  its  cash  flows  for  each  of  the  three  years  in  the  period  ended  December  31,  2018,  in  conformity  with  U.S.  generally
accepted accounting principles.

Adoption of ASU No. 2014-09
As discussed in Note 1 to the consolidated financial statements, the Company changed its method of accounting for revenue in 2017 and 2018 due to the
adoption of ASU No. 2014-09, Revenue from Contracts with Customers (Topic 606).

Basis for Opinion
These  financial  statements  are  the  responsibility  of  the  Company's  management.  Our  responsibility  is  to  express  an  opinion  on  the  Company’s  financial
statements based on our audits. We are a public accounting firm registered with the Public Company Accounting Oversight Board (United States) (PCAOB)
and are required to be independent with respect to the Company in accordance with the U.S. federal securities laws and the applicable rules and regulations of
the Securities and Exchange Commission and the PCAOB.

We conducted our audits in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audit to obtain reasonable
assurance about whether the financial statements are free of material misstatement, whether due to error or fraud. The Company is not required to have, nor
were  we  engaged  to  perform,  an  audit  of  its  internal  control  over  financial  reporting.  As  part  of  our  audits  we  are  required  to  obtain  an  understanding  of
internal control over financial reporting but not for the purpose of expressing an opinion on the effectiveness of the Company's internal control over financial
reporting. Accordingly, we express no such opinion.  

Our  audits  included  performing  procedures  to  assess  the  risks  of  material  misstatement  of  the  financial  statements,  whether  due  to  error  or  fraud,  and
performing procedures that respond to those risks. Such procedures included examining, on a test basis, evidence regarding the amounts and disclosures in the
financial statements. Our audits also included evaluating the accounting principles used and significant estimates made by management, as well as evaluating
the overall presentation of the financial statements. We believe that our audits provide a reasonable basis for our opinion.

/s/ Ernst & Young LLP

We have served as the Company’s auditor since 2016.

Boston, Massachusetts
March 1, 2019

F-2

 
 
 
 
 
 
 
 
 
 
 
AKCEA THERAPEUTICS, INC.
CONSOLIDATED BALANCE SHEETS
(In thousands, except share and per share data)

ASSETS

December 31,

2018

2017
(as revised)

Current assets:

Cash and cash equivalents
Short-term investments
Accounts receivable
Other current assets

Total current assets
Property, plant and equipment, net
Licenses, net
Deposits and other assets

Total assets

LIABILITIES AND STOCKHOLDERS’ EQUITY

Current liabilities:

Accounts payable
Payable to Ionis Pharmaceuticals, Inc.
Accrued compensation
Accrued liabilities
Current portion of deferred revenue
Other current liabilities

Total current liabilities
Long-term portion of deferred rent
Long-term portion of deferred revenue

Total liabilities

  $

  $

  $

Stockholders’ equity:
Common stock, $0.001 par value; 125,000,000 and 100,000,000 shares
   authorized, 89,345,978 and 66,541,629 shares issued and
   outstanding at December 31, 2018 and 2017, respectively.

Additional paid-in capital
Accumulated other comprehensive loss
Accumulated deficit

Total stockholders’ equity

Total liabilities and stockholders’ equity

  $

See accompanying notes.

F-3

86,454    $

166,155   
4,597   
10,029   
267,235   
5,696   
88,914   
3,416   
365,261    $

12,068    $
18,901   
8,583   
14,787   
25,354   
968   
80,661   
4,442   
3,434   
88,537   

89   
799,001   
(324)  
(522,042)  
276,724   
365,261    $

58,367 
201,763 
5,413 
1,302 
266,845 
77 
1,221 
661 
268,804 

2,381 
14,365 
4,083 
7,570 
58,192 
1,875 
88,466 
12 
12,501 
100,979 

67 
464,430 
(451)
(296,221)
167,825 
268,804

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
  
 
 
    
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
  
 
 
    
 
  
 
 
    
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
AKCEA THERAPEUTICS, INC.
CONSOLIDATED STATEMENTS OF OPERATIONS
(In thousands, except for share and per share data)

Revenue:

Commercial revenue:
Product revenue
Licensing revenue

Total commercial revenue

Research and development revenue under collaborative
   agreement

Total revenue

Expenses:

Cost of sales - product
Cost of sales - intangible asset amortization
Cost of license
Research and development
Selling, general and administrative

Total expenses

Loss from operations

Other income (expense):
Investment income
Interest expense
Other income (expense)

  $

2018

Years Ended December 31,
2017
(as revised)

2016

2,237    $
12,000   
14,237   

50,630   
64,867   

1,820   
2,713   
7,200   
130,340   
153,610   
295,683   

—    $
—   
—   

43,401   
43,401   

—   
—   
—   
126,890   
36,981   
163,871   

— 
— 
— 

— 
— 

— 
— 
— 
68,459 
15,053 
83,512 

(230,816)  

(120,470)  

(83,512)

5,631   
—   
(189)  

1,813   
(1,731)  
104   

295 
— 
— 

Loss before income tax expense

(225,374)  

(120,284)  

(83,217)

Income tax expense

Net loss

Net loss per share of preferred stock, basic and diluted

Weighted-average shares of preferred stock outstanding, basic
   and diluted

Net loss per share of common stock owned by Ionis, basic and
   diluted

Weighted-average shares of common stock outstanding
   owned by Ionis, basic and diluted

Net loss per share of common stock owned by others, basic and
   diluted

Weighted-average shares of common stock outstanding
   owned by others, basic and diluted

  $

  $

(447)  

(1,275)  

— 

(225,821)   $

(121,559)   $

(83,217)

—    $

(1.80)   $

(2.88)

—   

15,748,009   

28,884,540 

  $

(2.74)   $

(3.08)   $

59,812,394   

20,669,446   

  $

(2.87)   $

(3.08)   $

21,553,407   

9,593,322   

— 

— 

— 

—

See accompanying notes.

F-4

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
    
 
  
 
 
    
 
    
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
    
 
  
 
 
    
 
    
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
    
 
  
 
 
 
 
 
 
 
    
 
    
 
  
 
 
    
 
    
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
    
 
  
 
 
 
 
 
 
 
    
 
    
 
  
 
 
 
 
 
 
 
    
 
    
 
  
 
 
 
    
 
    
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
AKCEA THERAPEUTICS, INC.
CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS
(In thousands)

Net loss

Unrealized gains (losses) on investments, net of tax
Currency translation adjustment

Comprehensive loss

2018

Years Ended December 31,
2017
(as revised)

2016

  $

  $

(225,821)   $
144   
(17)  

(225,694)   $

(121,559)   $
(337)  
(93)  

(121,989)   $

(83,217)
75 
(21)
(83,163)

See accompanying notes.

F-5

 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
AKCEA THERAPEUTICS, INC.
CONSOLIDATED STATEMENTS OF CONVERTIBLE PREFERRED STOCK AND STOCKHOLDERS' EQUITY (DEFICIT)
Years Ended December 31, 2018, 2017 and 2016
(In thousands)

Description
Balance at December 31, 2015

Net loss
Change in unrealized gains, net of tax
Currency translation adjustment
Stock-based compensation expense
Balance at December 31, 2016

Net loss
Change in unrealized gains (losses), net of tax
Currency translation adjustment
Conversion of convertible preferred stock to
   common stock
Initial public offering of common stock, net of
   commissions, underwriting discounts and
   offering costs
Issuance of common stock in connection with
   conversion of line of credit with Ionis
   Pharmaceuticals Inc. together with accrued
   interest
Issuance of common stock in connection with
   private placement
Stock-based compensation expense
Balance at December 31, 2017

Net loss
Change in unrealized gains (losses), net of tax
Currency translation adjustment
Exercise of common stock options
Issuance of common stock in connection with
   employee stock purchase plan
Issuance of restricted common stock
Stock compensation expense
Issuance of common stock to Ionis in connection
   with TTR License Agreement
Distribution to Ionis in connection with the TTR
license transaction
Issuance of common stock to Ionis in connection
   with TEGSEDI regulatory milestones
Capital contribution from Ionis
Balance at December 31, 2018

Convertible
Preferred Stock

Common Stock

  Additional  
Paid In  

Shares

  Amount

Shares

  Amount

  Capital

Accumulated
Other
  Comprehensive 
Loss

  Accumulated 
Deficit
(as revised)  

Total
Stockholders'  
  Equity (Deficit) 
(as revised)

28,885    $ 100,000     

—     
—     
—     
—     

—     
—     
—     
—     
28,885    $ 100,000     

—     
—     
—     

—     
—     
—     

—    $

—     
—     
—     
—     
—    $

—     
—     
—     

—    $

46,787    $

(75)   $

(91,445)   $

—     
—     
—     
—     
—    $

—     
—     
—     

—     
—     
—     
10,149     
56,936    $

—     
—     
—     

(83,217)    
—     
—     
75     
—     
(21)    
—     
—     
(21)   $ (174,662)   $

—     
(337)    
(93)    

(121,559)    
—     
—     

55,267 

(83,217)
75 
(21)
10,149 
(17,747)

(121,559)
(337)
(93)

(28,885)     (100,000)    

28,885     

29     

99,971     

—     

—     

— 

—     

—     

17,969     

18      132,273     

—     

—     

132,291 

—     

—     

13,438     

14      107,717     

—     

—     

107,731 

—     
—     
—    $

—     
—     
—     
—     

—     
—     
—     

—     
—     
—     

—     
—     
—     
—     

—     
—     
—     

6,250     
—     
66,542    $

49,994     
6     
17,539     
—     
67    $ 464,430    $

—     
—     
—     
831     

32     
5     
—     

—     
—     
—     
1     

—     
—     
—     

—     
—     
—     
6,621     

341     
—     
44,282     

—     
—     

—     
—     
(451)   $ (296,221)   $

—     
144     
(17)    
—     

(225,821)    
—     
—     
—     

—     
—     
—     

—     
—     
—     

50,000 
17,539 
167,825 

(225,821)
144 
(17)
6,622 

341 
— 
44,282 

—     

—     

18,667     

18      200,094     

—     

—     

200,112 

—     

—     

—     

—     

(7,792)    

—     

—     

(7,792)

—     
—     
—     

—     
—     
—     

3,269     
—     
89,346    $

89,997     
3     
—     
1,028     
89    $ 799,001    $

—     
—     

—     
—     
(324)   $ (522,042)   $

90,000 
1,028 
276,724

See accompanying notes.

F-6

 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
 
 
AKCEA THERAPEUTICS, INC.
CONSOLIDATED STATEMENTS OF CASH FLOWS
(In thousands)

Operating activities:

Net loss

Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation
Amortization of licenses
Amortization of discount/premium on investment securities, net
Non-cash interest expense for line of credit with Ionis Pharmaceuticals, Inc.
Non-cash sublicensing expense
Stock-based compensation expense
Changes in operating assets and liabilities:

Accounts receivable
Other current and long-term assets
Accounts payable
Payable to Ionis Pharmaceuticals, Inc.
Accrued compensation
Deferred rent
Accrued liabilities
Income taxes payable
Deferred revenue

Net cash used in operating activities

Investing activities:

Purchases of short-term investments
Proceeds from sale of short-term investments
Purchase of property, plant and equipment

Net cash provided by (used in) investing activities

Financing activities:

Proceeds from exercise of common stock options and employee stock purchase plan
   issuances
Proceeds from issuance of common stock, net of underwriters' discount
Proceeds from sale of common stock to Novartis in private placement
Proceeds from line of credit from Ionis Pharmaceuticals, Inc.
Net proceeds from issuance of common stock to Ionis in connection with TTR License
   Agreement
Offering costs paid

Net cash provided by (used in) financing activities

Effect of exchange rates on cash

Net increase (decrease) in cash and cash equivalents

Cash, cash equivalents and restricted cash at beginning of period
Cash, cash equivalents and restricted cash at end of period

Supplemental disclosures of non-cash investing and financing activities:

Unpaid deferred offering costs
Conversion of preferred stock to common stock upon initial public offering
Conversion of line of credit from Ionis Pharmaceuticals, Inc. into common stock
Purchase of property, plant and equipment included in accounts payable
Purchase of property, plant and equipment included in long-term deferred rent liability
Acquisition of research and development licenses and milestone payments
Capital contribution from Ionis

2018

Years Ended December 31,
2017
(as revised)

2016

  $

(225,821)

  $

(121,559)

  $

(83,217)

307 
2,870 
(23)
— 
— 
44,282 

816 
(8,765)
8,444 
4,527 
4,500 
1,203 
7,217 
(540)
(41,905)
(202,888)

(136,895)
208,559 
(1,119)
70,545 

6,963 
— 
— 
— 

155,868 
— 
162,831 
(17)

30,471 
58,367 
88,838 

— 
— 
— 
1,252 
3,555 
90,563 
1,028 

  $

  $
  $
  $
  $
  $
  $
 $

108 
120 
499 
1,731 
33,394 
17,539 

(5,413)
(1,761)
1,905 
(43,385)
1,578 
(15)
6,587 
1,789 
70,693 
(36,190)

(301,377)
98,778 
(9)
(202,608)

— 
135,438 
50,000 
106,000 

— 
(2,037)
289,401 
(93)

50,510 
7,857 
58,367 

— 
100,000 
107,731 
— 
— 
— 
— 

  $

  $
  $
  $
  $
  $
  $
 $

12 
119 
170 
— 
— 
10,149 

— 
64 
(54)
15,157 
1,582 
20 
637 
— 
— 
(55,361)

(16,638)
51,464 
(179)
34,647 

— 
— 
— 
— 

— 
(818)
(818)
— 

(21,532)
29,389 
7,857 

291 
— 
— 
— 
— 
— 
—  

  $

  $
  $
  $
  $
  $
  $
  $

See accompanying notes.

F-7

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
  
   
  
   
  
   
  
   
  
   
  
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
  
   
  
   
  
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
 
   
  
   
  
   
  
   
  
   
  
   
  
   
   
   
   
   
   
   
   
   
   
   
   
 
   
  
   
  
   
  
   
  
   
  
   
  
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
 
   
  
   
  
   
  
   
   
   
   
   
   
 
   
  
   
  
   
  
   
  
   
  
   
  
 
Cash and cash equivalents
Restricted cash included in deposits and other assets
Total cash, cash equivalents and restricted cash

2018

Years Ended December 31,
2017

2016

  $

  $

86,454 
2,384 
88,838 

  $

  $

58,367 
— 
58,367 

  $

  $

7,857 
— 
7,857

See accompanying notes.

F-8

 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
   
 
 
 
AKCEA THERAPEUTICS, INC.
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
December 31, 2018

1.

Organization and Basis of Presentation

We  were  incorporated  in  Delaware  in  December  2014.  We  were  organized  by  Ionis  Pharmaceuticals,  Inc.,  or  Ionis,  to  focus  on  developing  and
commercializing drugs to treat patients with rare and serious diseases. On July 19, 2017, we completed our initial public offering, or IPO. As of December 31,
2018, Ionis owned approximately 75% of our common stock and is our majority shareholder. Prior to our IPO, we were wholly owned by Ionis.

The accompanying consolidated financial statements have been prepared in conformity with accounting principles generally accepted in the United
States of America, or U.S. GAAP. Certain amounts in the prior period financial statements have been revised to conform to the presentation of the current
period financial statements. See Note 2, Summary of Significant Accounting Policies, for a discussion of these revisions to prior period financial statements
made in connection with our adoption of the new revenue recognition guidance retroactive to January 1, 2016.

The consolidated financial statements include the accounts of Akcea Therapeutics, Inc. ("we," "our," and "us") and our wholly owned subsidiaries.
All intercompany transactions and balances were eliminated in consolidation. We included all normal recurring adjustments in the financial statements, which
we considered necessary for a fair presentation of our financial position and our operating results and cash flows for the years ended December 31, 2018,
2017 and 2016.

In accordance with Accounting Standard Codification, or ASC, 205-40, Going Concern,  we  evaluated  whether  there  are  conditions  and  events,
considered in the aggregate, that raise substantial doubt about our ability to continue as a going concern within one year after the date that the consolidated
financial statements are issued. We have incurred losses since our inception and have funded our cash flow deficits primarily through the issuance of capital
stock and the proceeds from licensing and collaboration agreements. As of December 31, 2018, we had an accumulated deficit of $522.0 million. During the
year  ended  December  31,  2018,  we  incurred  a  loss  of  $225.8  million  and  used  $202.9  million  of  cash  in  operations.  We  expect  to  continue  to  generate
operating losses and negative operating cash flows for the foreseeable future. The transition to profitability is dependent upon the successful development,
approval, and commercialization of our products and product candidates and the achievement of a level of revenue adequate to support our cost structure.  We
believe that our currently available funds of $252.6 million as of December 31, 2018, together with the receipt of the $150.0 million license fee payment
expected in March 2019 as a result of Novartis opt in for the ACKEA-APO(a)-LRx, and cash expected to be generated from sales of TEGSEDI, which has
been approved in the U.S., the EU and Canada, will be sufficient to fund our operations through at least the next 12 months from the issuance of this Annual
Report on Form 10-K. Management’s belief with respect to its ability to fund operations is based on estimates that are subject to risks and uncertainties. If
actual  results  are  different  from  management’s  estimates,  we  may  need  to  delay,  limit,  reduce  or  terminate  our  product  development  or  future
commercialization efforts or grant rights to develop and commercialize our drugs even if we would otherwise prefer to develop and commercialize the drugs
ourselves.

2.

Summary of Significant Accounting Policies

Use of Estimates

The preparation of financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the
reported amounts of assets and liabilities, the disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of
revenue and expenses during the reporting periods. Significant estimates and assumptions reflected in these financial statements include, but are not limited
to, revenue recognition, the accrual for research and development expenses and prior to our IPO, the valuation of common stock. Estimates are periodically
reviewed in light of changes in facts, circumstances and experience. Changes in estimates are recorded in the period in which they become known. Actual
results could differ from those estimates.

F-9

 
Translation of Foreign Currency

For our foreign subsidiaries that report in a functional currency other than U.S. dollars, we translate their assets and liabilities into U.S. dollars
using  the  exchange  rate  at  the  balance  sheet  date.  We  translate  revenue  and  expenses  at  the  monthly  average  exchange  rates  for  the  period.  We  translate
transactions in our capital accounts at the historic exchange rate in effect at the date of the transaction. We include foreign currency translation adjustments as
a component of accumulated other comprehensive loss within the consolidated statements of comprehensive loss.

Concentration of Credit Risk

Financial instruments that potentially subject us to concentrations of credit risk consist primarily of cash, cash equivalents, short-term investments
and accounts receivables. We place our cash, cash equivalents and short-term investments with reputable financial institutions. We primarily invest our excess
cash  in  commercial  paper  and  debt  instruments  of  the  U.S.  Treasury,  financial  institutions,  corporations  and  U.S.  government  agencies  with  strong  credit
ratings  and  an  investment  grade  rating  at  or  above  A-1,  P-1  or  F-1  by  Moody's,  Standard  &  Poor's,  or  S&P,  or  Fitch,  respectively.  We  have  established
guidelines relative to diversification and maturities that maintain safety and liquidity. We periodically review and modify these guidelines to maximize trends
in yields and interest rates without compromising safety and liquidity.

Cash Equivalents and Short-Term Investments

We  consider  all  liquid  investments  with  maturities  of  three  months  or  less  when  we  purchase  them  to  be  cash  equivalents.  Our  short-term
investments have initial maturities of greater than three months from date of purchase. We classify our short-term investments as available-for-sale and we
carry them at fair market value based upon prices for identical or similar items on the last day of the fiscal period. We record unrealized gains and losses as a
separate  component  of  comprehensive  income  (loss)  and  we  include  net  realized  gains  and  losses  in  investment  income  (expense)  on  our  consolidated
statement of operations. We use the specific identification method to determine the cost of securities sold.

Inventory

Prior  to  the  regulatory  approval  of  our  product  candidates,  we  incur  expenses  for  the  manufacturing  of  drug  product  that  could  potentially  be
available  to  support  the  commercial  launch  of  our  products.  Until  the  first  reporting  period  when  regulatory  approval  has  been  received  or  is  otherwise
considered probable, we record all such costs as research and development expense.

For TEGSEDI inventory related costs incurred subsequent to July 1, 2018, we reflected these amounts as inventory on our consolidated balance
sheets at the lower of cost or market value under the first-in, first-out, or FIFO, basis. We periodically analyze our inventory levels, and write down inventory
that has become obsolete, inventory that has a cost basis in excess of its estimated realizable value and inventory in excess of expected sales requirements as
cost of product sales. The determination of whether inventory costs will be realizable requires estimates by our management and if actual market conditions
are less favorable than projected by our management, additional write-downs of inventory may be required which would be recorded as a cost of product sales
in the consolidated statements of operations.

At  December  31,  2018  a  majority  of  our  physical  inventory  for  TEGSEDI  was  produced  prior  to  when  we  obtained  regulatory  approval  and
accordingly had no cost basis as we recorded the related costs as research and development expense in prior periods. At December 31, 2018 the amount of
finished goods recorded in our consolidated balance sheets in other current assets related to our approved product TEGSEDI was $85,000.

Property and Equipment

Property  and  equipment  are  recorded  at  cost  and  depreciated  over  their  estimated  useful  lives  using  the  straight-line  method  over  the  estimated
useful life of each asset. Furniture and fixtures are depreciated over seven years. Leasehold improvements are amortized over the shorter of the lease term or
the ten-year estimated useful life of the asset. Upon retirement or sale, the cost of assets disposed of and the related accumulated depreciation are removed
from the accounts and any resulting gain or loss is credited or charged to income. Repairs and maintenance costs are expensed as incurred.

F-10

 
 
Intangible Assets

We obtained exclusive licenses from Ionis for specific patents that Ionis owns and maintains related to our drug pipeline. We recorded our licenses
from Ionis as a capital contribution using the carryover basis of Ionis' historical cost for the related patents. We are amortizing our capitalized licenses over
their estimated useful life, which is the term of the underlying individual patents owned by Ionis.

In addition, we maintain definite-lived intangible assets related to regulatory milestone payments made to Ionis that are recoverable through future
cash flows from approved products, which are capitalized as license intangible assets. These assets are amortized over their remaining useful lives, which are
generally estimated to be the remaining patent life. If our estimate of the product’s useful life is shorter than the remaining patent life, then the shorter period
is used. Intangible assets are amortized using the economic consumption method if anticipated future revenue can be reasonably estimated. The straight-line
method  is  used  when  future  revenue  cannot  be  reasonably  estimated.  Amortization  expense  is  recorded  as  a  component  of  cost  of  sales  to  the  extent  the
underlying license is commercialized or research and development prior to its commercialization in the consolidated statements of operations.

Fair Value of Financial Instruments

We have estimated the fair value of our financial instruments. The amounts reported for cash equivalents, accounts payable and accrued expenses
approximate  fair  value  because  of  their  short  maturities.  We  report  our  investment  securities  at  their  estimated  fair  value  based  on  a  three-tier  fair  value
hierarchy  to  prioritize  the  inputs  used  in  our  fair  value  measurements.  These  tiers  include:  Level  1,  defined  as  observable  inputs  such  as  quoted  prices  in
active markets for identical assets, which includes our money market funds and treasury securities classified as available-for-sale securities; Level 2, defined
as  inputs  other  than  quoted  prices  in  active  markets  that  are  either  directly  or  indirectly  observable,  which  includes  our  fixed  income  securities  and
commercial paper classified as available-for-sale securities; and Level 3, defined as unobservable inputs in which little or no market data exists, therefore
requiring us to develop our own assumptions. We have not historically held any Level 3 investments. Our securities have been classified as Level 1 or Level
2. We obtain the fair value of our Level 2 investments from our custodian bank and from a professional pricing service. We validate the fair value of our
Level 2 investments by understanding the pricing model used by the custodian banks or professional pricing service provider and comparing that fair value to
the  fair  value  based  on  observable  market  prices.  We  recognize  transfers  between  levels  of  the  fair  value  hierarchy  on  the  date  of  the  event  or  change  in
circumstances that caused the transfer.

Revenue Recognition

Collaboration and License Revenue

In May 2014, the Financial Accounting Standards Board, or FASB, issued Accounting Standards Update, or ASU, No. 2014-09, which amended
the  guidance  for  accounting  for  revenue  from  contracts  with  customers.  This  ASU  superseded  the  revenue  recognition  requirements  in  ASC  Topic  605,
Revenue  Recognition,  or  Topic  605,  and  created  a  new  Topic  606,  Revenue  from  Contracts  with  Customers,  or  Topic  606.  Under  Topic  606,  an  entity
recognizes revenue when its customer obtains control of promised goods or services in an amount that reflects the consideration which the entity expects to
receive in exchange for those goods or services.

To determine revenue recognition for arrangements that an entity determines are within the scope of Topic 606, the entity performs the following five
steps: (i) identify the contract(s) with a customer; (ii) identify the performance obligations in the contract; (iii) determine the transaction price; (iv) allocate the
transaction price to the performance obligations in the contract; and (v) recognize revenue when (or as) the entity satisfies a performance obligation. At contract
inception, once the contract is determined to be within the scope of Topic 606, we assess the goods or services promised within each contract and determine those
that are performance obligations, then assess whether each promised good or service is distinct. When we offer options for additional goods or services, such as
an option to license a drug in the future or for additional goods or services to be provided in the future, we evaluate whether such options are material rights that
should be treated as additional performance obligations. We typically have not concluded that the option to license a drug or the options for additional goods or
services that may be requested in the future under our collaboration agreement are material rights as the amounts attributable to such options represent standalone
selling price, and therefore no consideration is allocated to these items at the inception of an agreement. When a partner exercises its option to license a drug or
requests the additional goods or services, a new performance obligation is created for that item. Once performance obligations are identified, we then recognize as
revenue the amount of the transaction price that we allocated to the respective performance obligation when (or as) each performance obligation is satisfied, either
at a point in time or over time. If the performance obligation is satisfied over time, we recognize revenue based on the use of an output or input method. As of
December 31, 2018, we have three revenue streams: our strategic collaboration, option and license

F-11

 
agreement, or collaboration agreement, with Novartis Pharma AG, or Novartis, which we entered into in January 2017, our collaboration and license agreement
with PTC Therapeutics International Limited, or PTC Therapeutics, which we entered into in August 2018 and commercial product revenue related  TEGESDI
sales  subsequent  to  product  launch  in  the  fourth  quarter  of  2018.  For  a  complete  discussion  of  the  accounting  for  our  revenue  streams,  see  Note  6, Strategic
Collaboration with Novartis, Note 8, Collaboration and License Agreement with PTC Therapeutics, and Note 2, Summary of Significant Accounting Policies.

Effective January 1, 2018, we adopted Topic 606 using the full retrospective transition method. Under this method, we revised our consolidated
financial statements for prior period amounts including the periods included in this Report on Form 10-K, as if Topic 606 had been effective for such periods.
The references “as revised” used herein refer to revisions of amounts originally reported for the year ended December 31, 2017 and as of December 31, 2017
as a result of our adoption of Topic 606.

Impact of Adoption

As a result of adopting Topic 606 on January 1, 2018, we revised our comparative financial statements for the prior years as if Topic 606 had been
effective for that period. On September 18, 2018, we filed a Current Report on Form 8-K to present recast consolidated financial statements for each of the
three years ended December 31, 2015, 2016 and 2017, to reflect our adoption of the new accounting standard for revenue recognition set forth in Topic 606.
The financial information recast in the Form 8-K was originally filed with the SEC in our Annual Report on Form 10-K for the fiscal year ended December
31, 2017, which was filed with the SEC on February 28, 2018. Under Topic 605, we recognized revenue from our collaboration with Novartis over time on a
straight-line basis. Under Topic 606, we recognize revenue from our collaboration with Novartis using the input method based on the total cost of performing
services over time. As a result, the following financial statement line items for fiscal year 2017 were affected.

Consolidated Balance Sheets

Current portion of deferred revenue
Long-term portion of deferred revenue
Accumulated deficit

Consolidated Statements of Operations and Comprehensive Loss

December 31, 2017
(in thousands)
As Originally
Reported

As Revised

Under Topic 606    

Under Topic 605    

  $

  $

58,192    $
12,501   
(296,221)   $

50,579    $
8,306   
(284,413)   $

Effect
of Change

7,613 
4,195 
(11,808)

Year Ended December 31, 2017
(in thousands, except per share data)
As Originally
Reported

As Revised

Under Topic 606    

Under Topic 605    

Effect
of Change

Research and development revenue under collaborative
   Agreement
Loss from operations
Net loss
Net loss per share of preferred stock, basic and diluted
Net loss per share of common stock owned by Ionis, basic
   and diluted
Net loss per share of common stock owned by others, basic
   and diluted

  $

43,401    $

55,209    $

(120,470)  
(121,559)  
(1.80)  

(108,662)  
(109,751)  
(1.55)  

(11,808)
(11,808)
(11,808)
(0.25)

(3.08)  

(2.82)  

(0.26)

  $

(3.08)  

(2.82)   $

(0.26)

F-12

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consolidated Statement of Cash Flows

Years Ended December 31, 2017
(in thousands)
As Originally
Reported

As Revised

Under Topic 606    

Under Topic 605    

Effect
of Change

Net loss
Adjustments to reconcile net loss to net cash used in
   operating activities:
Deferred revenue
Cash, cash equivalents and restricted cash at beginning of
   period
Cash, cash equivalents and restricted at end of period

  $

(121,559)   $

(109,751)   $

(11,808)

70,693   

58,885   

11,808 

  $

7,857   
58,367    $

7,857   
58,367    $

— 
—

Product Revenue, Net

Subsequent to regulatory approval in Europe on July 11, 2018 and FDA approval in the U.S. on October 5, 2018, in the fourth quarter of 2018 we
began  to  sell  TEGSEDI  in  the  U.S.  and  Germany.    In  the  U.S.,  the  product  is  distributed  through  an  exclusive  distribution  agreement  with  a  third-party
logistics (3PL) company that takes title to the product and represents our sole customer in the U.S.  Our U.S. customer distributes TEGSEDI to a specialty
pharmacy  and  a  specialty  distributor  (collectively  referred  to  as  “wholesalers”),  who  then  distribute  the  product  to  health  care  providers  and  patients.    In
Germany, the product is distributed through a non-exclusive distribution model with a 3PL that takes title to the product and currently represents our sole
customer in Germany.  Our customer in Germany then distributes TEGSEDI to hospitals and pharmacies in Germany.  

Revenue from product sales are recognized when the customer obtains control of our product, which occurs at a point in time, upon transfer of title
to  the  customer.   We  record  shipping  and  handling  costs  within  cost  of  goods  sold  on  our  consolidated  statement  of  operations.  We  classify  payments  to
customers or other parties in the distribution channel for services that are distinct and priced at fair value as selling, general and administrative expenses in
our consolidated statements of operations. Otherwise payments to customers or other parties in the distribution channel that do not meet those criteria are
classified  as  a  reduction  of  revenue,  as  discussed  further  below.    Taxes  collected  from  customers  relating  to  product  sales  and  remitted  to  governmental
authorities  are  excluded  from  revenue.  We  have  elected  not  to  adjust  consideration  for  the  effects  of  a  significant  financing  component  when  the  period
between the transfer of a promised good or service to the customer and when the customer pays for that good or service will be one year or less.  Our payment
terms are generally between thirty to ninety days.  We expense incremental costs of obtaining a contract as and when incurred since the expected amortization
period of the asset that we would have recognized is one year or less.

Reserves for Variable Consideration

Revenues from product sales are recorded at the net sales price (transaction price), which includes estimates of variable consideration for which
reserves  are  established  and  which  result  from  discounts,  returns,  chargebacks,  rebates,  co-pay  assistance  and  other  allowances  that  are  offered  within
contracts between us and our customers, wholesalers, health care providers and other indirect customers relating to the sale of TEGSEDI. These reserves are
based on the amounts earned or to be claimed on the related sales and are classified as reductions of accounts receivable (if the amount is payable to the
customer) or a current liability (if the amount is payable to a party other than a customer). Where appropriate, these estimates take into consideration a range
of  possible  outcomes  that  are  probability-weighted  for  relevant  factors  such  as  our  historical  experience,  current  contractual  and  statutory  requirements,
specific  known  market  events  and  trends,  industry  data  and  forecasted  customer  buying  and  payment  patterns.  Overall,  these  reserves  reflect  our  best
estimates of the amount of consideration to which we are entitled based on the terms of the contract. The amount of variable consideration that is included in
the transaction price may be constrained and is included in the net sales price only to the extent that it is considered probable that a significant reversal in the
amount  of  the  cumulative  revenue  recognized  will  not  occur  in  a  future  period.  Actual  amounts  of  consideration  ultimately  received  may  differ  from  our
estimates. If actual results in the future vary from our estimates, we will adjust these estimates, which would affect net product revenue and earnings in the
period such variances become known.

F-13

 
 
 
 
 
 
 
 
 
 
    
 
    
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
The following are the components of variable consideration related to product revenue:

Chargebacks:  In the U.S., we estimate obligations resulting from contractual commitments with the government and other entities to sell products
to qualified healthcare providers at prices lower than the list prices charged to our U.S. customer. Our U.S. customer charges us for the difference between
what they pay for the product and the selling price to the qualified healthcare providers. We record reserves for these chargebacks related to product sold to
our U.S. customer during the reporting period, as well as our estimate of product that remains in the distribution channel at the end of the reporting period that
we expect will be sold to qualified healthcare providers in future periods.

Government rebates: We are subject to discount obligations under government programs, including Medicaid programs and Medicare in the United
States.  We  estimate  Medicaid  and  Medicare  rebates  based  upon  a  range  of  possible  outcomes  that  are  probability-weighted  for  the  estimated  payer
mix.  These reserves are recorded in the same period the related revenue is recognized, resulting in a reduction of product revenue and the establishment of a
liability that is included in accrued expenses on our consolidated balance sheet.  For Medicare, we also estimate the number of patients in the prescription
drug coverage gap for whom we will owe an additional liability under the Medicare Part D program. On a quarterly basis, we update our estimates and record
any  adjustments  in  the  period  that  we  identify  the  adjustments.  In  Germany,  pharmaceutical  companies  must  grant  a  specified  rebate  percentage  to  the
German government. We have included this rebate as a reduction of revenue in the period the related product revenue is recognized.

Trade discounts and allowances: We provide customary invoice discounts on TEGSEDI sales to our U.S. customer for prompt payment that are
recorded as a reduction of revenue in the period the related product revenue is recognized.  In addition, we receive and pay for various distribution services
from our U.S. customer and wholesalers in the U.S. distribution channel.  For services that are either not distinct from the sale of our product or for which we
cannot reasonably estimate the fair value, such fees are classified as a reduction of product revenue.

Product Returns: Our U.S. customer has return rights and the wholesalers have limited return rights primarily related to the product’s expiration
date. We estimate the amount of product sales that may be returned and record the estimate as a reduction of revenue and a refund liability in the period the
related product revenue is recognized. Based on the distribution model for TEGSEDI, contractual inventory limits with our customer and wholesalers and the
price of TEGSEDI, we believe there will be minimal returns. Our customer in Germany only takes title to the product once it receives an order from a hospital
or pharmacy and therefore does not maintain any inventory of TEGSEDI. Therefore, there is limited return risk and the Company has not recorded any return
estimate in the transaction price for TEGSEDI sold in Germany.

Other incentives:  In the U.S., other incentives include co-payment assistance we provide to patients with commercial insurance that have coverage
and reside in states that allow co-payment assistance. The calculation of the accrual for co-pay assistance is based on an estimate of claims and the cost per
claim that we expect to receive associated with product that has been recognized as revenue. The estimate is recorded as a reduction of revenue in the same
period the related revenue is recognized.

During the year ended December 31, 2018, we recorded product revenue, net, of $2.2 million, which consist of $1.2 million of TEGSEDI sales in
the U.S., and $1.0 million of TEGSEDI sales in Germany. The following table summarizes balances and activity in each of the product revenue allowance and
reserve categories for the year ended December 31, 2018 (in thousands):

Balance at December 31, 2017
Provision related to current period sales
Adjustment related to prior period sales
Credit or payments made during the period
Balance at December 31, 2018

Chargebacks,
discounts and
fees

Government
and other
rebates

Returns

Total

—    $
50     
—     
—     
50    $

—    $
293     
—     
—     
293    $

—    $
5     
—     
—     
5    $

— 
348 
— 
— 
348

  $

  $

F-14

 
 
 
  
 
 
 
 
   
   
   
 
   
   
   
 
 
Cost of Product Sales

As a result of receiving marketing authorization, or MA, approval for TEGSEDI from the European Commission, or EC, in July 2018, we began
recording all TEGSEDI related expenses as cost of product sales starting in July 2018. Cost of product sales consists of manufacturing costs, transportation
and freight, and indirect overhead costs associated with the manufacturing and distribution of TEGSEDI. Cost of product sales may also include period costs
related  to  certain  manufacturing  services  and  inventory  adjustment  charges.  Additionally,  we  expensed  a  significant  portion  of  the  cost  of  producing
TEGSEDI that we will use in the commercial launch as research and development expense prior to the regulatory approval of TEGSEDI.

Commercial Sublicensing Expenses

We  incur  sublicense  expenses  under  our  TTR  Development,  Commercialization,  Collaboration  and  License  Agreement  with  Ionis  related  to  the
drugs  we  have  licensed  under  the  agreement.  We  include  our  sublicense  fee  expenses  in  our  cost  of  license  expenses  on  our  consolidated  statements  of
operations for those drugs that are approved for marketing. We recognize sublicense fee expenses in the period they are incurred.

Research and Development Expenses

Our research and development expenses include wages, benefits, facilities, supplies, external services, clinical study and manufacturing costs and
other expenses that are directly related to our research and development activities. We expense research and development costs as we incur them. We do not
conduct research activities and no such costs are included in these amounts.

If we make payments for research and development services prior to the services being rendered, we record those amounts as prepaid assets on our

balance sheet and we expense them as the services are provided.

Research and Development Sublicensing Expenses

We incur sublicense expenses under our cardiometabolic development, commercialization and license agreement and services agreement with Ionis
related  to  the  drugs  we  have  licensed  under  the  agreement.  We  include  our  sublicense  fee  expenses  in  our  research  and  development  expenses  on  our
consolidated statements of operations since the applicable drugs are not yet approved for marketing. We recognize sublicense fee expenses in the period they
are incurred.

Estimated Liability for Research and Development Costs

We record accrued liabilities related to expenses for which vendors or service providers have not yet billed us. These liabilities are for products or
services that we have received and primarily relate to ongoing nonclinical and clinical studies. These costs primarily include third-party clinical management
costs, laboratory and analysis costs, toxicology studies and investigator grants. We have drugs in concurrent nonclinical and clinical studies at several sites
throughout the world. To ensure that we have adequately provided for ongoing nonclinical and clinical research and development costs during the period in
which we incur such costs, we maintain an accrual to cover these costs. We update our estimate for this accrual on at least a quarterly basis. The assessment of
these costs is a subjective process that requires judgment. Upon settlement, these costs may differ materially from the amounts accrued in our consolidated
financial statements. Our historical accrual estimates have not been materially different from our actual amounts.

Stock-Based Compensation Expense

We measure stock-based compensation expense for equity-classified awards, principally related to stock options, restricted stock units, or RSUs,
and stock purchase rights under our employee stock purchase plan, or ESPP, based on the estimated fair value of the award on the date of grant. We recognize
the  value  of  the  portion  of  the  award  that  we  ultimately  expect  to  vest  as  stock-based  compensation  expense  over  the  requisite  service  period  in  our
consolidated statements of operations. We reduce stock-based compensation expense for estimated forfeitures at the time of grant and revise the expense in
subsequent periods if actual forfeitures differ from those estimates.

We value our stock option awards and stock purchase rights under our ESPP using the Black-Scholes model. The determination of the grant date
fair value of options using an option pricing model is affected principally by our estimated common stock fair value and requires us to make a number of
other assumptions, including: the expected life of the option, the volatility of the underlying stock, the risk-free interest rate and expected dividends.

F-15

 
The fair value of RSUs is based on the market price of our common stock on the date of grant. The RSUs we have granted vest annually over a

four-year period.

Prior to December 2015, Ionis granted our employees options to purchase shares of Ionis' common stock, or Ionis options. In December 2015, we granted

our employees holding Ionis options additional options to purchase shares of our common stock, or Akcea options.

We  determined  the  stock-based  compensation  expense  for  the  Ionis  options  at  the  date  of  grant  and  recognized  compensation  expense  over  the
vesting period of the Ionis options. In December 2015, we accounted for the issuance of the Akcea options as a modification to the original grant of the Ionis
options  because  the  grant  of  the  Ionis  options  and  Akcea  options  essentially  represented  a  single  stock  award  as  the  exercisability  provisions  of  the  Ionis
options and Akcea options grants were interrelated and mutually exclusive. The total compensation expense measured on the modification date was the sum
of the grant date fair value of the Ionis options plus any incremental compensation cost resulting from the grant of the Akcea options.

In 2016, we began concurrently granting Ionis options and Akcea options to our employees. Because the exercisability provisions of the awards are
interrelated and mutually exclusive as described above, the fair values of the Ionis options and the Akcea options were determined on the date of grant and the
option with the greater fair value was recognized over the vesting period of the awards. In 2017, we no longer concurrently granted Ionis and Akcea options. Our
board of directors only receive grants under the Akcea option plan.

Following our IPO, we no longer grant Ionis options to our employees. Under the terms of the Ionis options, when we completed our IPO, the Ionis
options  our  employees  were  holding  were  terminated.  The  termination  of  the  Ionis  options  was  determined  not  to  be  a  modification,  as  the  options  were
terminated based upon the existing contractual terms of the option agreements. As such, we will continue to recognize expense based on the valuation that
was determined upon the grant date for options issued in 2016 or the modification date for options issued in 2015 and 2017.

The fair value of stock options granted under our 2015 Equity Incentive Plan is based on the fair value of our common stock on the date of grant.
The  fair  value  of  stock  options  granted  under  the  Ionis  2011  Equity  Incentive  Plan  is  based  on  the  fair  value  of  Ionis'  common  stock  on  the  date  of
grant. Options granted to employees vest over a four-year period, with 25 percent exercisable at the end of one year from the date of the grant and the balance
vesting ratably, on a monthly basis, thereafter and have a term of ten years. Options granted to directors vest annually over a four-year period and have a term
of ten years.

See Note 9, Equity and Stock-based Compensation, for additional information regarding our stock-based compensation plans.

Accumulated Other Comprehensive Loss

Accumulated  other  comprehensive  loss  is  comprised  of  unrealized  gains  and  losses  on  investments,  net  of  taxes  and  currency  translation
adjustments. The following table summarizes changes in accumulated other comprehensive loss for the years ended December 31, 2018, 2017 and 2016 (in
thousands):

Beginning balance accumulated other comprehensive loss
Unrealized gains (losses) on investments, net of tax (1)
Currency translation adjustment
Net other comprehensive income (loss)
Ending balance accumulated other comprehensive loss

2018

Years Ended December 31,
2017

2016

  $

  $

(451)   $
144   
(17)  
127   
(324)   $

(21)   $
(337)  
(93)  
(430)  
(451)   $

(75)
75 
(21)
54 
(21)

(1)

There was no tax benefit for other comprehensive income (loss) for the years ended December 31, 2018, 2017 and 2016.

F-16

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Income Taxes

On December 22, 2017, the United States enacted H.R.1., known as the Tax Cuts and Jobs Act, which represented a substantial change to tax laws
in the United States.  The SEC staff subsequently issued Staff Accounting Bulletin No. 118, Income Tax Accounting Implications of the Tax Cuts and Jobs
Act (“SAB 118”), which allowed us to record provisional amounts during a measurement period not to extend beyond one year of the enactment date. For the
year ended December 31, 2017, we recorded provisional amounts in accordance SAB 118 where it was possible to make reasonable estimates of the effects of
the Tax Act. All aspects of the Tax Act were accounted for prior to the closure of the one-year measurement period provided by SAB 118 and our accounting
for these matters is now complete.

Prior  to  the  completion  of  our  IPO  we  filed  our  tax  returns  on  a  consolidated  and  combined  basis  with  Ionis  for  federal  and  state  income  tax
purposes,  respectively.  For  financial  statement  purposes  when  we  are  required  to  file  on  a  consolidated  or  combined  basis,  we  calculate  our  income  tax
amounts, including net operating losses and tax credit carryforwards, using a separate return methodology which determines income taxes as if we were a
separate taxpayer from Ionis.  Effective July 19, 2017, the date of our IPO, we are no longer included in the consolidated federal income tax return with Ionis.
We determined the amount of federal tax attributes, primarily net operating losses and tax credit carryforwards that transferred to us upon deconsolidation
from  Ionis.    We  are  still  required  to  file  most  of  our  state  tax  returns  on  a  consolidated  or  combined  basis  with  Ionis.    Therefore,  for  financial  statement
purposes we calculated our state income tax amounts using the separate return method. 

We  account  for  income  taxes  using  the  asset  and  liability  method,  which  requires  the  recognition  of  deferred  tax  assets  and  liabilities  for  the
expected future tax consequences of events that have been recognized in our financial statements or tax returns. In addition, deferred tax assets are recorded
for the future benefit of utilizing net operating losses and research and development credit carry forwards. Valuation allowances are provided when necessary
to reduce deferred tax assets to the amount expected to be realized.

We apply the authoritative accounting guidance prescribing a threshold and measurement attribute for the financial recognition and measurement of
a tax position taken or expected to be taken in a tax return. We recognize liabilities for uncertain tax positions based on a two-step process. The first step is to
evaluate the tax position for recognition by determining if the weight of available evidence indicates that it is more likely than not that the position will be
sustained on audit, including resolution of related appeals or litigation settlement. The second step is to estimate and measure the tax benefit as the largest
amount that is more than 50% likely to be realized upon ultimate settlement.

We  recognize  interest  and  penalties  related  to  unrecognized  tax  benefits  within  the  income  tax  expense  line  in  the  accompanying  consolidated

statements of operations. Accrued interest and penalties are included within other long-term liabilities in the consolidated balance sheets.

Significant judgment is required in evaluating our uncertain tax positions and determining our provision for income taxes. Although we believe our
reserves are reasonable, no assurance can be given that the final tax outcome of these matters will not be different from that which is reflected in our historical
income tax provisions and accruals. We adjust these reserves for changing facts and circumstances, such as the closing of a tax audit or the refinement of an
estimate.  To  the  extent  that  the  final  tax  outcome  of  these  matters  is  different  than  the  amounts  recorded,  such  differences  may  impact  the  provision  for
income taxes in the period in which such determination is made.

Significant  judgment  is  also  required  in  determining  any  valuation  allowance  recorded  against  deferred  tax  assets.  In  assessing  the  need  for  a
valuation allowance, we consider all available evidence, including scheduled reversal of deferred tax liabilities, past operating results, the feasibility of tax
planning strategies and estimates of future taxable income. Estimates of future taxable income are based on assumptions that are consistent with our plans.
Assumptions represent management's best estimates and involve inherent uncertainties and the application of management's judgment. Should actual amounts
differ from our estimates, the amount of our tax expense and liabilities could be materially impacted.

We  record  a  valuation  allowance  to  reduce  the  balance  of  our  net  deferred  tax  assets  to  the  amount  we  believe  is  more-likely-than-not  to  be
realized. We have incurred financial statement losses since inception and as a result we have a full valuation allowance recorded against our net deferred tax
assets.  We  regularly  assess  the  future  realization  of  our  net  deferred  tax  assets  and  will  reduce  the  valuation  allowance  in  any  such  period  in  which  we
determine that all, or a portion, of our deferred tax assets are more-likely-than-not to be realized.

F-17

 
We do not provide for a U.S. income tax liability and foreign withholding taxes on undistributed foreign earnings of our foreign subsidiaries. The

earnings of non-U.S. subsidiaries are currently expected to be indefinitely reinvested in non-U.S. operations.

New Accounting Pronouncements - Recently Issued

In February 2016, the FASB issued amended accounting guidance related to lease accounting, which will require us to record all leases with a term
longer than one year on our balance sheet. When we record leases on our balance sheet under the new guidance, we will record a liability with a value equal
to the present value of payments we will make over the life of the lease (lease liability) and an asset representing the underlying leased asset (right of use
asset). The new accounting guidance requires us to determine if our leases are operating or financing leases. We will record expense for operating leases on a
straight-line basis as an operating expense. If we determine a lease is a financing lease, we will record both interest and amortization expense and generally
the expense will be higher in the earlier periods of the lease. We adopted this guidance on January 1, 2019 and adjusted our opening balance sheet on that
date. We elected the available practical expedients. The most significant impact was the recognition of right of use assets and lease liabilities for our operating
leases. We are in the process of finalizing the impact of the adoption. The adoption will not have an impact in our consolidated statement of operations or
statement of cash flows.

In February 2018, the FASB issued updated guidance for reclassification of tax effects from accumulated other comprehensive income (loss). The
updated  guidance  gives  entities  an  option  to  reclassify  the  stranded  tax  effects  resulting  from  changes  due  to  the  Tax  Act  from  accumulated  other
comprehensive income (loss) to retained earnings. The updated guidance is effective for all entities for fiscal years beginning after December 31, 2018, and
interim periods within those fiscal years. Early adoption is permitted and adoption is optional. We are currently assessing the impact this updated guidance
could have on our consolidated financial statements and the timing of potential adoption.

In June 2018, the FASB issued updated guidance to simplify the accounting for stock-based compensation expense for non-employees. We adopted
this guidance in the second quarter of 2018. We have not granted stock options to non-employees as of December 31, 2018 and therefore this new guidance
has no impact on our consolidated financial statements.

In August 2018, the FASB updated its disclosure requirements related to Level 1, 2 and 3 fair value measurements. The update included deletion
and  modification  of  certain  disclosure  requirements  and  additional  disclosure  related  to  Level  3  measurements.   The  guidance  is  effective  for  fiscal  years
beginning after December 15, 2019 and early adoption is permitted. We anticipate we will adopt this updated guidance on January 1, 2019 and we do not
expect it to have a significant impact on our disclosures.

In August 2018, the FASB issued clarifying guidance on how to account for implementation costs related to hosted cloud-servicing arrangements.
The  primary  change  is  to  include  any  arrangement  in  which  the  customer  accesses  or  uses  software  but  does  not  take  possession  of  the  software  when
assessing for the capitalization of implementation costs of internal use software. Qualified costs are to be capitalized and amortized over the service period
and they need to be expensed in the same line item as the service expense and recognized on the balance sheet in the same category as amounts prepaid for
the hosted cloud-servicing arrangements generally as another asset. Cash flows related to the capitalized implementation costs should be presented consistent
with  the  presentation  of  cash  flows  for  the  fees  related  to  hosted  cloud-servicing  arrangements.  The  update  can  be  applied  either  retrospectively  or
prospectively to all implementation costs incurred after the date of adoption. The updated guidance is effective for fiscal years beginning after December 15,
2019,  and  interim  periods  within  those  fiscal  years.  Early  adoption  is  permitted  in  any  interim  period.  We  are  currently  assessing  the  effects  this  updated
guidance could have on our consolidated financial statements and timing of potential adoption.

In November 2018, the FASB issued clarifying guidance of the interaction between the collaboration accounting guidance and the new revenue

recognition guidance we adopted on January 1, 2018 (Topic 606).  The clarifying guidance included the following:

1) When  a  participant  is  considered  a  customer  in  a  collaborative  arrangement,  all  of  the  associated  accounting  under  Topic  606  should  be

applied;

2) Adds  “unit  of  account”  concept  to  collaboration  accounting  guidance  to  align  with  Topic  606.    This  is  used  to  determine  if  revenue  is

recognized or if a contra expense is recognized from consideration received under a collaboration; and

3)

Precludes revenue from being recognized under Topic 606 when a transaction with a collaborative partner is determined not be a customer
and is not directly related to the sales to third parties.

F-18

 
 
 
 
The updated guidance is effective for public entities for fiscal years beginning after December 15, 2019, and interim periods within those fiscal
years.  Early adoption is permitted.  We plan to adopt this guidance on January 1, 2020.  We are currently assessing the effects it will have on our consolidated
financial statements and disclosures.

3.

Investments and Fair Value Measurements

Investments

As  of  December  31,  2018  and  2017,  we  primarily  invested  our  excess  cash  in  debt  instruments  of  the  U.S.  Treasury,  financial  institutions,
corporations and U.S. government agencies with strong credit ratings and an investment grade rating at or above A-1, P-1 or F-1 by Moody's, S&P or Fitch,
respectively. We have established guidelines relative to diversification and maturities that maintain safety and liquidity. We periodically review and modify
these guidelines to maximize trends in yields and interest rates without compromising safety and liquidity.

The following is a summary of our investments at December 31, 2018 and 2017 (in thousands):

December 31, 2018
Available-for-sale securities:
Corporate debt securities
Debt securities issued by U.S. government agencies
Total securities with a maturity of one year or less

December 31, 2017
Available-for-sale securities:
Corporate debt securities
Debt securities issued by U.S. government agencies
Total securities with a maturity of one year or less

Corporate debt securities
Debt securities issued by U.S. government agencies
Total securities with a maturity of one to two years
Total available-for-sale securities

Cost

Gains

Losses

Gross Unrealized

Estimated
Fair Value

81,770    $
85,578     
167,348    $

—    $
—     
—    $

(151)   $
(42)    
(193)   $

81,619 
85,536 
167,155

Cost

Gains

Losses

Gross Unrealized

Estimated
Fair Value

132,434    $
38,135     
170,569     

8,267     
23,264     
31,531     
202,100    $

—    $
—     
—     

—     
—     
—     
—    $

(206)   $
(59)    
(265)    

(35)    
(37)    
(72)    
(337)   $

132,228 
38,076 
170,304 

8,232 
23,227 
31,459 
201,763 

  $

  $

  $

  $

We recorded unrealized losses related to the securities listed above as of December 31, 2018 and 2017. We believe that the decline in value of these
securities is temporary and primarily related to the change in market interest rates since purchase. We believe it is more likely than not that we will be able to
hold our debt securities to maturity. Therefore, we anticipate a full recovery of the amortized cost basis of our debt securities at maturity.

All of our available-for-sale securities are available to us for use in our current operations. As a result, we categorized all of these securities as

current assets even though the stated maturity of some individual securities may be one year or more beyond the balance sheet date.

F-19

 
 
 
 
 
 
   
   
 
 
   
   
   
 
   
      
      
      
  
   
 
 
 
 
 
 
   
   
 
 
   
   
   
 
   
      
      
      
  
   
   
 
   
      
      
      
  
   
   
   
 
Fair Value Measurements

The following tables present the investments we held at December 31, 2018 and 2017 that are regularly measured and carried at fair value. The
table segregates each security by the level within the fair value hierarchy of the valuation techniques we utilized to determine the respective securities' fair
value (in thousands):

Money market funds (1)
Corporate debt securities (2)
Debt securities issued by U.S. government agencies (3)
Total

Money market funds (1)
Corporate debt securities (3)
Debt securities issued by U.S. government agencies (3)
Total

At
December 31,
2018

Quoted Prices
in Active
Markets
(Level 1)

Significant
Other
Observable
Inputs
(Level 2)

82,343    $
81,619   
85,536   
249,498    $

82,343    $
—   
—   
82,343    $

— 
81,619 
85,536 
167,155 

At
December 31,
2017

Quoted Prices
in Active
Markets
(Level 1)

Significant
Other
Observable
Inputs
(Level 2)

48,430    $

140,460   
61,303   
250,193    $

48,430    $
—   
—   
48,430    $

— 
140,460 
61,303 
201,763 

  $

  $

  $

  $

(1)
(2)

(3)

4.

Included in cash and cash equivalents on our consolidated balance sheets.
At December 31, 2018, $1.0 million was included in cash and cash equivalents on our consolidated balance sheet, with the difference included in
short-term investments on our consolidated balance sheet.
Included in short-term investments on our consolidated balance sheets.

Property, Plant and Equipment

The following table presents property and equipment, at cost, and related accumulated depreciation (in thousands):

Furniture and fixtures
Computer equipment and software
Leasehold improvements
Total property and equipment, at cost
Less accumulated depreciation and amortization
Total property and equipment, net

December 31,

2018

2017

  $

  $

1,611    $
102   
4,213   
5,926   
(230)  
5,696    $

183 
15 
— 
198 
(121)
77

Total depreciation expense amounted to $307,000, $108,000 and $12,000 for the years ended December 31, 2018, 2017 and 2016, respectively. As
part of the operating lease for our new corporate headquarters, the landlord has provided a tenant improvement allowance of $3.6 million which is included in
our leasehold improvements.

F-20

 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
5.

Intangible Assets

The following table presents intangible assets (in thousands):

Acquired and in-licensed rights
Capitalized regulatory approval milestones
Less accumulated amortization
Total intangible assets, net

December 31,

2018

2017

  $

  $

2,262    $
90,000   
(3,348)  
88,914    $

1,699   
—   
(478)  
1,221   

Estimated
useful life
7 - 21 Years
16 Years

The  increase  in  capitalized  regulatory  milestones  as  of  December  31,  2018  was  due  to  a  milestone  of  $40.0  million  paid  to  Ionis  which  was
incurred upon the EU approval of TEDSEDI on July 11, 2018 and a milestone of $50.0 million paid to Ionis which was incurred upon the FDA approval of
TEDSEDI on October 5, 2018.

The Company recorded $2.9 million, $0.1 million and $0.1 million, respectively, in amortization expense related to intangible assets during the
years  ended  December  31,  2018,  2017  and  2016.    Estimated  future  amortization  expense  for  intangible  assets  as  of  December  31,  2018  is  as  follows  (in
thousands):

2019
2020
2021
2022
2023
Thereafter

  $

  $

Total

5,863 
5,879 
5,861 
5,856 
5,843 
59,613 
88,914

The weighted average remaining amortizable life of our patents was 12.15 years at December 31, 2018.

For additional detail of Akcea's license agreements with Ionis see Note 7, License Agreements and Services Agreement with Ionis.

6.

Strategic Collaboration with Novartis

In  January  2017,  we  initiated  a  strategic  collaboration  with  Novartis  for  the  development  and  commercialization  of  AKCEA-APO(a)-LRx  and
AKCEA-APOCIII-LRx.  Under  the  Novartis  collaboration,  Novartis  has  an  exclusive  option  to  further  develop  and  commercialize  these  drugs.  We  are
responsible for completing a Phase 2 program, conducting an end-of-Phase 2 meeting with the United States Food and Drug Administration, or FDA, and
providing initial quantities of the active pharmaceutical ingredient, or API, for each drug. On September 24, 2018 Akcea and Ionis announced positive top-
line results from the Phase 2 study of AKCEA-APO(a)-LRx. If Novartis exercises an option for one of these drugs, Novartis will be responsible for all further
global development, regulatory and co-commercialization activities and costs for such drug.

We received a $75.0 million upfront payment in the first quarter of 2017, of which we retained $60.0 million and we paid Ionis $15.0 million as a
sublicense fee under our Cardiometabolic License Agreement with Ionis. If Novartis exercises its option for a drug, Novartis will pay us a license fee equal to
$150.0 million for each drug licensed by Novartis. In addition, for we are eligible to receive up to $675.0 million in milestone payments, including $25.0
million for the achievement of a development milestone, up to $290.0 million for the achievement of regulatory milestones and up to $360.0 million for the
achievement of commercialization milestones. In addition, for AKCEA-APOCIII-LRx, we are eligible to receive up to $530.0 million in milestone payments,
including $25.0 million for the achievement of a development milestone, up to $240.0 million for the achievement of regulatory milestones and up to $265.0
million for the achievement of commercialization milestones. We will earn the next milestone payment of $25.0 million under this collaboration if Novartis
advances  the  Phase  3  study  for  either  drug.  We  are  also  eligible  to  receive  tiered  royalties  in  the  mid-teens  to  low  twenty  percent  range  on  net  sales  of
AKCEA-APO(a)-LRx  and  AKCEA-APOCIII-LRx.  Novartis  will  reduce  these  royalties  upon  the  expiration  of  certain  patents  or  if  a  generic  competitor
negatively impacts the product in a specific country. We will pay 50% of these license fees, milestone payments and royalties to Ionis as a sublicense fee. We
may co-commercialize through our specialized sales force any licensed drug commercialized by Novartis in selected markets, under terms and conditions that
we plan to negotiate with Novartis in the future.

F-21

 
 
 
 
   
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
At commencement of our strategic collaboration, we identified the following four distinct performance obligations:

•

•

•

•

Development activities for AKCEA-APO(a)-LRx;

Development activities for AKCEA-APOCIII-LRx;

API for AKCEA-APO(a)-LRx; and

API for AKCEA-APOCIII-LRx.

The  development  activities  and  the  supply  of  API  are  distinct  because  Novartis  or  another  third  party  could  provide  these  items  without  our

assistance.

We determined the transaction price for the Novartis collaboration was $108.4 million, comprised of the following:

•

•

•

$75.0 million from the upfront payment we received;

$28.4 million for the premium paid by Novartis, which represents the excess of the fair value Ionis received from Novartis' purchase of Ionis'
stock at a premium in the first quarter of 2017; and

$5.0  million  for  the  premium  Novartis  would  have  paid  to  purchase  Ionis'  stock  if  we  did  not  complete  our  IPO  within  15  months  of  the
inception of the agreement.

We  are  recognizing  the  $75.0  million  upfront  payment  plus  the  premium  paid  by  Novartis  from  its  purchase  of  Ionis’  stock  and  the  premium
associated with Novartis’ obligation to purchase Ionis’ stock if we did not complete our IPO because we are the party providing the services and API under
the collaboration agreement.

None  of  the  options  or  development  or  regulatory  milestone  payments  under  this  agreement  have  been  included  in  the  transaction  price  as  all
payments  are  fully  constrained.  As  part  of  our  evaluation  of  the  constraint,  we  considered  numerous  factors,  including  the  fact  that  achievement  of  the
milestones is outside of our control and contingent upon the success of our clinical trials, Novartis’ efforts, and the receipt of regulatory approval. We will re-
evaluate  the  transaction  price,  including  estimated  variable  consideration  included  in  the  transaction  price  and  all  constrained  amounts,  in  each  reporting
period and as uncertain events are resolved or other changes in circumstances occur.

Based on the distinct performance obligations under the Novartis collaboration, we allocated the $108.4 million transaction price based on relative

stand-alone selling prices of each of our performance obligations as follows:

•

•

•

•

$64.0 million for development services for AKCEA-APO(a)-LRx;

$40.1 million for development services for AKCEA-APOCIII-LRx;

$1.5 million for the delivery of AKCEA-APO(a)-LRx API; and

$2.8 million for the delivery of AKCEA-APOCIII-LRx API.

We are recognizing revenue related to each of our performance obligations as follows:

• We  will  satisfy  the  development  services  performance  obligation  for  AKCEA-APO(a)-LRx  as  the  research  and  development  services  are
performed. A  significant  portion  of  the  research  and  development  services  were  completed  by  December  2018  with  the  remainder  to  be
completed  through  mid-2019.  We  recognize  revenue  related  to  research  and  development  services  performed  using  an  input  method  by
calculating costs incurred at each period end relative to total costs expected to be incurred;

F-22

 
 
 
 
 
 
 
 
 
 
 
 
 
• We  will  satisfy  the  development  services  performance  obligation  for  AKCEA-APOCIII-LRx  as  the  research  and  development  services  are
performed. We expect a significant portion of the research and development services to be completed by the end of December 2019 with the
remainder  through  mid-2020.  We  recognize  revenue  related  to  research  and  development  services  performed  using  an  input  method  by
calculating costs incurred at each period end relative to total costs expected to be incurred;

• We recognized the amount attributed to the AKCEA-APO(a)-LRx API supply when we delivered API to Novartis in 2017; and

• We recognized the amount attributed to the AKCEA-APOCIII-LRx API supply when we delivered API to Novartis in May 2018.

Additionally, we and Ionis entered into a stock purchase agreement, or SPA, with Novartis. Under the SPA, in July 2017, Novartis purchased $50.0
million of our common stock in a separate private placement concurrent with the completion of our IPO at a price per share equal to the IPO price. Our IPO is
discussed in Note 11, Initial Public Offering.

During the years ended December 31, 2018 and 2017 (as revised), we earned revenue of $50.6 million and $43.4 million, respectively, from our
strategic collaboration with Novartis, representing 100% of our research and development revenue. We did not earn research and development revenue during
the  year  ended  December  31,  2016.  During  the  year  ended  December  31,  2018  we  recognized  $42.2  million  of  revenue  from  amounts  that  were  in  our
beginning deferred revenue balance. Our consolidated balance sheet at December 31, 2018 and 2017 (as revised) included deferred revenue of $28.8 million
and $70.7 million, respectively, related to our strategic collaboration with Novartis.

7.

License Agreements and Services Agreement with Ionis

In  December  2015,  we  entered  into  a  development,  commercialization  and  license  agreement  related  to  our  cardiometabolic  franchise  and  a
services agreement with Ionis.  In March 2018, we entered into a new development, commercialization, collaboration and license agreement related to our
TTR franchise and amended the services agreement previously in place with Ionis.  The following sections summarize these related party agreements with
Ionis.

Cardiometabolic Development, Commercialization and License Agreement

Our development, commercialization and license agreement, or Cardiometabolic License Agreement, with Ionis granted exclusive rights to us to
develop and commercialize WAYLIVRA, AKCEA-APO(a)-LRx, AKCEA-APOCIII-LRx, and AKCEA-ANGPTL3-LRx, which are collectively referred to as
the Lipid Drugs. Ionis granted us an exclusive license to certain patents to develop and commercialize products containing the Lipid Drugs. Ionis also granted
us a non-exclusive license to the Ionis antisense platform technology for us to develop and commercialize products containing the Lipid Drugs. Ionis also
granted us non-exclusive rights under its manufacturing technology to manufacture the Lipid Drugs in our own facility or at a contract manufacturer. As a part
of  this  agreement  both  companies  agreed  not  to  work  with  any  other  parties  to  develop  or  commercialize  other  RNA-targeting  drugs  that  are  designed  to
inhibit any of the Lipid Drug targets so long as we are developing or commercializing the Lipid Drugs.

We  and  Ionis  share  development  responsibilities  for  the  Lipid  Drugs.  We  pay  Ionis  for  the  research  and  development  expenses  it  incurs  on  our
behalf, which include both external and internal expenses. External research and development expenses include costs for contract research organizations, or
CROs, costs to conduct nonclinical and clinical studies on our drugs, costs to acquire and evaluate clinical study data, such as investigator grants, patient
screening fees and laboratory work, and fees paid to consultants. Internal research and development expenses include costs for the work that Ionis' research
and  development  employees  perform  for  us.  Ionis  charges  us  a  full-time  equivalent  rate  that  covers  personnel-related  expenses,  including  salaries  and
benefits, plus an allocation of facility-related expenses, including rent, utilities, insurance and property taxes, for those development employees who work
either directly or indirectly on the development of our drugs. We also pay Ionis for the API and drug product we use in our nonclinical and clinical studies for
all of our drugs. Ionis manufactures the API for us and charges us a price per gram consistent with the price Ionis charges its pharmaceutical partners, which
includes the cost for direct materials, direct labor and overhead required to manufacture the API. If we need the API filled in vials for our clinical studies and
Ionis contracts with a third party to perform this work, Ionis will charge us for the resulting cost.

F-23

 
 
 
 
As we commercialize each of the Lipid Drugs, we will pay Ionis royalties from the mid-teens to the mid-twenty percent range on sales related to
the Lipid Drugs that we sell. If we sell a Lipid Drug for a Rare Disease Indication (defined in the agreement as less than 500,000 patients worldwide or an
indication that required a Phase 3 program of less than 1,000 patients and less than two years of treatment), we will pay a higher royalty rate to Ionis than if
we sell a Lipid Drug for a Broad Disease Patient Population (defined in the agreement as more than 500,000 patients worldwide or an indication that required
a  Phase  3  program  of  1,000  or  more  patients  and  two  or  more  years  of  treatment).  Other  than  with  respect  to  the  drugs  licensed  to  Novartis  under  the
collaboration  agreement,  if  our  annual  sales  reach  $500.0  million,  $1.0  billion  and  $2.0  billion,  we  will  be  obligated  to  pay  Ionis  sales  milestones  in  the
amount of $50.0 million for each sales milestone reached by each Lipid Drug. If and when triggered, we will pay Ionis each of these sales milestones over the
subsequent 12 quarters in equal payments.

We may terminate this agreement if Ionis is in material breach of the agreement. Ionis may terminate this agreement if we are in material breach of
the agreement. In each circumstance the party that is in breach will have an opportunity to cure the breach prior to the other party terminating this agreement.

In the first quarter of 2017, we entered into letter agreements with Ionis to reflect the agreed upon payment terms with respect to the upfront option
payment that we received from Novartis and to allocate the premium that Novartis paid for Ionis' common stock in connection with our strategic collaboration
with Novartis. For additional detail regarding our strategic collaboration with Novartis, see Note 6, Strategic Collaboration with Novartis.

TTR Development, Commercialization, Collaboration and License Agreement

On April 17, 2018, our stockholders, other than Ionis and its affiliates, approved the development, commercialization, collaboration and license
agreement, or TTR License Agreement, and a stock purchase agreement, or Ionis SPA, with Ionis, our majority shareholder which was entered into on March
14, 2018. In addition, in connection with these agreements, we entered into an amended and restated services agreement, or Amended Services Agreement,
and an amended and restated investor rights agreement, or Amended Investor Rights Agreement, with Ionis.

We  determined  that  the  TTR  License  Agreement  and  Ionis  SPA  included  provisions  which  required  the  approval  of  the  agreements  by  our
stockholders  other  than  Ionis  and  its  affiliates,  which  we  deemed  was  not  perfunctory  in  nature,  therefore,  we  concluded  that  the  approved  date  of  the
agreements for accounting purposes was April 17, 2018, the date on which such approval was received and the closing of the agreements took place.

In accordance with the terms and provisions of the TTR License Agreement, we received rights to:

•

•

•

•

•

•

commercialize  TEGSEDI  following  receipt  of  regulatory  approval  and  perform  certain  other  non-commercial  activities  with  respect  to
TEGSEDI, in each case, in accordance with a global strategic plan;

partner  on  the  completion  of  all  pivotal  studies,  of  a  follow-on  drug  to  TEGSEDI,  AKCEA-TTR-LRx  and  perform  other  non-commercial
activities with respect to AKCEA-TTR-LRx;

commercialize AKCEA-TTR-LRx following receipt of regulatory approval in accordance with a global strategic plan;

share in profits and losses with respect to TEGSEDI and AKCEA-TTR-LRx;

manufacture (including through a third party) each product following receipt of regulatory approval for such product; and

sublicense the development and commercialization of either product to third parties or affiliates, with the consent of Ionis.

As consideration for the grant of rights under the TTR License Agreement, we paid an upfront licensing fee of $150.0 million, which was paid
through the issuance of 8 million shares of our common stock priced by reference to a trading average at the time of execution of the agreements. In addition,
we are obligated to make milestone payments to Ionis in connection with the achievement of certain development, regulatory and commercialization events.
These milestone payments include up to $110.0 million, if all TEGSEDI regulatory approval milestones are met; up to $145.0 million, if all AKCEA-TTR-
LRx regulatory milestones are met; and a total of $1.3 billion, in the form of seven milestone payments, if all sales milestones for the combined products are
met. We can elect to pay each milestone payment in cash or shares of our common stock and Ionis may require payment in shares of common stock up until
the achievement of the milestone event for aggregate worldwide annual net sales of $750.0 million for the products. Subsequent to the achievement of the
milestone event for aggregate worldwide annual net sales of $750.0 million, all subsequent milestone payments must be paid in cash.

F-24

 
 
 
 
 
 
 
Under  the  TTR  License  Agreement,  we  and  Ionis  also  agreed  to  share  TEGSEDI  and  AKCEA-TTR-LRx  profits  and  losses  as  follows:  for
TEGSEDI, beginning on the earlier of (i) the first day of the quarter after receipt of regulatory approval of TEGSEDI in the United States, or (ii) January 1,
2019, the parties will share profits and losses from the development and commercialization of TEGSEDI (A) on a 60/40 basis (60% to Ionis and 40% to us)
through the end of the quarter in which the first commercial sale of AKCEA-TTR-LRx occurs, and (B) on a 50/50 basis commencing on the first day of the
first  quarter  thereafter;  and  for  AKCEA-TTR-LRx,  beginning  January  1,  2018,  the  parties  will  share  all  profits  and  losses  from  the  development  and
commercialization of AKCEA-TTR-LRx on a 50/50 basis.

The TTR License Agreement will remain in effect until the expiration of all included payment obligations, or unless earlier terminated. The TTR
License Agreement can be terminated by mutual consent of us and Ionis, by either us or Ionis upon certain events, by either party upon material breach, or by
Akcea for convenience upon providing 90 days written notice to Ionis. Upon termination all rights received under the TTR License Agreement will terminate.

To support the commercialization of TEGSEDI and AKCEA-TTR-LRx, Ionis purchased 10.7 million shares of our common stock for $200 million.

In connection with the licensing transaction, we amended our Certificate of Incorporation to increase our authorized shares of common stock from

100,000,000 shares to 125,000,000 shares.

We  determined  that  the  upfront  accounting  for  the  TTR  License  Agreement  should  follow  the  accounting  guidance  for  common  control

transactions given the nature of the relationship between us and Ionis, including the fact that Ionis maintains a controlling ownership position in us.

In addition, we assessed the identifiable assets that were acquired under the terms of the TTR License Agreement, including the licensed rights to
TEGSEDI  and  AKCEA-TTR-LRx,  certain  batches  of  TEGSEDI  materials,  the  transfer  of  a  minimal  number  of  employees  from  Ionis  to  us  and  certain
manufacturing and clinical research agreements. We concluded that the licensed rights represented a group of similar identifiable assets and that substantially
all of the fair value of the acquisition resides in the licensed rights. As such, we concluded that the acquired assets did not meet the definition of a business
and that we should account for the TTR License Agreement as an asset acquisition under common control guidance. Accordingly, we recorded the carrying
value of the licensed rights held by Ionis of $0.6 million as an intangible asset at the date of acquisition and will amortize the amount over the remaining
patent life.  

In  connection  with  the  transaction,  we  also  purchased  $4.7  million  of  commercial  TEGSEDI  inventory  held  by  Ionis.  Prospectively  we  will  be
responsible for the procurement of all additional inventory. The inventory did not have a carrying value on the books of Ionis at the time of the acquisition. As
such,  in  accordance  with  the  accounting  guidance  for  common  control  transactions  above,  we  recorded  the  purchase  of  this  inventory  as  a  reduction  of
additional  paid  in  capital.  This  amount  represented  a  cash  distribution  to  Ionis,  therefore,  we  have  included  this  distribution  as  a  distribution  to  Ionis  for
purposes of loss per share and we have applied the two–class method as discussed in Note 13, Basic and Diluted Net Loss Per Share.

We also determined that the TTR License Agreement represented a collaboration arrangement as defined by ASC 808. Prior to April 1, 2018, Ionis
was  responsible  for  all  costs  associated  with  TEGSEDI  and  for  the  period  from  April  1,  2018  to  December  31,  2018,  we  are  responsible  for  all  costs
associated with TEGSEDI. We and Ionis share all costs associated with AKCEA-TTR-LRx from January 1, 2018 forward on a 50/50 basis. We recorded $3.1
million paid to Ionis for costs related to the period prior to the closing of the TTR license agreement to equity, as these amounts were previously expensed in
the financial statements of Ionis.  This amount also represents a cash distribution to Ionis and was included as an adjustment to the net loss attributable to
Ionis for purposes of applying the two-class method for loss per share as discussed in Note 13, Basic and Diluted Net Loss Per Share. Any amounts paid to or
received from Ionis subsequent to the closing of the TTR License Agreement will be recorded to expense based on the underlying nature of the activities.

During the year ended December 31, 2018, we recorded $26.0 million, as a component of research and development expense related to the TTR
License Agreement. We did not record any research and development expense related to the TTR License Agreement in the years ended December 31, 2017
and 2016.

F-25

 
In addition, on July 11, 2018, we received marketing authorization, or MA, approval for TEGSEDI from the European Commission, or EC, for the
treatment of stage 1 or stage 2 polyneuropathy in adult patients with hereditary transthyretin amyloidosis, or hATTR amyloidosis, in the European Union, or
EU. As a result of the MA approval in the EU, on August 3, 2018, we issued 1,597,571 shares of our common stock to Ionis as payment of the $40.0 million
regulatory approval milestone for TEGSEDI. As a result of the marketing authorization in the EU, we capitalized this regulatory approval milestone payment
as a license intangible asset on our consolidated balance sheets as the amount in expected to be recoverable through future cash flows.

In addition, on October 5, 2018, we received regulatory approval for TEGSEDI from the FDA for the treatment of polyneuropathy of hereditary
transthyretin-mediated amyloidosis in adults in the United States. As a result of the regulatory approval in the United States, on October 17, 2018 we issued
1,671,849 shares of our common stock to Ionis as payment of the $50.0 million regulatory approval milestone for TEGSEDI. As a result of the FDA approval
in  the  U.S.,  we  capitalized  this  regulatory  approval  milestone  payment  as  a  license  intangible  asset  on  our  consolidated  balance  sheets  as  the  amount  in
expected to be recoverable through future cash flows.

Both milestone payments are being amortized to cost of sales on a straight-line basis over the licensed assets expected useful life of approximately
16 years from the date of the initial regulatory approval milestone achievement. Amortization expense for the TTR milestone payments was $2.7 million for
the year ended December 31, 2018. We did not record any amortization expense for the TTR milestone payments for the years ended December 31, 2017 and
2016.

Services Agreement

We  originally  entered  into  a  services  agreement  with  Ionis  in  December  2015  in  conjunction  with  the  Cardiometabolic  License  Agreement.  We
entered  into  the  Amended  Services  Agreement  with  Ionis  in  April  2018  in  conjunction  with  the  TTR  License  Agreement  (collectively,  the  service
agreements). The primary purpose of the Amended Services Agreement was to allow for the expansion of general and administrative services provided to us
by Ionis to cover the TEGSEDI and AKCEA-TTR-LRx products under terms substantially similar to the prior services agreement.

Our  services  agreement  with  Ionis  is  designed  to  be  flexible  to  adjust  for  our  increasing  capabilities  in  various  functions.  Under  the  services
agreement, Ionis provides us certain services, including, without limitation, general and administrative support services and development support services.
Ionis allocated a certain percentage of personnel to perform the services that it provides to us based on its good faith estimate of the required services. We pay
Ionis for these allocated costs, which reflect the Ionis full-time equivalent, or FTE, rate for the applicable personnel, plus out-of-pocket expenses, such as
occupancy costs, associated with the FTEs allocated to providing us these services. We do not pay a mark-up or profit on the external or internal expenses
Ionis  bills  to  us.  Ionis  invoices  us  quarterly  for  all  amounts  due  under  the  services  agreement  and  payments  are  due  within  30  days  of  the  receipt  of  an
invoice.

In addition, as long as Ionis continues to consolidate our financials, we will comply with Ionis' policies and procedures and internal controls. As

long as we are consolidated into Ionis' financial statements under U.S. GAAP, we may continue to access the following services from Ionis:

•

•

•

•

•

•

•

•

investor relations services,

human resources and personnel services,

risk management and insurance services,

tax related services,

corporate record keeping services,

financial and accounting services,

credit services, and

COO/CFO/CBO oversight.

However,  if  we  wanted  to  provide  the  foregoing  services  internally,  and  doing  so  would  not  negatively  impact  Ionis'  internal  controls  and
procedures for financial reporting, we can negotiate in good faith with Ionis for a reduced scope of services related to the aforementioned services. When
Ionis determines it should no longer consolidate our financials, we may mutually agree with Ionis in writing to extend the term of this arrangement in six-
month increments.

F-26

 
 
 
 
 
 
 
 
 
We can establish our own benefits programs or continue to use Ionis' benefits, however we must provide Ionis a minimum advance notice to opt-

out of using Ionis' benefits. We do not currently plan to establish our own benefits programs at this time or in the near future.

As of December 31, 2018 and 2017, we owed Ionis $18.9 million and $14.4 million, respectively.

The following table summarizes the amounts recorded related to transactions with Ionis including amounts related to the TTR licensing transaction

for the following periods (in thousands):

Operating expenses:

Services performed by Ionis
Active pharmaceutical ingredient manufactured by Ionis
Commercial inventory manufactured by Ionis
Sublicensing expenses
Out-of-pocket expenses paid by Ionis

Total operating expenses generated by transactions with Ionis
Distributions to Ionis:

Commercial inventory manufactured by Ionis
Distribution to Ionis in connection with the TTR license transaction

Total distribution to Ionis
Total charges generated by transactions with Ionis
Payable balance to Ionis at the beginning of the period
Less: total amounts paid to Ionis during the period
Less: non-cash sublicensing expenses
Total amount payable to Ionis at period end

2018

Years Ended December 31,
2017

2016

15,404    $
5,229   
1,288   
7,200   
50,870   
79,991   

4,707   
3,085   
7,792   
87,783   
14,365   
(83,247)  
—   
18,901    $

9,742    $
6,012   
—   
48,394   
37,426   
101,574   

—   
—   
—   
101,574   
24,355   
(78,170)  
(33,394)  
14,365    $

8,599 
12,648 
— 
— 
42,367 
63,614 

— 
— 
— 
63,614 
9,198 
(48,457)
— 
24,355

  $

  $

8.

Collaboration and License Agreement with PTC Therapeutics

In August 2018, we entered into a collaboration and license agreement with PTC Therapeutics, or the PTC License Agreement, to commercialize

TEGSEDI and WAYLIVRA in Latin America and certain Caribbean countries, or the PTC Territory.

We received a $12.0 million upfront payment from PTC Therapeutics related to TEGSEDI in the third quarter of 2018 upon execution of the PTC
License Agreement, of which we paid Ionis $7.2 million as a sub-license royalty related to the TTR License Agreement. If WAYLIVRA is approved by the
FDA  or  EMA,  PTC  Therapeutics  will  pay  us  $6.0  million.  In  addition,  we  are  eligible  to  receive  up  to  $8.0  million  for  the  achievement  of  regulatory
milestones and royalties in the mid-twenty percent range on net sales of TEGSEDI and WAYLIVRA in the PTC Territory. PTC Therapeutics’ obligation to
pay  royalties  to  us  begins  on  the  earlier  of  12  months  after  the  first  commercial  sale  of  a  product  in  Brazil  or  the  date  that  PTC  Therapeutics  recognized
revenue  of  at  least  $10.0  million  in  the  PTC  Territory.  PTC  Therapeutics  will  reduce  these  royalties  upon  the  expiration  of  certain  patents  or  if  a  generic
competitor negatively impacts the market share of the product in the PTC Territory.  Milestone payments and royalties that we are eligible to receive from
PTC  Therapeutics  for  TEGSEDI  will  be  split  60%  to  Ionis  and  40%  to  Akcea.  All  WAYLIVRA  milestone  payments  and  royalties  that  we  are  eligible  to
receive from PTC will be split 50/50 with Ionis. PTC Therapeutics is solely responsible for the commercialization of the products in the PTC Territory at its
sole cost and expense, including the pursuit and maintenance of applicable regulatory approvals. Unless earlier terminated, the PTC License Agreement will
continue in effect until the date on which the royalty term and all payment obligations with respect to all products in all countries in the PTC Territory have
expired.

At the commencement of the PTC License Agreement, we identified two performance obligations, consisting of the transfer of (1) the license to
TEGSEDI and related know-how and (2) the license to WAYLIVRA and related know-how, both of which were satisfied during the third quarter of 2018. In
addition,  we  identified  a  customer  option  related  to  PTC  Therapeutics  option  to  purchase  supply  of  product  from  us  for  its  development  and  commercial
needs. The option to purchase supply from us is subject to a supply agreement we are negotiating with PTC. We considered the manufacturing capabilities of
PTC Therapeutics and the fact that manufacturing services are not proprietary and can be provided by other vendors, to conclude that the licenses have stand-
alone  functionality  and  are  distinct.    Further,  the  customer  options  for  manufacturing  of  product  is  expected  to  be  priced  similar  to  other  manufacturing
options  with  similar  customers  and  is  therefore  not  considered  a  material  right.  As  there  were  no  remaining  unsatisfied  performance  obligations  as  of
September 30, 2018, the $12.0 million upfront payment was recognized as license revenue upon contract execution in the third quarter of 2018. None of the
regulatory milestones have been included in the transaction price, as all

F-27

 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
    
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
    
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
milestones were fully constrained.  As part of our evaluation of the constraint, we considered numerous factors, including that regulatory approvals are not
within  our  control  and  accordingly  the  related  milestones  are  fully  constrained  and  excluded  from  the  arrangement  consideration  until  such  regulatory
approvals are received. Any consideration related to sales-based royalties will be recognized when the related sales occur.

9.

Equity and Stock-Based Compensation

Series A Convertible Preferred Stock

In December 2015, we issued and sold to Ionis an aggregate of 28,884,540 shares of Series A convertible preferred stock for a total purchase price
of  $100.0  million  plus  the  grant  of  the  rights  and  licenses  we  received  under  the  development,  commercialization  and  license  agreement  with  Ionis.  The
$100.0 million of proceeds we received was recorded in Series A convertible preferred stock on our consolidated balance sheet. We had 28,884,540 shares of
Series A convertible preferred stock authorized, issued and outstanding as of December 31, 2016, of which all was held by Ionis.

Conversion

Shares  of  our  Series  A  convertible  preferred  stock  were  convertible  1:1  into  common  stock,  subject  to  certain  adjustments  for  reorganizations,
reclassifications, stock splits, stock dividends and dilutive issuances. All shares of Series A convertible preferred stock automatically converted into common
stock  upon  completion  of  the  IPO  in  July  2017.  As  of  December  31,  2018  and  2017,  we  had  no  shares  of  Series  A  convertible  preferred  stock  issued  or
outstanding. Our IPO is discussed in Note 11, Initial Public Offering.

Preferred Stock

In July 2017, our board of directors approved an amendment and restatement of our certificate of incorporation to, among other things, change the
authorized shares of our preferred stock to 10,000,000 shares with a par value of $0.001, all of which are undesignated.  Our board of directors may establish
the  rights,  preference  and  privileges  of  the  preferred  stock  from  time  to  time. The  amended  and  restated  certificate  of  incorporation  was  approved  by  our
stockholders and became effective upon the completion of our IPO and the filing of the amended and restated certificate of incorporation with the State of
Delaware in July 2017. As of December 31, 2018 and 2017, there were no shares of Preferred Stock outstanding.

Common Stock

At December 31, 2018 and 2017, we had 125,000,000 and 100,000,000, respectively shares of common stock authorized, of which 89,345,978 and

66,541,629 were issued and outstanding as of December 31, 2018 and 2017, respectively.

In May 2017, our board of directors approved an amendment to our certificate of incorporation to (1) effect a reverse stock split on outstanding
shares  of  our  common  stock  and  preferred  stock  on  a  one-for-2.555  basis,  (2)  change  the  authorized  shares  of  our  preferred  stock  to  40,000,000  and  (3)
modify the threshold for automatic conversion of our preferred stock into shares of our common stock in connection with an IPO to eliminate the price per
share threshold and only require that we raise at least $50.0 million in gross proceeds (collectively, the "Charter Amendment"). The par values of the common
stock  and  preferred  stock  were  not  adjusted  as  a  result  of  the  reverse  stock  split.  The  amendment  to  our  certificate  of  incorporation  was  approved  by  our
stockholder and became effective upon the filing with the State of Delaware in June 2017. All issued and outstanding common stock and preferred stock and
related share and per share amounts contained in these consolidated financial statements have been retroactively adjusted to reflect the reverse stock split for
all periods presented.

Stock Plans

2015 Equity Incentive Plan

In December 2015, our board of directors and stockholder adopted and approved our 2015 Equity Incentive Plan, or the 2015 Plan. In May 2017
and  June  2017,  our  board  of  directors  and  stockholder,  respectively,  approved  an  amendment  to  our  2015  Equity  Incentive  Plan  in  order  to,  among  other
things, increase the number of shares of common stock reserved for issuance thereunder to 8,500,000 shares of common stock in conjunction with the IPO.

F-28

 
 
As of December 31, 2018, the aggregate number of shares of common stock that may be issued pursuant to stock awards under the 2015 Plan was
18,500,000 shares. The 2015 Plan also provides for the grant of nonstatutory stock options, or NSOs, incentive stock options, or ISOs, stock appreciation
rights, restricted stock awards and restricted stock unit awards. At December 31, 2018, a total of 11,010,828 options were outstanding, of which 4,305,172
were exercisable, 38,134 restricted stock unit awards were outstanding, and 1,610,490 shares were available for future grant under the 2015 Plan.

2017 Employee Stock Purchase Plan

In  May  2017  and  June  2017,  our  board  of  directors  and  stockholder,  respectively,  approved  our  2017  Employee  Stock  Purchase  Plan,  or  2017
ESPP, which became effective upon the completion of our IPO, and the reservation for issuance thereunder of 500,000 shares of common stock. In addition,
the number of shares of common stock that may be issued under the ESPP will automatically increase commencing on January 1, 2018 and ending on (and
including) January 1, 2027 in an amount equal to the lesser of (i) 1% of the total number of shares of Common Stock outstanding on December 31st of the
preceding calendar year, and (ii) 500,000 shares of Common Stock. On January 1, 2018, 500,000 shares of common stock were added to the ESPP.

As of December 31, 2018, the aggregate number of shares of common stock reserved under the 2017 ESPP was 1,000,000 and we had 968,449
shares available for future issuance under the 2017 ESPP. During the year ended December 31, 2018, 31,551 shares were issued under our 2017 ESPP. At
December 31, 2018, accrued liabilities included $0.4 million of ESPP contributions for which the related shares were issued on January 1, 2019.

Stock Option Activity

The following table summarizes the stock option activity for the year ended December 31, 2018 (in thousands, except per share and contractual life

data) for the 2015 Plan:

Outstanding at December 31, 2017
Granted
Exercised
Cancelled/forfeited/expired
Outstanding at December 31, 2018

Exercisable at December 31, 2018

Number of
Shares

Weighted
Average Exercise
Price per Share  

Average
Remaining
Contractual
Term (Years)

Aggregate
Intrinsic
Value

7,905    $
4,833    $
(835)   $
(892)   $
11,011    $

4,305    $

9.64   
22.86   
7.98   
16.53   
15.00   

8.04   

8.07    $

7.11    $

167,184 

95,124 

The  weighted-average  estimated  fair  value  of  options  granted  were  $18.29,  $10.4  and  $4.13  for  the  years  ended  December  31,  2018,  2017  and
2016, respectively. For the year ended December 31, 2017, no stock options were exercised. For the year ended December 31, 2018, 834,800 stock options
were exercised. As of December 31, 2018, total unrecognized estimated non-cash stock-based compensation expense related to non-vested stock options was
$60.5  million.  We  will  adjust  total  unrecognized  compensation  cost  for  future  forfeitures.  We  expect  to  recognize  the  cost  of  non-cash  stock-based
compensation expense related to non-vested stock options over a weighted average amortization period of 1.32 years.

Stock-based Compensation Expense and Valuation Information

The following table summarizes stock-based compensation expense for the years ended December 31, 2018, 2017 and 2016 (in thousands):

Cost of sales - product
Research and development expenses
Selling, general and administrative expenses
Total

2018

Years Ended December 31,
2017

2016

  $

  $

160 
9,435 
34,687 
44,282 

  $

  $

— 
8,630 
8,909 
17,539 

  $

  $

— 
4,576 
5,573 
10,149

F-29

 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
  
 
 
 
    
 
  
 
 
 
    
 
  
 
 
 
    
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
   
   
   
   
 
 
Determining Fair Value

Valuation. We measure stock-based compensation expense for equity-classified awards related to stock options and stock purchase rights under the

ESPP at the grant date, based on the estimated fair value of the award and we recognize the expense over the employee's requisite service period.

We use the Black-Scholes model to estimate the fair value of stock options granted and stock purchase rights under our ESPP. The expected term of
stock options granted represents the period of time that we expect them to be outstanding. We estimate the expected term of options granted based on actual
and projected exercise patterns. We recognize compensation expense for stock options granted and stock purchase rights under the ESPP using the accelerated
multiple-option  approach.  Under  the  accelerated  multiple-option  approach  (also  known  as  the  graded-vesting  method),  an  entity  recognizes  compensation
expense  over  the  requisite  service  period  for  each  separately  vesting  tranche  of  the  award  as  though  the  award  were  in  substance  multiple  awards,  which
results in the expense being front-loaded over the vesting period.

In  valuing  our  options,  we  make  a  number  of  assumptions,  including  the  risk-free  interest  rate,  expected  dividend  yield,  expected  volatility,

expected term, rate of forfeitures and fair value of common stock. We considered the following factors in applying these assumptions:

Risk-Free Interest Rate.  We  determine  the  risk-free  interest  rate  assumption  based  on  the  yields  of  U.S.  Treasury  securities  with  maturities  that

correspond to the term of the award.

Expected Dividend Yield. We assume a dividend yield of zero as we have not paid dividends in the past and do not expect to pay dividends on our

common stock for the foreseeable future.

Expected Volatility. We do not have sufficient history to estimate the volatility of our common stock. We calculate expected volatility based on a
blend  of  our  historical  volatility  and  reported  data  from  selected  publicly  traded  peer  companies  for  which  historical  information  is  available.  We  plan  to
continue to use this blend to calculate our volatility until the historical volatility of our common stock is sufficient to measure expected volatility for future
option grants.

Expected Term. The expected term estimates represent the period of time that we expect the options to be outstanding. As we do not have historical
information, we use the simplified method for estimating the expected term. Under the simplified method we calculate the expected term as the average time-
to-vesting and the contractual life of the options. As we gain additional historical information, we will transition to calculating our expected term based on our
exercise patterns.

Rate  of  Forfeiture.  We  estimate  forfeitures  based  on  Ionis'  historical  rates  of  forfeiture  as  we  do  not  have  similar  historical  information  for
ourselves. We and Ionis are engaged in similar businesses and we believe this is a good estimate of expected forfeitures. As we gain additional historical
information, we will transition to using our historical forfeiture rate.

Fair  Value  of  Common  Stock.  Prior  to  our  IPO  our  board  of  directors  estimated  the  fair  value  of  our  common  stock  considering,  among  other
things, contemporaneous valuations of our common stock prepared by an unrelated third-party valuation firm in accordance with the guidance provided by
the American Institute of Certified Public Accountants 2013 Practice Aid, Valuation of Privately-Held-Company Equity Securities Issued as Compensation.
Subsequent to the IPO, we use the market closing price for our common stock on the date of grant as reported on Nasdaq to determine the fair value of our
common stock on the date of grant.

For the years ended December 31, 2018, 2017 and 2016, we used the following weighted-average assumptions in our Black-Scholes calculations

for stock option grants under our 2015 Equity Incentive Plan:

Employee Stock Options:

Risk-free interest rate
Dividend yield
Volatility
Expected life

2018

Years Ended December 31,
2017

2016

2.8%  
0.0%  
77.1%  

1.9%  
0.0%  
79.5%  

1.6%
0.0%
71.4%

6.08 years 

6.06 years 

6.08 years

F-30

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Board of Director Stock Options:

Risk-free interest rate
Dividend yield
Volatility
Expected life

10.

Income Taxes

Loss before income taxes is comprised of (in thousands):

United States
Foreign
Loss before income tax expense

The provision (benefit) for income taxes is comprised of (in thousands):

Current:
Federal
State
Foreign
Total current

Deferred:
Federal
State
Foreign
Total deferred
Income tax expense

2018

Years Ended December 31,
2017

2016

2.9%  
0.0%  
78.2%  

1.9%  
0.0%  
79.4%  

2.0%
0.0%
79.6%

6.42 years 

6.25 years 

6.08 years

2018

Years Ended December 31,
2017
(as revised)

2016

  $

  $

(218,794)   $
(6,580)  
(225,374)   $

(108,691)   $
(11,593)  
(120,284)   $

(83,217)
— 
(83,217)

2018

Years Ended December 31,
2017

2016

  $

  $

—    $
73     
374     
447     

—     
—     
—     
—     
447    $

—    $
1,041     
234     
1,275     

—     
—     
—     
—     
1,275    $

— 
— 
— 
— 

— 
— 
— 
— 
—

We  recorded  income  tax  expense  of  $0.4  million  for  the  year  ended  December  31,  2018,  which  primarily  consists  of  foreign  income  tax.    We
recorded income tax expense of $1.3 million for the year ended December 31, 2017, which primarily consists of state and foreign income tax. There is no
provision for income taxes for the year ended December 31, 2016 because we have historically incurred net operating losses and we maintain a full valuation
allowance against our net deferred tax assets.

F-31

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
   
      
      
  
   
   
   
 
   
      
      
  
   
      
      
  
   
   
   
   
 
 
The reconciliation between our effective tax rate on loss from continuing operations and the statutory U.S. tax rate is as follows (in thousands):

Pre-tax loss
Statutory rate
State income tax net of federal benefit
Impact of foreign tax rate differential
Net change in valuation allowance
IP Transfer
Tax credits
IPO/Deconsolidation adjustment
Tax rate change
Nondeductible items and other
Stock-based compensation
Effective rate

2018

  $ (225,374)    
(47,329)    
(6,441)    
1,735     
54,173     
(3,947)    
(4,035)    
—     
3,906     
1,734     
651     
447     

  $

Years Ended December 31,
2017
(as revised)

  $ (120,284)    
(42,099)    
(2,371)    
4,072     
(18,917)    

21.0%    
2.9%    
(0.8)%    
(24.0)%    
1.8%    
1.8%    
— 

(1.7)%    
(0.9)%    
(0.3)%    
(0.2)%   $

4,189     
37,911     
19,046     
(556)    
—     
1,275     

2016

(83,217)    
(29,126)    
(4,099)    
—     
43,438     

(11,007)    
—     
—     
794     
—     
—     

35.0%
4.9%
— 
(52.1)%

13.2%
— 
— 
(1.0)%
— 
—

  $
35.0%    
2.0%    
(3.4)%    
15.7%    

(3.5)%    
(31.5)%    
(15.8)%    
0.5%    
— 

(1.0)%   $

Significant components of our deferred tax assets and liabilities as of December 31, 2017 and 2016 are as follows (in thousands):

Deferred Tax Assets:
Net operating loss carryovers
Tax credits
Stock-based compensation
Deferred revenue
Intangible and capital assets
Other
Total deferred tax assets

Deferred Tax Liabilities:
Fixed assets
Total deferred tax liabilities
Valuation allowance

Net deferred tax assets and liabilities

December 31,

2018

2017
(as revised)

51,280    $
31,768     
11,812     
6,876     
56,984     
1,996     
160,716    $

1,157 
29,334 
7,515 
29,256 
— 
240 
67,502 

(811)    
(811)   $
(159,905)    

(125)
(125)
(67,377)

—    $

—

  $

  $

  $

  $

On December 22, 2017, the U.S. government enacted comprehensive tax legislation commonly referred to as the Tax Cuts and Jobs Act of 2017
(the  "Tax  Act").  The  Tax  Act  created  a  new  requirement  on  global  intangible  low-taxed  income  (“GILTI”)  earned  by  foreign  subsidiaries  for  tax  years
beginning on or after January 1, 2018. The GILTI provisions require foreign subsidiary earnings in excess of an allowable return on the foreign subsidiary’s
assets to be included in our U.S. income tax return. Under U.S. GAAP, we are permitted to make an accounting policy election to either treat taxes due on
future  inclusions  in  U.S.  taxable  income  related  to  GILTI  as  a  current-period  expense  when  incurred  or  to  factor  such  amounts  into  our  measurement  of
deferred taxes. We have made the election to account for GILTI as a component of current taxes incurred rather than as a component of deferred taxes.

F-32

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
  
  
  
   
   
   
   
   
      
  
   
      
  
   
   
   
   
   
   
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
   
      
  
   
   
   
   
   
 
   
      
  
   
      
  
   
   
 
   
      
  
 
 
 
Prior  to  the  completion  of  our  IPO  we  filed  our  tax  returns  on  a  consolidated  and  combined  basis  with  Ionis  for  federal  and  state  income  tax
purposes,  respectively.  For  financial  statement  purposes  when  we  are  required  to  file  on  a  consolidated  or  combined  basis,  we  calculate  our  income  tax
amounts, including net operating losses and tax credit carryforwards, using a separate return methodology which determines income taxes as if we were a
separate taxpayer from Ionis.  Effective July 19, 2017, the date of our IPO, we are no longer included in the consolidated federal income tax return with Ionis.

We  are  still  required  to  file  most  of  our  state  tax  returns  on  a  consolidated  or  combined  basis  with  Ionis.    Therefore,  for  financial  statement
purposes  we  calculated  our  state  income  tax  amounts  using  the  separate  return  method.  We  have  excluded  from  the  deferred  tax  table  above  state  net
operating loss carryforwards (and the associated valuation allowance) that have been generated by Akcea on a separate company basis and utilized by Ionis in
consolidated state tax return filings as the amounts represent hypothetical deferred tax assets which are not legally eligible to be utilized on tax returns by
Akcea in future years.

At  December  31,  2018,  we  had  federal  and  state  tax  net  operating  loss  carry  forwards  on  a  separate  basis  of  $238.7  million  and  $4.2  million,
respectively.  $4.3  million  of  the  federal  net  operating  loss  carry  forwards  will  expire  in  2034  and  the  remaining  $234.4  million  can  be  carried  forward
indefinitely.  The  state  tax  net  operating  loss  carry  forwards  will  begin  to  expire  in  2029.  We  also  have  federal  research  and  development  tax  credit  carry
forwards of $37.4 million that will begin to expire in 2034.

Utilization  of  the  net  operating  loss  carry  forwards  and  credits  may  be  subject  to  an  annual  limitation  due  to  the  ownership  change  limitations
provided by the Internal Revenue Code of 1986, as amended, and similar state provisions. The annual limitation may result in the expiration of net operating
losses and credits before utilization.

We  record  a  valuation  allowance  to  reduce  the  balance  of  our  net  deferred  tax  assets  to  the  amount  we  believe  is  more-likely-than-not  to  be
realized. We have incurred financial statement losses since inception and as a result we have a full valuation allowance recorded against our net deferred tax
assets.  We  regularly  assess  the  future  realization  of  our  net  deferred  tax  assets  and  will  reduce  the  valuation  allowance  in  any  such  period  in  which  we
determine that all, or a portion, of our deferred tax assets are more-likely-than-not to be realized.

Our  valuation  allowance  increased  by  $92.5  million  from  December  31,  2017  to  December  31,  2018.  The  increase  relates  primarily  to  the  net
operating loss carryforward generated in 2018 and certain costs associated with the Inotersen transaction with Ionis which are capitalized and amortized for
tax purposes.

Pursuant  to  the  SEC  Staff  Accounting  Bulletin  No.  118,  Income  Tax  Accounting  Implications  of  the  Tax  Cuts  and  Jobs  Act  (“SAB  118”),  a
company  may  select  between  one  of  three  scenarios  to  determine  a  reasonable  estimate  arising  from  the  Tax  Act.  Those  scenarios  are  (i)  a  final  estimate
which effectively closes the measurement window; (ii) a reasonable estimate leaving the measurement window open for future revisions; and (iii) no estimate
as the law is still being analyzed. The Company was able to provide a reasonable estimate for the provisional revaluation of deferred taxes and the effects of
the transition tax on undistributed foreign earnings and profits for the period ended December 31, 2017. During the quarter ended December 31, 2018 the
Company completed its accounting for the impacts of the Tax Act and identified no material changes from its original analysis.

In  February  2018,  the  FASB  issued  Accounting  Standards  Update  No.  2018-02,  Income  Statement—Reporting  Comprehensive  Income  (Topic
220):  Reclassification  of  Certain  Tax  Effects  from  Accumulated  Other  Comprehensive  Income  (ASU  2018-02),  which  allows  companies  to  reclassify
stranded  tax  effects  resulting  from  the  Tax  Act,  from  accumulated  other  comprehensive  income  to  retained  earnings.  The  new  standard  is  effective  for  us
beginning January 1, 2019, with early adoption permitted. We elected to early adopt the new standard at the beginning of the fourth quarter of 2018 using the
aggregate portfolio approach. We elected not to reclassify the income tax effects of the Tax Act from AOCI to retained earnings.

We analyze our filing positions in all the U.S. federal, state and foreign jurisdictions where we are required to file income tax returns to determine
if we have any uncertain tax positions on any income tax returns. We recognize the impact of an uncertain tax position on an income tax return at the largest
amount  that  the  relevant  taxing  authority  is  more-likely-than  not  to  sustain  upon  audit.  We  do  not  recognize  a  tax  benefit  if  the  position  has  a  less  than
50 percent likelihood of being sustained upon examination.

F-33

 
The following table summarizes our gross unrecognized tax benefits (in thousands):

Beginning balance of unrecognized tax benefits
Additions related to the current year
Decreases related to prior year tax positions
Ending balance of unrecognized tax benefits

Years Ended December 31,

2018

2017

2016

5,001    $
691     
(86)    
5,606    $

5,012    $
1,723     
(1,734)    
5,001    $

1,766 
3,246 
— 
5,012

  $

  $

We have unrecognized tax benefits of $5.6 million and $5.0 million for the years ended December 31, 2018 and 2017, respectively. Due to our

valuation allowance, there are no unrecognized tax benefits at December 31, 2018 that would impact our effective tax rate, if recognized.

We do not foresee any material changes to our gross unrecognized tax benefits within the next twelve months.

We recognize interest and/or penalties related to income tax matters in income tax expense. We did not recognize any accrued interest and penalties

related to gross unrecognized tax benefits during the year ended December 31, 2018, 2017 or 2016.

We  are  subject  to  taxation  in  the  United  States  and  various  state  and  foreign  jurisdictions.  The  tax  years  for  2014  through  2018  are  subject  to

examination by the U.S. federal, state and foreign tax authorities.

We do not provide for a U.S. income tax liability and foreign withholding taxes on undistributed foreign earnings of our foreign subsidiaries as we

consider those earnings to be permanently reinvested. The amount of unrecognized deferred tax liabilities associated with these earnings is immaterial.

11.

Initial Public Offering

On July 19, 2017, we completed our IPO. Total net proceeds were $182.3 million, including the following:

•

•

$132.3 million from the sale of 17,968,750 shares of our common stock in our IPO of which $25.0 million was invested by Ionis; and

$50.0 million from the purchase of 6,250,000 shares by Novartis in a concurrent private placement.

In addition, both of the following occurred in connection with the completion of our IPO on July 19, 2017:

•

•

the conversion of all outstanding shares of Series A convertible preferred stock into 28,884,540 shares of our common stock; and

the  conversion  of  $106.0  million  of  outstanding  principal  plus  accrued  interest  from  the  line  of  credit  into  13,438,339  shares  of  common
stock.

12.

Employment Benefits

We have an employee 401(k) salary deferral plan covering all employees. Employees may make contributions by withholding a percentage of their
salary up to the IRS annual limit $18,500 and $24,500 in 2018 for employees under 50 years old and employees 50 years old or over, respectively. We made
approximately $1.6 million, $0.3 million and $0.2 million in matching contributions for the years ended December 31, 2018, 2017 and 2016, respectively.

F-34

 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
13.

Basic and Diluted Net Loss Per Share

We issued 28,884,540 shares of Series A convertible preferred stock in December 2015. The Series A convertible preferred stock converted into
common stock in conjunction with the IPO in July 2017. As a result there were 66,541,629 shares of common stock issued and outstanding and there were no
longer any outstanding shares of Series A convertible preferred stock. We determined that the Series A convertible preferred stock was in substance common
stock  during  the  period  that  it  was  outstanding  because  the  Series  A  convertible  preferred  stock  was  the  lowest  form  of  subordinated  equity  outstanding
during that period and this class of stock would have been required to absorb the losses of the Company. Accordingly, we are using the two-class method for
computing EPS.

In  connection  with  the  TTR  License  Agreement  completed  on  April  17,  2018  with  Ionis,  we  made  distributions  to  Ionis  representing  the
consideration to be paid in cash provided to Ionis in excess of the carrying value of the related assets acquired. These distributions are treated as dividends to
Ionis; therefore, we have applied the two-class method loss per share to reflect the allocation of these distributions to the participating Ionis common shares.

The two-class method is an earnings allocation formula that determines loss per share for each class of common stock and participating security
according to dividends declared (or accumulated) and participation rights in undistributed earnings. For the purposes of calculating loss per share under the
two-class method, we have allocated the net loss between the Series A convertible preferred stock, common stock owned by Ionis and common stock owned
by others.

Basic loss per share for each class of stock is computed by dividing total distributable losses applicable to Series A convertible preferred stock,
common stock owned by Ionis and common stock owned by others, including the 6% cumulative dividend contractually due to Series A convertible preferred
shareholders, by the weighted-average of preferred and common shares outstanding during the requisite period. The cumulative preferred stock dividend was
not  paid  upon  completion  of  the  IPO  because  the  IPO  was  not  a  liquidation  event  or  a  change  in  control.  Prior  to  the  IPO,  the  6%  cumulative  Series  A
convertible preferred stock dividend was considered as required under the two-class method regardless of whether those dividends were actually distributed.

The following table summarizes the distributable losses for the years ended December 31, 2018, 2017 and 2016:

Net loss
Preferred stock dividend
Distributions to Ionis
Distributable losses

  $

  $

2018

(225,821)   $

—   
(7,792)  
(233,613)   $

Year Ended
December 31,
2017

(121,559)   $
(20,100)  
—   

(141,659)   $

2016

(83,217)
— 
— 
(83,217)

The following table summarizes the reconciliation of weighted-average shares outstanding used in the calculation of basic loss per share for the

years ended December 31, 2018, 2017 and 2016:

Determination of shares:
Weighted-average preferred shares outstanding
Weighted-average common shares outstanding
   owned by Ionis
Weighted-average common shares outstanding
   owned by others
Total weighted-average shares outstanding

Year Ended
December 31,

2018

—   

2017
15,748,009   

2016
28,884,540 

59,812,394   

20,669,446   

— 

21,553,407   
81,365,801   

9,593,322   
46,010,777   

— 
28,884,540

F-35

 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The  following  table  summarizes  the  calculation  of  basic  loss  per  share  for  the years  ended  December  31,  2018,  2017  and  2016  (in  thousands,

except per share amounts):

Losses attributable to preferred shares
Less: Assumed dividend to preferred shares
Income (losses) allocated to preferred shares
Weighted-average preferred shares outstanding
Basic loss per preferred share

Losses allocated to Ionis

Plus: Distribution to Ionis

Losses available to Ionis
Weighted-average common shares outstanding
   owned by Ionis
Basic loss per common share owned by Ionis

Losses allocated to common shares owned by others
Weighted-average common shares outstanding
   owned by others
Basic loss per common share owned by others

2018

Year Ended
December 31,
2017

—    $
—   
—   
—   
—    $

(48,485)   $
20,100   
(28,385)  
15,748,009   

(1.80)   $

2016

(83,217)
— 
(83,217)
28,884,540 
(2.88)

(171,730)   $
7,792   
(163,938)  

(63,638)   $

—   
(63,638)  

59,812,394   

20,669,446   

(2.74)   $

(3.08)   $

(61,883)   $

(29,536)   $

21,553,407   

9,593,322   

(2.87)   $

(3.08)   $

— 
— 
- 

— 
— 

— 

— 
—

  $

  $

  $

  $

  $

  $

For the years ended December 31, 2018, 2017 and 2016, we incurred a net loss; therefore, we did not include dilutive common equivalent shares in
the computation of diluted net loss per share because the effect would have been anti-dilutive. Common stock from the following would have had an anti-
dilutive effect on net loss per share:

•

•

•

Options to purchase common stock;

Unvested restricted stock units; and

Employee Stock Purchase Plan.

14.

Contractual Obligations and Commitments

The following table summarizes the contractual obligations as of December 31, 2018 (in thousands):

Year Ending December 31,
Operating lease obligations
Purchase commitments
Total

Operating Lease

Total

Less than 1 year

Payments due by period
1 to 3 years

3 to 5 years

  $

  $

23,688 
5,033 
28,721 

 $

 $

2,308 
5,033 
7,341 

 $

 $

4,711 
- 
4,711 

 $

 $

4,805 
- 
4,805 

  More than 5 years
 $

11,864 
- 
11,864

 $

On April 5, 2018, we entered into an operating lease agreement with MEPT Seaport 13 Stillings LLC, or MEPT, for 30,175 square feet of office
space located in Boston, Massachusetts for our new corporate headquarters. The commencement date of the lease was August 2018 and the initial term of the
lease  is  123  months  with  one  five-year  renewal  option.  We  took  occupancy  of  the  office  space  in  Boston,  Massachusetts  in  September  2018.  MEPT  is
providing  us  with  a  three-month  free  rent  period,  which  commenced  on  August  15,  2018,  and  a  tenant  improvement  allowance  up  to  $3.8  million.  We
provided MEPT with a letter of credit to secure our obligations under the lease in the initial amount of $2.4 million, to be reduced to $1.8 million on the third
anniversary of the rent commencement date and to $1.2 million on the fifth anniversary of the rent commencement date if we meet certain conditions set forth
in the lease at each such time. This balance is included in deposits and other assets on the accompanying consolidated balance sheets.

F-36

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
    
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
    
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
  
  
  
 
On  November  12,  2018,  we  entered  into  an  operating  lease  agreement  with  Ionis  Pharmaceuticals  to  sublease  4,723  square  feet  of  office  space

located in Carlsbad, California.  The commencement date was March 2018 and the term of the lease is 64 months with a four-month free rent period.

Rent expense for the year ended December 31, 2018, 2017 and 2016 was $2.4 million, $0.7 million and $0.4 million, respectively.  We recognize
rent  expense  on  a  straight-line  basis  over  the  lease  term  for  the  lease  of  our  office  spaces,  which  resulted  in  a  deferred  rent  balance  of  $4.8  million  and
$39,000 at December 31, 2018 and 2017, respectively.

Purchase Commitments

Purchase  commitments  include  agreements  to  purchase  goods  or  services  that  are  enforceable  and  legally  binding  on  us  and  that  specify  all
significant terms, including, fixed or minimum quantities to be purchased; fixed, minimum or variable price provisions; and the approximate timing of the
transaction.  Such obligations are related principally to inventory purchase orders based on our current manufacturing needs and require significant lead times
to be fulfilled by our vendors.  Purchase commitments exclude agreements that are cancelable without penalty.

15.

Restructuring

On September 6, 2018, we enacted a plan to reorganize our workforce to better align with the immediate needs of our business, the Reorganization
Plan, following the August 27, 2018 announcement of the FDA’s issuance of a Complete Response Letter for our New Drug Application for WAYLIVRA. In
connection with the Reorganization Plan, we reduced our workforce by approximately 12%. The Reorganization Plan was approved by our board of directors
on September 2, 2018, and affected employees were informed on September 6, 2018. The Reorganization Plan impacted U.S. team members primarily from
the WAYLIVRA field team and functions focused principally on WAYLIVRA.

For the year ended December 31, 2018, we recorded $1.7 million of restructuring-related costs in operating expense including employee severance,
benefits and related costs, net of adjustments for employees who forfeited part of their benefits. In addition, we also recorded $0.4 million of non-cash stock
option modifications expenses related to the Reorganization Plan for the year ended December 31, 2018. We do not expect to incur any additional significant
costs associated with this reorganization.

The following table summarizes the restructuring costs by category for the periods indicated (in thousands):

Research and development
Selling, general and administrative
Total

Cash

Year Ended December 31, 2018
Adjustment

Non-Cash

  $

  $

327    $

1,562   
1,889    $

(34)
(116)
(150)

 $

 $

209    $
200    $
409    $

Total

502 
1,646 
2,148

The following table summarizes the restructuring reserve included in accrued compensation for the periods indicated (in thousands):

Restructuring reserve beginning balance
Restructuring expenses incurred during the period
Adjustments during the period
Amounts paid during the period
Restructuring reserve ending balance

F-37

Year Ended December
31, 2018

  $

  $

— 
1,889 
(150)
(1,696)
43

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
16.

Quarterly Financial Data (Unaudited)

The  following  financial  information  reflects  all  normal  recurring  adjustments,  which  are,  in  the  opinion  of  management,  necessary  for  a  fair
statement of the results of the interim periods. Summarized quarterly data for the years ended December 31, 2018 and 2017 are as follows (in thousands,
except per share data):

2018 Quarters
Revenue:

Commercial revenue:
Product revenue
Licensing revenue

Total commercial revenue

Research and development revenue under collaborative
   agreement

Total revenue

Expenses:

Cost of sales - product
Cost of sales - intangible asset amortization
Cost of license
Research and development
Selling, general and administrative

Total expenses

Loss from operations

Other income (expense):
Investment income
Interest expense
Other income (expense)

First
Quarter

Second
Quarter

Third
Quarter

Fourth
Quarter

  $

—    $
—     
—     

—    $
—     
—     

—    $
12,000     
12,000     

17,108     
17,108     

18,321     
18,321     

7,241     
19,241     

—     
—     
—     
27,970     
19,465     
47,435     

—     
—     
—     
39,457     
42,287     
81,744     

1,043     
701     
7,200     
29,381     
45,924     
84,249     

2,237 
— 
2,237 

7,960 
10,197 

777 
2,012 
— 
33,532 
45,934 
82,255 

(30,327)    

(63,423)    

(65,008)    

(72,058)

868     
—     
(168)    

1,546     
—     
45     

1,675     
—     
(25)    

1,542 
— 
(41)

Loss before income tax expense

(29,627)    

(61,832)    

(63,358)    

(70,557)

Income tax expense

Net loss

Net loss per share of preferred stock, basic and diluted

Weighted-average shares of preferred stock outstanding,
   basic and diluted

Net loss per share of common stock owned by Ionis,
   basic and diluted

Weighted-average shares of common stock outstanding
   owned by Ionis, basic and diluted

Net loss per share of common stock owned by others,
   basic and diluted

Weighted-average shares of common stock outstanding
   owned by others, basic and diluted

  $

  $

—     

(214)    

(233)    

— 

(29,627)   $

(62,046)   $

(63,591)   $

(70,557)

—    $

—    $

—    $

—     

—     

—     

— 

— 

  $

(0.44)   $

(0.72)   $

(0.73)   $

(0.79)

    45,447,879     

60,832,494     

65,538,467     

67,129,553 

  $

(0.44)   $

(0.85)   $

(0.73)   $

(0.79)

    21,171,372     

21,492,157     

21,671,415     

21,869,713

F-38

 
 
 
   
   
   
 
   
      
      
      
  
   
      
      
      
  
   
   
   
   
 
   
      
      
      
  
   
      
      
      
  
   
   
   
   
   
   
 
   
      
      
      
  
   
 
   
      
      
      
  
   
      
      
      
  
   
   
   
 
   
      
      
      
  
   
 
   
      
      
      
  
   
 
   
      
      
      
  
 
   
      
      
      
  
   
 
2017 Quarters

Revenue:

Commercial revenue:
Product revenue
Licensing revenue

Total commercial revenue

Research and development revenue under collaborative
   agreement

Total revenue

Expenses:

Cost of sales - product
Cost of sales - intangible asset amortization
Cost of license
Research and development
Selling, general and administrative

Total expenses

Loss from operations

Other income (expense):
Investment income
Interest expense
Other income (expense)

First
Quarter

Second
Quarter

Third
Quarter

Fourth
Quarter

  $

—    $
—     
—     

(as revised)

—    $
—     
—     

—    $
—     
—     

— 
— 
— 

6,094     
6,094     

5,713     
5,713     

9,906     
9,906     

21,688 
21,688 

—     
—     
—     
64,794     
4,676     
69,470     

—     
—     
—     
18,487     
6,915     
25,402     

—     
—     
—     
17,640     
8,373     
26,013     

— 
— 
— 
25,968 
17,018 
42,986 

(63,376)    

(19,689)    

(16,107)    

(21,298)

61     
(541)    
—     

245     
(965)    
50     

687     
(224)    
73     

819 
— 
(19)

Loss before income tax expense

(63,856)    

(20,359)    

(15,571)    

(20,498)

Income tax expense

Net loss

Net loss per share of preferred stock, basic and diluted

Weighted-average shares of preferred stock outstanding,
   basic and diluted

Net loss per share of common stock owned by Ionis,
   basic and diluted

Weighted-average shares of common stock outstanding
   owned by Ionis, basic and diluted

Net loss per share of common stock owned by others,
   basic and diluted

Weighted-average shares of common stock outstanding
   owned by others, basic and diluted

  $

  $

—     

—     

(2,066)    

791 

(63,856)   $

(20,359)   $

(17,637)   $

(19,707)

(2.21)   $

(0.70)   $

(0.01)   $

    28,884,540     

28,888,450     

5,651,323     

— 

— 

  $

—    $

—    $

(0.33)   $

(0.30)

—     

—     

36,555,903     

45,447,879 

  $

—    $

—    $

(0.33)   $

(0.30)

—     

—     

16,966,712     

21,093,750

(1)

(2)

We  computed  net  loss  per  share  independently  for  each  of  the  quarters  presented.  Therefore,  the  sum  of  the  quarterly  net  loss  per  share  will  not
necessarily equal the total for the year.
For the purposes of calculating EPS under the two-class method since our IPO in July 2017, we have allocated the net loss between the common stock
and  the  Series  A  convertible  preferred  stock  for  the  three-month  period  ended  September  30,  2017.  We  determined  it  was  appropriate  to  allocate
losses to the Series A convertible preferred stock because it was the lowest form of subordinated equity during such period and because Ionis, the sole
holder of the Series A convertible preferred stock, was

F-39

 
 
 
   
   
   
 
 
 
 
   
      
      
      
  
   
      
      
      
  
   
   
   
   
 
   
      
      
      
  
   
      
      
      
  
   
   
   
   
   
   
 
   
      
      
      
  
   
 
   
      
      
      
  
   
      
      
      
  
   
   
   
 
   
      
      
      
  
   
 
   
      
      
      
  
   
 
   
      
      
      
  
 
   
      
      
      
  
   
   
 
 
absorbing our losses during such period. Basic EPS for each class of stock is computed by dividing total distributable losses applicable to preferred
and common stock, including the 6% cumulative dividend contractually due to Series A convertible preferred shareholders, by the weighted-average
of preferred and common shares outstanding during the requisite period. The cumulative preferred stock dividend was not paid upon completion of
the IPO because the IPO was not a liquidation event or a change in control. Prior to the IPO, the 6% cumulative Series A convertible preferred stock
dividend was considered as required under the two-class method regardless of whether those dividends were actually distributed.

The following table summarizes the distributable losses for the quarter ended September 30, 2017 (in thousands):

Net loss
Preferred stock dividend
Distributable losses

September 30,
2017
(as revised)

  $

  $

(17,637)
(1,791)
(19,428)

The  following  table  summarizes  the  reconciliation  of  weighted-average  shares  outstanding  used  in  the  calculation  of  basic  EPS  for  the  quarter

ended September 30, 2017:

Determination of shares:
Weighted-average preferred shares outstanding
Weighted-average common shares outstanding
Total weighted-average shares outstanding

September 30,
2017

5,651,323 
53,522,615 
59,173,938

The following table summarizes the calculation of basic EPS for the quarter ended September 30, 2017 (in thousands, except per share amounts):

Losses attributable to preferred shares
Less: Assumed dividend to preferred shares
Income (losses) allocated to preferred shares
Weighted-average preferred shares outstanding
Basic income (loss) per preferred share

Losses allocated to common shares
Weighted-average common shares outstanding
Basic loss per common share

September 30,
2017
(as revised)

  $

  $

  $

  $

  $

(1,855)
1,791 
(64)
5,651,323 
0.01 

(17,573)
53,522,615 
(0.33)

(3)

We  did  not  include  dilutive  common  equivalent  shares  in  the  computation  of  diluted  net  loss  per  share  because  the  effect  would  have  been
antidilutive.

17.

Subsequent Events

AKCEA-APO(a)-LRx License Fee

On February 22, 2019, Novartis exercised its option to license AKCEA-APO(a)-LRx as part of our strategic collaboration with Novartis discussed
in Note 6, Strategic Collaboration with Novartis.  As  a  result  we  earned  a  license  fee  of  $150.0  million  of  which  we  will  pay  $75.0  million  to  Ionis  as  a
sublicense fee. We will issue 2,837,373 shares of our common stock to Ionis as payment of the $75.0 million sublicense fee.

F-40

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
SUBLEASE

Exhibit 10.3

This Sublease (the "Sublease") is made and entered into as of November 12, 2018 ("Effective Date") between Ionis Pharmaceuticals, Inc., a
Delaware corporation ("Sublessor"), with its principal place of business at 2855 Gazelle Court, Carlsbad, CA 92010 and Akcea Therapeutics,
Inc., a Delaware corporation ("Subtenant"), with its principal place of business at 22 Boston Wharf Road, 9th Floor, Boston, MA 02210.

1.
Premises: In accordance with that certain Standard Industrial/Commercial Multi-Tenant Lease - Net dated January 25, 2018 between
Sublessor and Landlord (defined below) (“Prime Lease”), Sublessor leases from SR22 Carlsbad I, LLC, a California limited liability company;
APG Carlsbad I, LLC, a California limited liability company; and PRE IV C Oaks, LLC, a California limited liability company (collectively
"Landlord") certain premises containing approximately 18,710 rentable square feet of industrial space in the approximate aggregate 156,977
square foot in the project known as Elevate located at 2870 Whiptail Loop, Suite 102, Carlsbad, CA 92010 ("Leased Premises"). The Leased
Premises are further described in the Prime Lease, a copy of which is attached hereto as Exhibit A and is incorporated by reference herein.

Demise: In accordance with this Sublease, Sublessor hereby subleases to Subtenant, and Subtenant hereby subleases from Sublessor,

2.
4,723 square feet of the Leased Premises ("Subleased Premises"). The actual Subleased Premises is located within that portion of the Leased
Premises identified in yellow on Exhibit B attached hereto. Subject to the terms of the Prime Lease, at no additional charge to Subtenant (except
such charges as may be included in the Common Area Operating Expenses in accordance with the terms of the Prime Lease, Subtenant shall
have the right to use all associated common areas and shall have such other use and access rights as may be necessary for the exercise of its
rights and the performance of its obligations hereunder, including, but not limited to, access to electrical, phone and data rooms, existing phone
and data wiring infrastructure, and restrooms.

3.
subject and subordinate.

Sublease: This Sublease is subject and subordinate to the Prime Lease and to the matters to which the Prime Lease is or shall be

Term: The parties acknowledge and agree that Subtenant took possession of the premises on March 15, 2018, the usage of which was

4.
in accordance with the provisions of this Sublease.  As such, for the purposes of this Agreement, the Sublease commenced on March 15, 2018
and shall expire on June 29, 2023 (the "Term"), unless sooner terminated in accordance with this Sublease.

Prime Lease: The Prime Lease is incorporated herein by reference so that, except to the extent that certain provisions of the Prime

5.
Lease are inapplicable or modified by this Sublease, or excluded below, each and every term, covenant and condition of the Prime Lease
binding or inuring to the benefit of Landlord shall, in respect of the Sublease, bind or inure to the benefit of Sublessor, and each and every term,
covenant and condition of the Prime Lease binding or inuring to the benefit of lessee thereunder shall, in respect to the Sublease, bind or inure
to the benefit of Subtenant, with the same force and effect as if such terms, covenants and conditions were completely set forth in the Sublease,
and as if the words "Lessor(s)" and "Lessee(s)", or words of similar import, wherever the same appear in the Prime Lease, were construed to
mean, respectively, "Sublessor" and "Subtenant" in the Sublease, and as if the words "Leased Premises", "Premises", "Leased Property", or
words of similar import, wherever the same appear in the Prime Lease, were construed to mean "Subleased Premises" in the Sublease, and as if
the word "Lease", or words of similar import, wherever the same appear in the Prime Lease, were construed to mean the "Sublease."

If any of the express provisions of the Sublease shall conflict with any of the provisions of the Prime Lease incorporated by reference herein,
such conflict shall be resolved in every instance in favor of the express provisions of the Sublease. Notwithstanding the foregoing or anything
to the contrary contained herein, Subtenant shall not have the right to exercise any renewal options, expansion options, rights of first offer or
similar rights set forth in the Prime Lease.

Rent: Subtenant shall pay a portion of the total rent paid by Sublessor, including base rent, additional costs and other charges

6.
(collectively referred to herein as "Rent") as set forth on Exhibit C. Subtenant shall make all payments to Sublessor at the address set forth
herein or to such other place as Sublessor may designate in writing. If the Effective Date is other than the first day of a calendar month, the
Rent for the first month shall be prorated and shall be tendered to Sublessor on the first day of the following calendar month.

Performance by Sublessor: Any obligations of Sublessor which are contained in the Sublease by the incorporation by reference of

7.
the provisions of the Prime Lease shall be observed or performed by Sublessor using reasonable efforts to cause the Landlord to observe and/or
perform the same (which obligations include, without limitation, services to be provided by Landlord and restoration of damaged property), and
Sublessor shall diligently enforce its rights to cause such observance or performance. Subtenant shall not in any event have any rights in respect
of the Subleased Premises greater than Sublessor's right with respect thereto under the Prime Lease.

No Breach of Prime Lease:  Subtenant shall not take any action or omission which may constitute (or be reasonably likely to lead

8.
to) a breach or violation of any term, covenant or condition of the Prime Lease by the lessee thereunder, whether or not such act or thing is
permitted under the provisions of the Sublease. Sublessor shall not take any action or omission which may constitute (or be reasonably likely to
lead to) a breach or violation of any term, covenant or condition of the Prime Lease.

9.
between Subtenant and the Landlord.

No Privity of Estate or Contract: Nothing contained in the Sublease shall be construed to create privity of estate or of contract

Indemnity:  Subtenant shall indemnify and hold harmless Sublessor from any claims, liabilities and damages that Sublessor may

10.
sustain as a result of a breach by Subtenant of this Sublease. Sublessor shall indemnify and hold harmless Subtenant from any claims, liabilities
and damages that Subtenant may sustain as a result of a breach by Sublessor of this Sublease.

11.
Releases: Subtenant hereby releases Sublessor or anyone claiming through or under the Sublessor by way of subrogation or
otherwise.  Subtenant hereby releases the Landlord or anyone claiming through or under the Landlord by way of subrogation or otherwise to
the extent that Sublessor, as tenant, released the Landlord pursuant to the terms of the Prime Lease, and/or the Landlord was relieved of liability
or responsibility pursuant to the provisions of the Prime Lease. Subtenant will cause its insurance carriers to include any clauses or
endorsements in favor of the Sublessor, Landlord and any additional parties which Sublessor is required to provide pursuant to the provisions of
the Prime Lease with respect to the Subleased Premises.

Use: Subtenant shall use and occupy the Subleased Premises solely for general office purposes and lawful uses incidental thereto in
12.
accordance with the provisions of the Prime Lease. Any other activities not specifically mentioned above regarding the use and occupancy of
the Subleased Premises are subject to the prior written approval of Sublessor and Landlord.

Condition of Subleased Premises:  Subtenant is leasing the Subleased Premises in its "as is," "where is" condition on the date hereof.

13.
On or before the end of the Term of the Sublease, or earlier termination or expiration of this Sublease, Subtenant shall restore the Subleased
Premises to the condition existing as of the commencement of the Term of the Sublease ordinary wear and tear excepted.  The obligations of
Subtenant hereunder shall survive the expiration or earlier termination of this Sublease.

Consent and Approvals: Sublessor shall reasonably cooperate to seek Landlord's consent to any matter under the Prime Lease as may

14.
be reasonably requested by Subtenant. Pursuant to the provisions of the Prime Lease, consent of the Landlord is not required for any
assignment or sublease by Sublessor to a Lessee Affiliate as such term is defined in the Prime Lease.  

Notices:  Any notice, report, statement, approval, consent, designation, demand or request to be given under this Sublease shall be

15.
effective when made in writing, deposited for mailing with the United States Postal Service or with a recognized overnight delivery service and
addressed to Sublessor or Subtenant at the following addresses:

Subtenant:

With an email copy to:

  Akcea Therapeutics, Inc.
  22 Boston Wharf Road, 9th Floor
  Boston, MA 02210
  Attn: Chief Operating Officer

  Akcea Therapeutics, Inc.
  22 Boston Wharf Road, 9th Floor
  Boston, MA 02210
  Attn: Vice President, Legal

  With an email copy to: legalnotices@akceatx.com

Sublessor:

  Ionis Pharmaceuticals, Inc.
  2855 Gazelle Court
  Carlsbad, CA 92010
  Attn: Legal Department

With an email copy to: legalnotices@ionisph.com

Sublessor shall promptly give written notice to Subtenant of (i) all claims, demands or controversies by or with the Landlord under the Prime
Lease and (ii) any events which require that Sublessor give notice to Landlord under the Prime Lease, which would materially affect
Subtenant's rights or obligations hereunder.

Termination: If for any reason the Prime Lease shall terminate prior to the expiration of the Sublease Term, this Sublease shall

16.
thereupon be terminated and Sublessor shall have no liability whatsoever to Subtenant by reason thereof (unless the termination occurred as a
result of Sublessor's default or breach under the Prime Lease.

Assignment and Subletting: Subtenant shall not sublet the Subleased Premises or any part thereof or assign the Sublease or otherwise

17.
encumber or dispose of its interest therein without Sublessor's and Landlord's prior written consent in each instance, which consent may be
withheld in Sublessor's and/or Landlord's sole discretion.

Insurance: Subtenant shall, throughout the Term of this Sublease, maintain for the Subleased Premises comparable insurance coverage
18.
as required of Sublessor under the Prime Lease. Such insurance shall, in addition to complying with the requirements of the Prime Lease, name
Sublessor as an additional insured.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
19.
Default:  The default provisions set forth in the Prime Lease are incorporated herein by reference, provided that Subtenant shall have a
five (5) day notice and cure period for monetary default and a thirty (30) day notice and cure period for non-monetary default (unless such non-
monetary default is not capable of cure within thirty (30) days, in which case Subtenant shall have a reasonable period of time in which to
effect a cure, so long as Subtenant diligently prosecutes the cure to completion). In addition, Subtenant shall be responsible for payment of any
applicable late charges and fees as set forth in the Prime Lease arising out of any default by Subtenant.

Brokerage:  Each party represents and warrants to the other that no broker or other person had any part, or was instrumental in any

20.
way, in bringing about the Sublease. Each party agrees to indemnify, defend and hold harmless the other from and against any claims made by
any broker or other person for a brokerage commission, finder's fee, or similar compensation, by reason of or in connection with the Sublease,
and any loss, liability, damage, cost and expense (including, without limitation, reasonable attorney's fees) which may be incurred in connection
with such claims if such other broker or other person claims to have had dealings with such party.

Waiver of Jury Trial and Right to Counterclaim: Each party hereby waives all right to trial by jury in any action, proceeding or

21.
counterclaim arising out of or in any way connected with the Sublease, the relationship of Sublessor and Subtenant, the Subleased Premises and
the use and occupancy thereof, and any claim of injury or damages.

Modifications:  The Sublease cannot be changed orally or in any manner other than by a written agreement executed by both parties.
22.
Sublessor shall not amend the Prime Lease with respect to any material provision that would materially affect Subtenant's rights or obligations
hereunder without Subtenant's prior written consent.

Successors and Assigns:  The provisions of the Sublease, except as herein otherwise specifically provided, shall extend to, bind and

23.
inure to the benefit of the parties hereto and their respective personal representatives, heirs, successors and permitted assigns.

24.
Interpretation:  This Sublease shall be governed by and construed in accordance with the laws of the state in which the Subleased
Premises are located. If any provision of the Sublease or application thereof to any person or circumstance shall, for any reason and to any
extent, be invalid or unenforceable, the remainder of the Sublease and the application of that provision to other persons or circumstances shall
not be affected but rather shall be enforced to the extent permitted by law. The captions and headings are solely for convenience of reference
and shall be construed without regard to any presumption or other rule requiring construction against the party causing the Sublease to be
drafted.

Authority: Each party represents and warrants that the undersigned has the full right, power and authority to execute this Sublease on

25.
behalf of the party indicated.

26.
Quiet Enjoyment: Sublessor warrants that, upon payment of the Rent, as defined herein, and performance of all obligations,
covenants and agreements of Subtenant hereunder, Subtenant shall peaceably and quietly have, hold and enjoy the Subleased Premises during
the Sublease Term, subject however to the provisions of this Sublease.

Parking:  Subject to the terms and conditions of the Prime Lease, Sublessor shall, at no cost to Subtenant, allow Subtenant the use of

27.
such parking as is made available to Sublessor under the Prime Lease with respect to the Subleased Premises.

Counterparts: This Sublease may be executed in multiple counterparts. A signed copy of this Sublease delivered either by facsimile

28.
or email shall be deemed to have the same legal effect as delivery of an original signed copy of this Sublease.  

IN WITNESS WHEREOF, Sublessor and Subtenant have hereunto executed the Sublease as of the Effective Date.

SUBLESSOR:

By:

Name:

Date

SUBTENANT:

By:

Name:

Title

Date

 /s/ Elizabeth L. Hougen

 Elizabeth L. Hougen

 December 21, 2018

 /s/ Jeffrey M. Goldberg

 Jeffrey M. Goldberg

 COO

 December 26, 2018

Exhibit A – Prime Lease

Exhibit B - Subleased Premises

Exhibit C – Rent Schedule

 
  
 
   
 
   
 
   
 
   
  
 
   
 
   
 
   
 
   
 
Exhibit A –Prime Lease

air cr standard industrial/commercial multi-tenant lease-net 1.basic provisions (“basic provisions”). 1.1 parties. this lease(“lease”), dated for reference purposes only january 25, 2018, is made by and between sr22 carlsbad oaks distribution, llc, a california limited liability company; apg carlsbad I, LLC, a california limited liability company; and pre iv c oaks, llc, a california limited liability company (collectively” lessor”)and ionis pharmaceuticals, inc, a delaware corporation (“lessee”), (collectively the “parties”, or individually a”party”). 1.2(a) premises: that certain real property, including all improvements therein or to be provided by lessor under the terms of this lease, commonly known as (street address, unit/suite, city, state): 2870 whiptail loop, suite 102, carlsbad, ca 92010 (“premises”).the premises are located in the county of san dieao, and are generally described as (describe briefly the nature of the premises and the premises are located in the county of san dieao, and are geerally described as (describe briefly the nature of the premises and the “project”): an approximately 18,710 rentable square foot industrial space in an approximately 156,977 square foot project known as elevate in addition to lessee’s rights to use and occupy the premises as hereinafter specified, lessee shall have non-exclusive rights to any utility raceways of the building containing the premises (“building”) and to the common areas (as defined in paragraph 2.7 below), but shall not have any rights to the roof, or exterior walls of the building or to any other buildings in the project. the premises,
the building, the common areas, the land upon which they are located, along with all other buildings and improvements theron, are herein collectively referred to as the “project”(see also paragraph 2) 1.2(b) parking: 43 unreserved vehicle parking spaces. (see also paragraph 2.6) 1.3 term: five (5) years, and  three (3) months and seventeen (17) days (“original term”) commencing march 15, 2018 (“commencement date”) and ending june 30, 2023 (“expiration date”). (see also paragraph 3) 1.4 early possession: if the premises are available lessee may have non-exclusive possession of the premises commencing upon full execution of this lease, payment of monies due pursuant to paragraph 1.7 and compliance with other provision of the lease (“early possession date”),(see also paragraphs 3.2 and 3.3) 1.5 base rent: $20,196.00 per month (“base rent”), payable on the first day of each month commencing on the commencement date.(see also paragraph 4) ☑if this box is checked, there are provisions in this lease for the base rent to be adjusted. see paragraph 50 1.6 lessee’s share of common area operating expenses: eleven and 92/100 percent (11.92%)(“lessee’s share”). in the event that the size of the premises and/or the project are modified during the term of this lease. lessor shall recalculate lessee’s share to reflect such modification. 1.7 base rent and other monies paid upon execution: (a) base rent: $20,196.00 for the period first calendar month of the term (b) common area operating expenses: $4,677.50 for the period first calendar month of the term (c) security deposit:
$23,412.70 (“security deposit”). (see also paragraph 5) (d) other:------------- for-------------------- (e) total due upon execution of this lease: $48,286.20 1.8 agreed use: administrative office, warehouse and distribution for a pharmaceutical company.(see also paragraph 6) 1.9 insuring party. lessor is the “insuring party”. (see also paragraph 8) 1.10 real estate brokers. (see also paragraph 15 and 25) (a) representation: the following real estate brokers (the “brokers”) and brokerage relationships exist in this transaction (check applicable boxes): ☑cushman & wakefield (aric starck and dennis visser) represents lessor exclusively(“lessor’s broker”) ☑cbre (roger carlson) represents lessee exclusively(“lessee’s broker”);or ☐------ represents both lessor and lessee(“dual agency”). (b) payment to brokers. (see paragraph 58)upon execution and delivery of this lease by both parties,lessor shall pay to the brokers the brokerage fee agreed to in a separate written agreement(or if there is no such agreement, the sum of------or--------% of the total base rent) for the brokerage services rendered by the brokers. 1.11 guarantor. the obligations of the lessee under this lease are to be guaranteed by n/a (“guarantor”). (see also paragraph 37) 1.12 attachments. attached here to are the following , all of which constitute a part of this lease: ☑an addendum consisting of paragraph 50 through 60; ☑a site plan depicting the premises (exhibit a): ☐a site plan depicting the project; ☐a current set of the rules and regulations for the project; ☐a current set of the rules and regulations adopted by the owners’
association; ☐a work letter; ☑other(specify): option (s) to extend (paragraph 61). 2. premises. 2.1 letting. lessor hereby leases to lessee, and lessee hereby leases from lessor,the premises, for the term,at the rental, and upon all of the terms, covenants and conditions set forth in this lease. while the approximate square footage of the premises may have been used in the marketing of the premises for purposes of comparison, the base rent stated herein is not tied to square footage and is not subject to adjustment should the actual size be determined to be different. note :lessee is advised to verify the  page 1 of 20 initials last edited: 2/26/2018 3:14 PM initials © 2017 air cre. all rights reserved. MTN-26.00, Revised 01-03-2017  

 
 
actual size prior to executing this Lease. 2.2 Condition. Lessor shall deliver that portion of the Premises contained within the Building ("Unit") to Lessee broom clean and free of debris on the Commencement Date or the Early Possession Date, whichever first occurs ("Start Date"), and, so long as the required service contracts described in Paragraph 7.l(b) below are obtained by Lessee and in effect within thirty days following the Start Date, warrants that the existing electrical, plumbing, fire sprinkler, lighting, heating, ventilating and air conditioning systems ("HVAC") , loading doors, sump pumps, if any, and all other such elements in the Unit, other than those constructed by Lessee, shall be in good operating condition on said date, that the structural elements of the roof, bearing walls and foundation of the Unit shall be free of material defects, and that the Unit does not contain hazardous levels of any mold or fungi defined as toxic under applicable state or federal law. If a non-compliance with such warranty exists as of the Start Date, or if one of such systems or elements should malfunction or fail within the appropriate warranty period, Lessor shall, as Lessor's sole obligation with respect to such matter, except as otherwise provided in this Lease, promptly after receipt of written notice from Lessee setting forth with specificity the nature and extent of such non-compliance, malfunction or failure, rectify same at Lessor's expense. The warranty periods shall be as follows: (i) 6 months as to the HVAC systems, and (ii) 30 days as to the remaining systems and other
elements of the Unit. If Lessee does not give Lessor the required notice within the appropriate warranty period, correction of any such non-compliance, malfunction or failure shall be the obligation of Lessee at Lessee's sole cost and expense (except for the repairs to the fire sprinkler systems, roof, foundations, and/or bearing walls- see Paragraph 7). Lessor also warrants, that unless otherwise specified in writing, Lessor is unaware of (i) any recorded Notices of Default affecting the Premise; (ii) any delinquent amounts due under any loan secured by the Premises; and (iii) any bankruptcy proceeding affecting the Premises. 2.3 Compliance. Lessor warrants that to the best of its knowledge the improvements on the Premises comply with the building codes, applicable laws, covenants or restrictions of record, regulations, and ordinances ("Applicable Requirements ") that were in effect at the time that each improvement, or portion thereof, was constructed. Said warranty does not apply to the use to which Lessee will put the Premises, modifications which may be required by the Americans with Disabilities Act or any similar laws as a result of Lessee's use (see Paragraph 49), or to any Alterations or Utility Installations (as defined in Paragraph 7.3(a)) made or to be made by Lessee. NOTE: Lessee Is responsible for determining whether or not the Applicable Requirements, and especially the zoning are appropriate for Lessee's Intended use, and acknowledges that past uses of the Premises may no longer be allowed. If the Premises do not comply with said warranty, Lessor
shall, except as otherwise provided, promptly after receipt of written notice from Lessee setting forth with specificity the nature and extent of such non-compliance, rectify the same at Lessor's expense. If Lessee does not give Lessor written notice of a non-compliance with this warranty within 6 months following the Start Date, correction of that non-compliance shall be the obligation of Lessee at Lessee's sole cost and expense. If the Applicable Requirements are hereafter changed so as to require during the term of this Lease the construction of an addition to or an alteration of the Unit, Premises and/or Building, the remediation of any Hazardous Substance, or the reinforcement or other physical modification of the Unit, Premises and/or Building ("Capital Expenditure"), Lessor and Lessee shall allocate the cost of such work as follows: (a) Subject to Paragraph 2.3(c) below, if such Capital Expenditures are required as a result of the specific and unique use of the Premises by Lessee as compared with uses by tenants in general, Lessee shall be fully responsible for the cost thereof, provided, however, that if such Capital Expenditure is required during the last 2 years of this Lease and the cost thereof exceeds 6 months' Base Rent, Lessee may instead terminate this Lease unless Lessor notifies Lessee, in writing, within 10 days after receipt of Lessee's termination notice that Lessor has elected to pay the difference between the actual cost thereof and the amount equal to 6 months' Base Rent. If Lessee elects termination, Lessee shall Immediately cease the use of the Premises
which requires such Capital Expenditure and deliver to Lessor written notice specifying a termination date at least 90 days thereafter. Such termination date shall, however, in no event be earlier than the last day that Lessee could legally utilize the Premises without commencing such Capital Expenditure. (b) If such Capital Expenditure is not the result of the specific and unique use of the Premises by Lessee (such as, governmentally mandated seismic modifications), then Lessor shall pay for such Capital Expenditure and Lessee shall only be obligated to pay, each month during the remainder of the term of this Lease or any extension thereof, on the date that on which the Base Rent is due, an amount equal to 1/144th of the portion of such costs reasonably attributable to the Premises. Lessee shall pay Interest on the balance but may prepay its obligation at any time. If, however, such Capital Expenditure is required during the last 2 years of this Lease or if lessor reasonably determines that it is not economically feasible to pay its share thereof, Lessor shall have the option to terminate this Lease upon 90 days prior written notice to Lessee unless Lessee notifies Lessor, in writing, within 10 days after receipt of Lessor's termination notice that Lessee will pay for such Capital Expenditure. If Lessor does not elect to terminate, and fails to tender its share of any such Capital Expenditure, Lessee may advance such funds and deduct same, with Interest, from Rent until Lessor's share of such costs have been fully paid. If Lessee is unable to finance Lessor's share, or if the balance of
the Rent due and payable for the remainder of this Lease is not sufficient to fully reimburse Lessee on an offset basis, Lessee shall have the right to terminate this Lease upon 30 days written notice to Lessor. (c) Notwithstanding the above, the provisions concerning Capital Expenditures are intended to apply only to non-voluntary, unexpected, and new Applicable Requirements. If the Capital Expenditures are instead triggered by Lessee as a result of an actual or proposed change in use, change in intensity of use, or modification to the Premises then, and in that event, Lessee shall either : (i) immediately cease such changed use or intensity of use and/or take such other steps as may be necessary to eliminate the requirement for such Capital Expenditure, or (ii) complete such Capital Expenditure at its own expense. Lessee shall not have any right to terminate this Lease. 2.4 Acknowledgements. Lessee acknowledges that: (a) it has been given an opportunity to inspect and measure the Premises, (b) it has been advised by Lessor and/or Brokers to satisfy itself with respect to the size and condition of the Premises (Including but not limited to the electrical, HVAC and fire sprinkler systems, security, environmental aspects, and compliance with Applicable Requirements and the Americans with Disabilities Act), and their suitability for Lessee's intended use, (c) Lessee has made such investigation as it deems necessary with reference to such matters and assumes all responsibility therefor as the same relate to its occupancy of the Premises, (d) it is not relying on any representation
as to the size of the Premises made by Brokers or Lessor, (e) the square footage of the Premises was not material to Lessee's decision to lease the Premises and pay the Rent stated herein, and (f) neither Lessor, Lessor's agents, nor Brokers have made any oral or written representations or warranties with respect to said matters other than as set forth in this Lease. In addition, Lessor acknowledges that: (i) Brokers have made no representations, promises or warranties concerning Lessee's ability to honor the Lease or suitability to occupy the Premises, and (ii) it is Lessor's sole responsibility to investigating the financial capability and/or suitability of all proposed tenants. 2.5 Lessee as Prior Owner/Occupant. The warranties made by Lessor in Paragraph 2 shall be of no force or effect if immediately prior to the Start Date Lessee was the owner or occupant of the Premises. In such event, Lessee shall be responsible for

 
 
 
any necessary corrective work. 2.6 Vehicle Parking. Lessee shall be entitled to use the number of Parking Spaces specified in Paragraph 1.2(b) on those portions of the Common Areas designated from time to time by Lessor for parking. Lessee shall not use more parking spaces than said number. Said parking spaces shall be used for parking by vehicles no larger than full-size passenger automobiles or pick-up trucks, herein called "Permitted Size Vehicles." Lessor may regulate the loading and unloading of vehicles by adopting Rules and Regulations as provided in Paragraph 2.9. No vehicles other than Permitted Size Vehicles may be parked in the Common Area without the prior written permission of Lessor. In addition: (a) Lessee shall not permit or allow any vehicles that belong to or are controlled by Lessee or Lessee's employees, suppliers, shippers, customers, contractors or invitees to be loaded, unloaded, or parked in areas other than those designated by Lessor for such activities. (b) Lessee shall not service or store any vehicles in the Common Areas,  (c) If Lessee permits or allows any of the prohibited activities described in this Paragraph 2.6, then Lessor shall have the right, without notice, in addition to such other rights and remedies that it may have, to remove or tow away the vehicle involved and charge the cost to Lessee, which cost shall be immediately payable upon demand by Lessor. 2.7 Common Areas- Definition. The term "Common Areas" is defined as all areas and facilities outside the Premises and within the exterior boundary line of the Project and
interior utility raceways and installations within the Unit that are provided and designated by the Lessor from time to time for the general non-exclusive use of Lessor, Lessee and other tenants of the Project and their respective employees, suppliers, shippers, customers, contractors and invitees, including parking areas, loading and unloading areas, trash areas, roofs, roadways, walkways, driveways and landscaped areas. 2.8 Common Areas- Lessee's Rights. Lessor grants to Lessee, for the benefit of Lessee and its employees, suppliers, shippers, contractors ,customers and invitees, during the term of this Lease, the non-exclusive right to use, in common with others entitled to such use, the Common Areas as they exist from time to time, subject to any rights, powers, and privileges reserved by Lessor under the terms hereof or under the terms of any rules and regulations or restrictions governing the use of the Project. Under no circumstances shall the right herein granted to use the Common Areas be deemed to include the right to store any property, temporarily or permanently, in the Common Areas. Any such storage shall be permitted only by the prior written consent of Lessor or Lessor's designated agent, which consent may be revoked at any time. In the event that any unauthorized storage shall occur, then Lessor shall have the right, without notice, in addition to such other rights and remedies that it may have, to remove the property and charge the cost to Lessee, which cost shall be immediately payable upon demand by Lessor. 2.9 Common Areas- Rules and
Regulations. Lessor or such other person(s) as Lessor may appoint shall have the exclusive control and management of the Common Areas and shall have the right. from time to time, to establish, modify, amend and enforce reasonable rules and regulations ("Rules and Regulations") for the management, safety, care, and cleanliness of the grounds, the parking and unloading of vehicles and the preservation of good order, as well as for the convenience of other occupants or tenants of the Building and the Project and their invitees. Lessee agrees to abide by and conform to all such Rules and Regulations, and shall use its best efforts to cause its employees, suppliers, shippers, customers, contractors and invitees to so abide and conform. Lessor shall not be responsible to Lessee for the non-compliance with said Rules and Regulations by other tenants of the Project. 2.10 Common Areas- Changes. Lessor shall have the right, in Lessor's sole discretion, from time to time: (a) To make changes to the Common Areas, including, without limitation, changes in the location, size, shape and number of driveways, entrances, parking spaces, parking areas, loading and unloading areas, ingress, egress, direction of traffic, landscaped areas, walkways and utility raceways; (b) To close temporarily any of the Common Areas for maintenance purposes so long as reasonable access to the Premises remains available; (c) To designate other land outside the boundaries of the Project to be a part of the Common Areas; (d) To add additional buildings and improvements to the Common Areas; (e) To
use the Common Areas while engaged in making additional improvements, repairs or alterations to the Project, or any portion thereof; and (f) To do and perform such other acts and make such other changes in, to or with respect to the Common Areas and Project as Lessor may, in the exercise of sound business judgment, deem to be appropriate. 3 Term. 3.1 Term. The Commencement Date, Expiration Date and Original Term of this Lease are as specified in Paragraph 1.3. 3.2 Early Possession. Any provision herein granting Lessee Early Possession of the Premises is subject to and conditioned upon the Premises being available for such possession prior to the Commencement Date. Any grant of Early Possession only conveys a non-exclusive right to occupy the Premises. If Lessee totally or partially occupies the Premises prior to the Commencement Date, the obligation to pay Base Rent and Lessee's Share of Common Area Operating Expenses. Real Property Taxes and insurance premiums shall be abated for the period of such Early Possession. All other terms of this Lease (including but not limited to the obligations to pay Lessee’s Share of Common Area Operating Expenses, Real Property Taxes and insurance premiums and maintain the Premises) shall be in effect during such period. Any such Early Possession shall not affect the Expiration Date. 3.3 Delay In Possession. Lessor agrees to use its best commercially reasonable efforts to deliver possession of the Premises to Lessee by the Commencement Date. If, despite said efforts, Lessor is unable to deliver
possession by such date, Lessor shall not be subject to any liability therefor, nor shall such failure; affect the validity of this Lease or change the Expiration Date Lessee shall not, however, be obligated to pay Rent or perform its other obligations until Lessor delivers possession of the Premises and any period of rent abatement that Lessee would otherwise have enjoyed shall run from the date of delivery of possession and continue for a period equal to what Lessee would otherwise have enjoyed under the term s here of, but minus any days of delay caused by the acts or omissions of Lessee. If possession is not delivered within 90 60 days after the Commencement Date. as the same may be extended under the terms of any Work Letter executed by Parties, Lessee may, at its option, by notice in writing within 10 days after I the end of such 90 60 days period, cancel this Lease, in which event the Parties shall be discharged from all obligations hereunder. If such written notice is not received by Lessor within said 10 day period, Lessee's right to cancel shall terminate. If possession of the Premises is not delivered within 120 days after the Commencement Date, this Lease shall terminate unless other agreements are reached between Lessor and Lessee, in writing. 3.4 Lessee Compliance. Lessor shall not be required to tender possession of the Premises to Lessee until Lessee complies with obligation to provide evidence of insurance (Paragraph 8.5). Pending delivery of such evidence. Lessee shall be required to perform all of its obligations under this Lease from and after the Start
Date, including the payment of Rent, notwithstanding Lessor's election to withhold possession pending receipt of such evidence of insurance. Further, if Lessee Is required to perform any other  

 
 
conditions prior to or concurrent with the Start Date, the Start Date shall occur but Lessor may elect to withhold possession until such conditions are satisfied. 4. Rent. 4.1 Rent Defined. All monetary obligations of Lessee to Lessor under the terms of this Lease (except for the Security Deposit) are deemed to be rent ("Rent"). All rent shall be payable to SR22 Carlsbad Oaks Distribution, LLC, at the address sel forth below its signature to this Lease, unless changed in accordance with Paragraph 23. 4.2 Common Area Operating Expenses. Lessee shall pay to Lessor during the term hereof, in addition to the Base Rent, Lessee's Share (as specified in Paragraph 1.6) of all Common Area Operating Expenses, as hereinafter defined, during each calendar year of the term of this Lease, in accordance with the following provisions: (a) "Common Area Operating Expenses" are defined, for purposes of this Lease, as all costs relating to the ownership and operation of the Project, including, but not limited to, the following: (i) The operation, repair and maintenance, in neat, clean, good order and condition, and if necessary the replacement, of the following: (aa) The Common Areas and Common Area improvements, including parking areas, loading and unloading areas, trash areas, roadways, parkways, walkways, driveways, landscaped areas, bumpers, irrigation systems, Common Area lighting facilities, fences and gates, elevators, roofs, exterior walls of the buildings, building systems and roof drainage systems. (bb) Exterior signs and any tenant directories. (cc) Any tire sprinkler
systems. (dd) All other areas and improvements that are within the exterior boundaries of the Project but outside of the Premises and/or any other space occupied by a tenant. (ii)  The cost of water, gas, electricity and telephone to service the Common Areas and any utilities not separately metered. (iii) The cost of trash disposal, pest control services, property management (equal to 3% of scheduled Base Rent. without giving effect to any abatements. and Lessee's Share of Common Area Operating Expenses), security services, owners' association dues and fees, the cost to repaint the exterior of any structures and the cost of any environmental inspections. (iv) Reserves set aside for maintenance, repair and/or replacement of Common Area improvements and equipment. (v) Real Property Taxes (as defined in Paragraph 10). (vi) The cost of the premiums for the insurance maintained by Lessor pursuant to Paragraph 8. (vii) Any deductible portion of an insured loss concerning the Building or the Common Areas. (viii) Auditors', accountants' and attorneys' fees and costs related to the operation, maintenance, repair and replacement of the Project. (ix) The cost of any capital improvement to the Building or the Project not covered under the provisions of Paragraph 2.3 provided; however, that lessor shall allocate the cost of any such capital improvement over a 12 year period and lessee shall not be required to pay more than lessee's Share of 1/144th of the cost of such capital improvement in any given month. (x) The cost of any other services to be provided by lessor that are
stated elsewhere in this Lease to be a Common Area Operating Expense. (b) Any Common Area Operating Expenses and Real Property Taxes that are specifically attributable to the Unit, the Building or to any other building in the Project or to the operation, repair and maintenance thereof, shall be allocated entirely to such Unit, Building, or other building. However, any Common Area Operating Expenses and Real Property Taxes that are not specifically attributable to the Building or to any other building or to the operation, repair and maintenance thereof, shall be equitably allocated by lessor to all buildings in the Project. (c) The inclusion of the improvements, facilities and services set forth in Subparagraph 4.2(a) shall not be deemed to impose an obligation upon Lessor to either have said improvements or facilities or to provide those services unless the Project already has the same, Lessor already provides the services, or Lessor has agreed elsewhere in this Lease to provide the same or some of them. (d) lessee's Share of Common Area Operating Expenses is payable monthly on the same day as the Base Rent is due hereunder. The amount of such payments shall be based on Lessor's estimate of the annual Common Area Operating Expenses. Within 180 days after the expiration of each calendar year of the term written request (but not more than once each year) Lessor shall deliver to Lessee a reasonably detailed statement showing lessee's Share of the actual Common Area Operating Expenses for the preceding year. If lessee's payments during such year exceed
lessee's Share, Lessor shall credit the amount of such over-payment against Lessee's future payments or. if no future payments are remaining, Lessor shall pay to Lessee the amount of such overpayment within 10 days after delivery by Lessor to Lessee of the statement. If lessee's payments during such year were less than Lessee's Share, lessee shall pay to lessor the amount of the deficiency within 10 days after delivery by Lessor to Lessee of the statement. (e) Common Area Operating Expenses shall not include any expenses paid by any tenant directly to third parties, or as to which lessor is otherwise reimbursed by any third party, other tenant, or insurance proceeds. 4.3 Payment. lessee shall cause payment of Rent to be received by Lessor in lawful money of the United States, without offset or deduction (except as specifically permitted in this Lease), on or before the day an which it is due. All monetary amounts shall be rounded to the nearest whole dollar. In the event that any invoice prepared by Lessor is inaccurate such inaccuracy shall not constitute a waiver and lessee shall be obligated to pay the amount set forth in this lease. Rent for any period during the term hereof which Is for less than one full calendar month shall be prorated based upon the actual number of days of said month. Payment of Rent shall be made to Lessor at its address stated herein or to such other persons or place as lessor may from time to time designate in writing. Acceptance of a payment which is less than the amount then due shall not be a waiver of lessor's rights to the balance of such
Rent, regardless of lessor's endorsement of any check so stating. In the event that any check, draft, or other instrument of payment given by Lessee to Lessor is dishonored for any reason, Lessee agrees to pay to lessor the sum of $25 in addition to any Late Charge and Lessor, at its option, may require all future Rent be paid by cashier's check. Payments will be applied first to accrued late charges and attorney's fees, second to accrued interest, then to Base Rent and Common Area Operating Expenses, and any remaining amount to any other outstanding charges or costs. 5. Security Deposit. Lessee shall deposit with Lessor upon execution hereof the Security Deposit as security for Lessee’s faithful  

 
 
performance of its obligations under this Lease. If Lessee fails to pay Rent, or otherwise Defaults under this Lease, Lessor may use, apply or retain all or any portion of said Security Deposit for the payment of any amount already due Lessor, for Rents which will be due in the future, and/ or to reimburse or compensate Lessor for any liability, expense, loss or damage which Lessor may suffer or incur by reason thereof. If Lessor uses or applies all or any portion of the Security Deposit, Lessee shall within 10 days after written request therefor deposit monies with Lessor sufficient to restore said Security Deposit to the full amount required by this Lease. If the Base Rent increases during the term of this Lease, Lessee shall, upon written request from Lessor, deposit additional monies with Lessor so that the total amount of the Security Deposit shall at all times bear the same proportion to the increased Base Rent as the initial Security Deposit bore to the initial Base Rent. Should the Agreed Use be amended to accommodate a material change in the business of Lessee or to accommodate a sublessee or assignee, Lessor shall have the right to increase the Security Deposit to the extent necessary, in Lessor's reasonable judgment, to account for any increased wear and tear that the Premises may suffer as a result thereof. If a change in control of Lessee occurs during this Lease and following such change the financial condition of Lessee is, in Lessor's reasonable judgment, significantly reduced, Lessee shall deposit such additional monies with Lessor as shall be sufficient to cause
the Security Deposit to be at a commercially reasonable level based on such change in financial condition. Lessor shall not be required to keep the Security Deposit separate from its general accounts. Within 90 days after the expiration or termination of this Lease, Lessor shall return that portion of the Security Deposit not used or applied by Lessor. Lessor shall upon written request provide Lessee with an accounting showing how that portion of the Security Deposit that was not returned was applied. No part of the Security Deposit shall be considered to be held in trust, to bear interest or to be prepayment for any monies to be paid by Lessee under this Lease. THE SECURITY DEPOSIT SHALL NOT BE USED BY LESSEE IN LIEU OF PAYMENT OF THE LAST MONTH'S RENT. 6. Use. 6.1 Use. Lessee shall use and occupy the Premises only for the Agreed Use, or any other legal use which is reasonably comparable thereto, and for no other purpose. Lessee shall not use or permit the use of the Premises in a manner that is unlawful, creates damage, waste or a nuisance, or that disturbs occupants of or causes damage to neighboring premises or properties. Other than service guide, single and seeing eye dogs, lessee shall not keep or allow in the. Premises any pets, animals, birds, fish, or reptiles. Lessor shall not unreasonably withhold or delay its consent to any written request for a modification of the Agreed Use, so long as the same will not impair the structural integrity of the Building or the mechanical or electrical systems therein, and/or is not significantly more
burdensome to the Project. If Lessor elects to withhold consent, Lessor shall within 7 days after such request give written notification of same, which notice shall include an explanation of Lessor's objections to the change in the Agreed Use. 6.2 Hazardous Substances. (a) Reportable Uses Require Consent. The term "Hazardous Substance" as used in this Lease shall mean any product, substance, or waste whose presence, use, manufacture, disposal, transportation, or release, either by itself or in combination with other materials expected to be on the Premises, is either:(i) potentially injurious to the public health, safety or welfare, the environment or the Premises, (ii) regulated or monitored by any governmental authority, or (iii) a basis for potential liability of Lessor to any governmental agency or third party under any applicable statute or common law theory. Hazardous Substances shall include, but not be limited to, hydrocarbons, petroleum, gasoline, and/or crude oil or any products, by-products or fractions thereof. Lessee shall not engage in any activity in or on the Premises which constitutes a Reportable Use of Hazardous Substances without the express prior written consent of Lessor and timely compliance (at Lessee's expense) with all Applicable Requirements. "Reportable Use" shall mean (i) the installation or use of any above or below ground storage tank, (ii) the generation, possession, storage, use, transportation, or disposal of a Hazardous Substance that requires a permit from, or with respect to which a report, notice, registration or business plan is required to
be filed with, any governmental authority, and/or (iii) the presence at the Premises of a Hazardous Substance with respect to which any Applicable Requirements requires that a notice be given to persons entering or occupying the Premises or neighboring properties. Notwithstanding the foregoing, Lessee may use any ordinary and customary materials reasonably required to be used in the normal course of the Agreed Use, ordinary office supplies (copier toner, liquid paper, glue, etc.) and common household cleaning materials, so long as such use is in compliance with all Applicable Requirements, is not a Reportable Use, and does not expose the Premises or neighboring property to any meaningful risk of contamination or damage or expose lessor to any liability therefor. In addition, lessor may condition its consent to any Reportable Use upon receiving such additional assurances as Lessor reasonably deems necessary to protect itself, the public, the Premises and/or the environment against damage, contamination, injury and/or liability, including, but not limited to, the installation (and removal on or before Lease expiration or termination) of protective modifications (such as concrete encasements) and/or increasing the Security Deposit. (b) Duty to Inform Lessor. If Lessee knows, or has reasonable cause to believe, that a Hazardous Substance has come to be located in, on, under or about the Premises, other than as previously consented to by Lessor, Lessee shall immediately give written notice of such fact to Lessor, and provide Lessor with a copy of any report, notice,
claim or other documentation which it has concerning the presence of such Hazardous Substance. (c) Lessee Remediation. Lessee shall not cause or permit any Hazardous Substance to be spilled or released in, on, under, or about the Premises (including through the plumbing or sanitary sewer system) and shall promptly, at Lessee's expense, comply with all Applicable Requirements and take all investigatory and/or remedial action reasonably recommended, whether or not formally ordered or required, for the cleanup of any contamination of, and for the maintenance, security and/or monitoring of the Premises or neighboring properties, that was caused or materially contributed to by Lessee, or pertaining to or involving any Hazardous Substance brought onto the Premises during the term of this Lease, by or for Lessee, or its agents, employees or invitees. any third party (d) Lessee Indemnification. Lessee shall indemnify, defend and hold Lessor, its agents, employees, lenders and ground lessor, if any, harmless from and against any and all loss of rents and/or damages, liabilities, judgments, claims, expenses, penalties, and attorneys' and consultants' fees arising out of or Involving any Hazardous Substance brought onto the Premises by or for Lessee, or its agents, employees or invitees any third party (provided, however, that Lessee shall have no liability under this Lease with respect to underground migration of any Hazardous Substance under the Premises from areas outside of the Project not caused or contributed to by Lessee). Lessee's obligations shall include, but not
be limited to, the effects of any contamination or injury to person, property or the environment created or suffered by Lessee, and the cost of investigation, removal, remediation, restoration and/or abatement, and shall survive the expiration or termination of this Lease. No termination, cancellation or release agreement entered into by Lessor and Lessee shall release Lessee from its obligations under this Lease with respect to Hazardous Substances, unless specifically so agreed by Lessor in writing at the time of such agreement. (e) Lessor Indemnification. Except as otherwise provided in paragraph 8.7, Lessor and its successors and assigns shall identify, defend, reimburse and hold Lessee, its employees and lenders, harmless from and against any and all environmental  

 
 
damages, including the cost of remediation, liabilities, judgments, claim, expenses, penalties and attorneys' and consultants' fees which are suffered as a direct result of Hazardous Substances on the Premises prior to Lessee taking possession or which are caused by the gross negligence or willful misconduct of Lessor, its agents or employees. Lessor's obligations, as and when required by the Applicable Requirements, shall include, but not be limited to, the cost of investigation, removal, remediation, restoration and/or abatement, and shall survive the expiration or termination of this Lease. (f) Investigations and Remediations. Lessor shall retain the responsibility and pay for any investigations or remediation measures required by governmental entities having jurisdiction with respect to the existence of Hazardous Substances on the Premises prior to the Lessee taking possession, unless such remediation measure is required as a result of Lessee's use (including "Alterations", as defined in paragraph 7.3(a) below) of the Premises, in which event Lessee shall be responsible for such payment . Lessee shall cooperate fully in any such activities at the request of lessor, including allowing lessor and lessor's agents to have reasonable access to the Premises at reasonable times in order to carry out Lessor's investigative and remedial responsibilities. (g) Lessor Termination Option. If a Hazardous Substance Condition (see Paragraph 9.1(e)) occurs during the term of this Lease, unless Lessee is legally responsible therefor (in which case Lessee shall make the investigation and
remediation thereof required by the Applicable Requirements and this Lease shall continue in full force and effect, but subject to Lessor's rights under Paragraph 6.2(d) and Paragraph 13), Lessor may, at Lessor's option, either (i) investigate and remediate such Hazardous Substance Condition, if required, as soon as reasonably possible at Lessor's expense, in which event this Lease shall continue in full force and effect, or (ii) if the estimated cost to remediate such condition exceeds 12 times the then monthly Base Rent or $100,000, whichever is greater, give written notice to Lessee, within 30 days after receipt by lessor of knowledge of the occurrence of such Hazardous Substance Condition, of Lessor's desire to terminate this Lease as of the date 60 days following the date of such notice. In the event Lessor elects to give a termination notice, Lessee may, within 10 days thereafter, give written notice to Lessor of Lessee's commitment to pay the amount by which the cost of the remediation of such Hazardous Substance Condition exceeds an amount equal to 12 times the then monthly Base Rent or $100,000, whichever is greater. Lessee shall provide lessor with said funds or satisfactory assurance thereof within 30 days following such commitment. In such event, this lease shall continue in full force and effect, and Lessor shall proceed to make such remediation as soon as reasonably possible after the required funds are available. If Lessee does not give such notice and provide the required funds or assurance thereof within the time provided, this lease shall terminate as of
the date specified in Lessor's notice of termination. 6.3 lessee's Compliance with Applicable Requirements. Except as otherwise provided in this Lease, lessee shall, at Lessee's sole expense, fully, diligently and in a timely manner, materially comply with all Applicable Requirements, the requirements of any applicable fire insurance underwriter or rating bureau, and the recommendations of Lessor's engineers and/or consultants which relate in any manner to the Premises, without regard to whether said Applicable Requirements are now in effect or become effective after the Start Date . Lessee shall, within 10 days after receipt of Lessor's written request, provide Lessor with copies of all permits and other documents, and other information evidencing Lessee's compliance with any Applicable Requirements specified by Lessor, and shall immediately upon receipt, notify Lessor in writing (with copies of any documents involved) of any threatened or actual claim, notice, citation, warning, complaint or report pertaining to or involving the failure of Lessee or the Premises to comply with any Applicable Requirements. likewise, Lessee shall immediately give written notice to lessor of: (i) any water damage to the Premises and any suspected seepage, pooling, dampness or other condition conducive to the production of mold; or (ii) any mustiness or other odors that might indicate the presence of mold In the Premises. 6.4 Inspection; Compliance. Lessor and Lessor 's "Lender" (as defined in Paragraph 30) and consultants authorized by lessor shall have the right to enter into
Premises at any time, in the case of an emergency, and otherwise at reasonable times after reasonable notice, for the purpose of inspecting and/or testing the condition of the Premises and/or for verifying compliance by Lessee with this Lease. The cost of any such inspections shall be paid by Lessor, unless a violation of Applicable Requirements, or a Hazardous Substance Condition (see Paragraph 9.1) is found to exist or be imminent, or the Inspection is requested or ordered by a governmental authority. In such case, Lessee shall upon request reimburse Lessor for the cost of such inspection, so long as such inspection is reasonably related to the violation or contamination. In addition, Lessee shall provide copies of all relevant material safety data sheets (MSDS) to Lessor within 10 days of the receipt of written request therefor. Lessee acknowledges that any failure on its part to allow such inspections or testing will expose Lessor to risks and potentially cause Lessor to incur costs not contemplated by this Lease, the extent of which will be extremely difficult to ascertain. Accordingly, should the Lessee fail to allow such inspections and/or testing in a timely fashion the Base Rent shall be automatically increased, without any requirement for notice to Lessee, by an amount equal to 10% of the then existing Base Rent or $100, whichever is greater for the remainder to the Lease. The Parties agree that such Increase in Base Rent represents fair and reasonable compensation for the additional risk/costs that Lessor will incur by reason of Lessee's failure to allow such Inspection
and/or testing. Such increase in Base Rent shall in no event constitute a waiver of Lessee's Default or Breach with respect to such failure nor prevent the exercise of any of the other rights and remedies granted hereunder. 7. Maintenance; Repairs; Utility Installations; Trade Fixtures and Alterations. 7.1 Lessee's Obligations. (a) In General. Subject to the provisions of Paragraph 2 .2 (Condition). 2.3 (Compliance), 6.3 (Lessee's Compliance with Applicable Requirements), 7.2 (Lessor's Obligations). 9 (Damage or Destruction), and 14 (Condemnation), Lessee shall, at Lessee's sole expense, keep the Premises, Utility Installations (intended for Lessee's exclusive use, no matter where located), and Alterations in good order, condition and repair (whether or not the portion of the Premises requiring repairs, or the means of repairing the same, are reasonably or readily accessible to lessee, and whether or not the need for such repairs occurs as a result of Lessee's use, any prior use, the elements or the age of such portion of the Premises), including, but not limited to, all equipment or facilities, such as plumbing, HVAC equipment, electrical, lighting facilities, boilers, pressure vessels, fixtures, interior walls, Interior surfaces of exterior walls, ceilings, floors (including floor coverings). windows, doors, plate glass, and skylights but -excluding any items which are the responsibility of Lessor pursuant to Paragraph 7.2. Lessee, in keeping the Premises in good order, condition and repair, shall exercise and perform good maintenance practices, specifically including the procurement and
maintenance of the service contracts required by Paragraph 7.1(b) below. Lessee's obligations shall include restorations. replacements or renewals when necessary to keep the Premises and all improvements thereon or a part thereof in good order, condition and state of repair. (b) Service Contracts. Lessee shall, at Lessee's sole expense, procure and maintain contracts, with copies to Lessor, in customary form and substance for, and with contractors specializing and experienced in the maintenance of the following equipment and improvements, if any, if and when installed on the Premises: (i) HVAC equipment, (ii) boiler and pressure vessels, and (iii) clarifiers. However, Lessor reserves the right, upon notice to Lessee, to procure and maintain any or all of such service contracts, and Lessee shall reimburse Lessor, upon demand, for the cost thereof.  Initials 2017 AIR CRE. All Rights Reserved.  Initials  Page 6 of 20 Last Edited: 2/26/2018 3:14 PM MTN-26 00,Revised 01-03-2017  

 
 
(c) Failure to Perform. If lessee fails to perform lessee's obligations under this Paragraph 7 .1, Lessor may enter upon the Premises after 10 days' prior written notice to Lessee (except in the case of an emergency, in which case no notice shall be required), perform such obligations on lessee's behalf, and put the Premises in good order, condition and repair, and lessee shall promptly pay to Lessor a sum equal to 115% of the cost thereof. (d) Replacement. Subject to Lessee's indemnification of Lessor as set forth in Paragraph 8.7 below, and without relieving Lessee of liability resulting from Lessee's failure to exercise and perform good maintenance practices, if an item described in Paragraph 7.1(b) cannot be repaired other than at a cost which is in excess of 50% of the cost of replacing such item, then such item shall be replaced by Lessor, and the cost thereof shall be prorated between the Parties and Lessee shall only be obligated to pay, each month during the remainder of the term of this lease, on the date on which Base Rent is due, an amount equal to the product of multiplying the cost of such replacement by a fraction, the numerator of which is one, and the denominator of which is 144 (i.e. l/144th of the cost per month). Lessee shall pay Interest on the unamortized balance but may prepay its obligation at any time. 7.2 Lessor's Obligations. Subject to the provisions of Paragraphs 2.2 (Condition), 2.3 (Compliance), 4.2 (Common Area Operating Expenses), 6 (Use), 7.1 (Lessee's Obligations), 9 (Damage or Destruction) and 14 (Condemnation), Lessor, subject to
reimbursement pursuant to Paragraph 4.2, shall keep in good order, condition and repair the foundations, exterior walls, structural condition of interior bearing walls, exterior roof, fire sprinkler system, Common Area fire alarm and/or smoke detection systems, fire hydrants, parking lots, walkways, parkways, driveways, landscaping, fences, signs and utility systems serving the Common Areas and all parts thereof, as well as providing the services for which there is a Common Area Operating Expense pursuant to Paragraph 4.2. Lessor shall not be obligated to paint the exterior or interior surfaces of exterior walls nor shall Lessor be obligated to maintain, repair or replace windows, doors or plate glass of the Premises. 7.3 Utility Installations; Trade Fixtures; Alterations. (a) Definitions. The term "Utility Installations" refers to all floor and window coverings, air and/or vacuum lines, power panels, electrical distribution, security and fire protection systems, communication cabling, lighting fixtures, HVAC equipment, plumbing, and fencing in or on the Premises. The term "Trade Fixtures" shall mean lessee's machinery and equipment that can be removed without doing material damage to the Premises. The term "Alterations" shall mean any modification of the improvements, other than Utility Installations or Trade Fixtures, whether by addition or deletion. "Lessee Owned Alterations and/or Utility Installations" are defined as Alterations and/or Utility Installations made by lessee that are not yet owned by Lessor pursuant to Paragraph 7.4(a). (b) Consent. Lessee shall not
make any Alterations or Utility Installations to the Premises without Lessor's prior written consent. Lessee may, however, make non-structural Alterations or Utility Installations to the interior of the Premises (excluding the roof) without such consent but upon notice to Lessor, as long as they are not visible from the outside, do not involve puncturing, relocating or removing the roof or any existing walls, will not affect the electrical, plumbing, HVAC, and/or life safety systems, do not trigger the requirement for additional modifications and/or improvements to the Premises resulting from Applicable Requirements, such as compliance with Title 24, and/or life safety systems, and the cumulative cost thereof during this Lease as extended does not exceed a sum equal to 3 month's Base Rent in the aggregate or a sum equal to one month's Base Rent in any one year. Notwithstanding the foregoing, Lessee shall not make or permit any roof penetrations and/or install anything on the roof without the prior written approval of Lessor. Lessor may, as a precondition to granting such approval, require Lessee to utilize a contractor chosen and/or approved by Lessor. Any Alterations or Utility Installations that Lessee shall desire to make and which require the consent of the Lessor shall be presented to Lessor in written form with detailed plans. Consent shall be deemed conditioned upon Lessee's: (i) acquiring all applicable governmental permits, (ii) furnishing Lessor with copies of both the permits and the plans and specifications prior to commencement of the work, and (iii)
compliance with all conditions of said permits and other Applicable Requirements in a prompt and expeditious manner. Any Alterations or Utility Installations shall be performed in a workmanlike manner with good and sufficient materials. lessee shall promptly upon completion furnish Lessor with as-built plans and specifications. For work which costs an amount in excess of one month's Base Rent, lessor may condition its consent upon Lessee providing a lien and completion bond in an amount equal to 150% of the estimated cost of such Alteration or Utility Installation and/or upon Lessee's posting an additional Security Deposit with Lessor. (c) Liens; Bonds. Lessee shall pay, when due, all claims for labor or materials furnished or alleged to have been furnished to or for Lessee at or for use on the Premises, which claims are or may be secured by any mechanic's or materialmen's lien against the Premises or any interest therein. Lessee shall give Lessor not less than 10 days notice prior to the commencement of any work in, on or about the Premises, and lessor shall have the right to post notices of non-responsibility. If lessee shall contest the validity of any such lien, claim or demand, then Lessee shall, at its sole expense defend and protect itself, Lessor and the Premises against the same and shall pay and satisfy any such adverse judgment that may be rendered thereon before the enforcement thereof. If Lessor shall require, Lessee shall furnish a surety bond in an amount equal to 150% of the amount of such contested lien, claim or demand, indemnifying lessor against
liability for the same. IF lessor elects to participate in any such action, Lessee shall pay Lessor's attorneys' Fees and costs. 7.4 Ownership; Removal; Surrender; and Restoration. (a) Ownership. Subject to lessor's right to require removal or elect ownership as hereinafter provided, all Alterations and Utility Installations made by lessee shall be the property of Lessee, but considered a part of the Premises. Lessor may, at any time, elect in writing to be the owner of all or any specified part of the Lessee Owned Alterations and Utility Installations. Unless otherwise instructed per paragraph 7.4(b) hereof, all Lessee Owned Alterations and Utility Installations shall, at the expiration or termination of this Lease, become the property of lessor and be surrendered by lessee with the Premises. (b) Removal. By delivery to Lessee of written notice from Lessor not earlier than 90 and not later than 30 days prior to the end of the term of this Lease, Lessor may require that any or all Lessee Owned Alterations or Utility Installations be removed by the expiration or termination of this lease. lessor may require the removal at any time of all or any part of any lessee Owned Alterations or Utility Installations made without the required consent. (c) Surrender; Restoration, lessee shall surrender the Premises by the Expiration Date or any earlier termination date, with all of the improvements, parts and surfaces thereof broom clean and free of debris, and in good operating order, condition and state of repair, ordinary wear and tear excepted. "Ordinary wear and tear" shall not include any damage or
deterioration that would have been prevented by good maintenance practice. Notwithstanding the foregoing, if the Lessee occupies the Premises for 12 months or less, then Lessee shall surrender the Premises in the same condition as delivered to Lessee on the Start Date with NO allowance for ordinary wear and tear. Lessee shall repair any damage occasioned by the installation, maintenance or removal of Trade Fixture, Lessee owned Alterations and/or Utility Installations, furnishings, and equipment as well as the removal of any storage tank installed by or for lessee. lessee shall also remove from the Premises any and all Hazardous Substances brought onto  Initials  ©2017 AIR CRE. All Rights Reserved.  Initials  Page 7 of 20 Last Edited: 2/26/2018 3:14 PM MTN-26 00,Revised 01-03-2017    

 
 
the Premises by or for Lessee, or its agents, employees or invitees any third party (except Hazardous Substances which were deposited via underground migration from areas outside of the Project) to the level specified in Applicable Requirements. Trade Fixtures shall remain the property of Lessee and shall be removed by Lessee. Any personal property of Lessee not removed on or before the Expiration Date or any earlier termination date shall be deemed to have been abandoned by Lessee and may be disposed of or retained by Lessor as Lessor may desire. The failure by Lessee to timely vacate the Premises pursuant to this Paragraph 7.4(c) without the express written consent of Lessor shall constitute a holdover under the provisions of Paragraph 26 below. 8.Insurance; Indemnity. 8.1 Payment of Premiums. The cost of the premiums for the insurance policies required to be carried by lessor, pursuant to Paragraphs 8.2(b), 8.3(a) and 8.3(b), shall be a Common Area Operating Expense. Premiums for policy periods commencing prior to, or extending beyond, the term of this lease shall be prorated to coincide with the corresponding Start Date or Expiration Date. 8.2 Liability Insurance. (a) Carried by lessee. Lessee shall obtain and keep in force a Commercial General Liability policy of insurance protecting Lessee and Lessor as an additional insured against claims for bodily injury, personal injury, owned/non-owned/hired auto liability and property damage based upon or arising out of the ownership, use, occupancy or maintenance of the Premises and all areas appurtenant
thereto. Such insurance shall be on an occurrence basis providing single limit coverage in an amount not less than $1,000,000 per occurrence with an annual aggregate of not less than $2.000,000 Lessee shall add Lessor as an additional insured by means of an endorsement at least as broad as the Insurance Service Organization's "Additional Insured-Managers and or'-Lessors of Premises" Endorsement. The policy shall not contain any intra-insured exclusions as between insured persons or organizations, but shall include coverage for liability assumed under this lease as an "insured contract" for the performance of Lessee's indemnity obligations under this Lease. The limits of said insurance shall not, however, limit the liability of Lessee nor relieve Lessee of any obligation hereunder. Lessee shall provide an endorsement on its liability policy(ies) which provides that its insurance shall be primary to and not contributory with any similar insurance carried by Lessor, whose insurance shall be considered excess insurance only. (b) Carried by Lessor. Lessor shall maintain liability insurance as described in Paragraph 8.2(a), in addition to, and not in lieu of, the insurance required to be maintained by lessee. Lessee shall not be named as an additional insured therein. 8.3 Property Insurance- Building, Improvements and Rental Value. (a) Building and Improvements. lessor shall obtain and keep in force a policy or policies of insurance in the name of Lessor, with loss payable to Lessor, any ground-lessor, and to any Lender insuring loss or damage to the Premises. The amount of
such insurance shall be equal to the full insurable replacement cost of the Premises, as the same shall exist from time to time, or the amount required by any Lender, but in no event more than the commercially reasonable and available insurable value thereof. Lessee Owned Alterations and Utility Installations, Trade Fixtures, and Lessee's personal property shall be insured by Lessee not by Lessor. If the coverage is available and commercially appropriate, such policy or policies shall insure against all risks of direct physical loss or damage (except the perils of flood and/or earthquake unless required by a Lender), including coverage for debris removal and the enforcement of any Applicable Requirements requiring the upgrading, demolition, reconstruction or replacement of any portion of the Premises as the result of a covered loss Said policy or policies shall also contain an agreed valuation provision in lieu of any coinsurance clause, waiver of subrogation, and inflation guard protection causing an increase in the annual property insurance coverage amount by a factor of not less than the adjusted U.S. Department of Labor Consumer Price Index for All Urban Consumers for the city nearest to where the Premises are located. If such insurance coverage has a deductible clause, the deductible amount shall not exceed $5,000 per occurrence. (b) Rental Value. Lessor shall also obtain and keep in force a policy or policies in the name of Lessor with loss payable to lessor and any Lender, insuring the loss of the full Rent for one year with an extended period of indemnity for an
additional180 days ("Rental Value insurance"). Said insurance shall contain an agreed valuation provision in lieu of any coinsurance clause, and the amount of coverage shall be adjusted annually to reflect the projected Rent otherwise payable by Lessee, for the next 12 month period. (c) Adjacent Premises. Lessee shall pay for any increase in the premiums for the property insurance of the Building and for the Common Areas or other buildings in the Project if said increase is caused by Lessee's acts, omissions, use or occupancy of the Premises. (d) Lessee's Improvements. Since Lessor is the Insuring Party, Lessor shall not be required to insure Lessee Owned Alterations and Utility Installations unless the item in question has become the property of lessor under the terms of this Lease. 8.4 Lessee's Property; Business Interruption Insurance; Worker's Compensation Insurance. (a) Property Damage. lessee shall obtain and maintain insurance coverage on all of lessee's personal property, Trade Fixtures, and Lessee Owned Alterations and Utility Installations. Such insurance shall be full replacement cost coverage with a deductible of not to exceed $75,000 $1,000 per occurrence. The proceeds from any such insurance shall be used by Lessee for the replacement of personal property, Trade Fixtures and lessee Owned Alterations and Utility Installations. (b) Business Interruption. Lessee shall obtain and maintain loss of income and extra expense insurance in amounts as will reimburse Lessee for direct or indirect loss of earnings attributable to all perils commonly insured against
by prudent lessees in the business of Lessee or attributable to prevention of access to the Premises as a result of such perils. (c) Worker's Compensation Insurance. Lessee shall obtain and maintain Worker's Compensation Insurance in such amount as may be required by Applicable Requirements. Such policy shall include a 'Waiver of Subrogation' endorsement. Lessee shall provide Lessor with a copy of such endorsement along with the certificate of insurance or copy of the policy required by paragraph 8.5. (d) No Representation of Adequate Coverage. Lessor makes no representation that the limits or forms of coverage of insurance specified herein are adequate to cover Lessee's property, business operations or obligations under this Lease. 8.5 Insurance Policies. Insurance required herein shall be by companies maintaining during the policy term a "General Policyholders Rating" of at least A-, VII, as set forth in the most current issue of "Best's Insurance Guide", or such other rating as may be required by a Lender. Lessee shall not do or permit to be done anything which invalidates the required insurance policies. Lessee shall, prior to the Start Date, deliver to Lessor certified copies of policies of such insurance or certificates with copies of the required endorsements evidencing the existence and amounts of the required insurance. No such policy shall be cancelable except after 10 days’ prior written notice to Lessor in event of nonpayment of premium. Additionally, within five (5) business days of receipt of any notice of cancellation of insurance, Lessee shall provide
Lessor with a copy of such notice received from an insurer together with proof of replacement coverage that complies with the INITIALS 2017 AIR CRE. All Rights Reserved. Page 8 of 20 Last Edited: 2/26/2018 3:14 PM INITIALS MTN-26 00,Revised 01-03-2017

 
 
insurance requirements of this Lease. Or subject to modification except after 30 days prior written notice to lessor. Lessee shall, at least 10 days prior to the expiration of such policies, furnish Lessor with evidence of renewals or "insurance binders" evidencing renewal thereof, or Lessor may increase his liability insurance coverage and charge the cost thereof to Lessee, which amount shall be payable by Lessee to Lessor upon demand. Such policies shall be for a term of at least one year, or the length of the remaining term of this Lease, whichever is less. If either Party shall fail to procure and maintain the insurance required to be carried by it, the other Party may, but shall not be required to, procure and maintain the same. 8.6 Waiver of Subrogation. Without affecting any other rights or remedies, Lessee and Lessor each hereby release and relieve the other, and waive their entire right to recover damages against the other, for loss of or damage to its property arising out of or incident to the perils required to be insured against herein. The effect of such releases and waivers is not limited by the amount of insurance carried or required, or by any deductibles applicable hereto. The Parties agree to have their respective property damage insurance carriers waive any right to subrogation that such companies may have against Lessor or Lessee, as the case may be, so long as the insurance is not invalidated thereby. 8.7 Indemnity. Except for Lessor's gross negligence or willful misconduct, Lessee shall indemnify, protect, defend and hold harmless the Premises, Lessor and its agents,
Lessor's master or ground lessor, partners and Lenders, from and against any and all claims, loss of rents and/or damages, liens, judgments, penalties, attorneys' and consultants' fees, expenses and/or liabilities arising out of, involving, or in connection with, the use and/or occupancy of the Premises by lessee. If any action or proceeding is brought against Lessor by reason of any of the foregoing matters, Lessee shall upon notice defend the same at Lessee's expense by counsel reasonably satisfactory to Lessor and lessor shall cooperate with Lessee in such defense. Lessor need not have first paid any such claim in order to be defended or indemnified. 8.8 Exemption of Lessor and its Agents from liability. Notwithstanding the negligence or breach of this Lease by Lessor or its agents, but without limiting Lessor's liability for any of its covenants, obligations or warranties expressly set forth in the Lease (nor any of Lessee's releases and waivers set forth in Paragraph 8.6), neither Lessor nor its agents shall be liable under any circumstances for: (i) injury or damage to the person or goods, wares, merchandise or other property of Lessee, Lessee's employees, contractors, invitees, customers, or any other person in or about the Premises, whether such damage or injury is caused by or results from fire, steam, electricity, gas, water or rain, indoor air quality, the presence of mold or from the breakage, leakage, obstruction or other defects of pipes, fire sprinklers, wires, appliances, plumbing, HVAC or lighting fixtures, or from any other cause, whether the said injury or damage results
from conditions arising upon the Premises or upon other portions of the Building, or from other sources or places, (ii) any damages arising from any act or neglect of any other tenant of Lessor or from the failure of Lessor or its agents to enforce the provisions of any other lease in the Project, or (iii) injury to Lessee's business or for any loss of income or profit therefrom. Instead, it is intended that Lessee's sole recourse in the event of such damages or injury be to file a claim on the insurance policy(ies) that Lessee is required to maintain pursuant to the provisions of paragraph 8. 8.9 Failure to Provide Insurance. Lessee acknowledges that any failure on its part to obtain or maintain the insurance required herein will expose Lessor to risks and potentially cause Lessor to incur costs not contemplated by this Lease, the extent of which will be extremely difficult to ascertain. Accordingly, for any month or portion thereof that Lessee does not maintain the required insurance and/or does not provide Lessor with the required binders or certificates evidencing the existence of the required insurance, the Base Rent shall be automatically increased, without any requirement for notice to Lessee, by an amount equal to 10% of the then existing Base Rent or $100, whichever is greater. The parties agree that such increase in Base Rent represents fair and reasonable compensation for the additional risk/costs that Lessor will incur by reason of lessee's failure to maintain the required insurance. Such increase in Base Rent shall in no event constitute a waiver of Lessee's Default or Breach
with respect to the failure to maintain such insurance, prevent the exercise of any of the other rights and remedies granted hereunder, nor relieve Lessee of its obligation to maintain the insurance specified in this Lease. 9. Damage or Destruction. 9.1 Definitions. (a) "Premises Partial Damage" shall mean damage or destruction to the improvements on the Premises, other than Lessee Owned Alterations and Utility Installations, which can reasonably be repaired in 6 3 months or less from receipt of insurance proceeds, the date of the damage or destruction, and the cost thereof does not exceed a sum equal to 6 month's Base Rent. Lessor shall notify Lessee in writing within 30 days from the date of the damage or destruction as to whether or not the damage is Partial or Total. (b) "Premises Total Destruction" shall mean damage or destruction to the improvements on the Premises, other than Lessee Owned Alterations and Utility Installations and Trade Fixtures, which cannot reasonably be repaired in 6 3 months or less from receipt of insurance proceeds the date of the damage or destruction, and/or the cost thereof exceeds a sum equal to 6 month's Base Rent. Lessor shall notify Lessee in writing within 30 days from the date of the damage or destruction as to whether or not the damage is Partial or Total. (c) "Insured Loss" shall mean damage or destruction to improvements on the Premises, other than Lessee Owned Alterations and Utility Installations and Trade Fixtures, which was caused by an event required to be covered by the insurance described in Paragraph 8.3(a), and
for which insurance proceeds are received (provided that the foregoing limitation shall not apply unless Lessor has maintained the required insurance coverage), less irrespective of any deductible amounts or coverage limits involved. (d) "Replacement Cost" shall mean the cost to repair or rebuild the improvements owned by Lessor at the time of the occurrence to their condition existing immediately prior thereto, including demolition, debris removal and upgrading required by the operation of Applicable Requirements, and without deduction for depreciation. (e) "Hazardous Substance Condition" shall mean the occurrence or discovery of a condition involving the presence of, or a contamination by, a Hazardous Substance, in, on, or under the Premises which requires restoration. 9.2 Partial Damage- Insured Loss. If a Premises Partial Damage that is an Insured Loss occurs, then Lessor shall, at Lessor's expense (if Lessor receives insurance proceeds, provided that the foregoing limitation shall not apply unless Lessor has maintained the required insurance coverage), repair such damage (but not Lessee's Trade Fixtures or Lessee Owned Alterations and Utility Installations) as soon as reasonably possible and this Lease shall continue in full force and effect; provided, however, that Lessee shall, at Lessor's election, make the repair of any damage or destruction the total cost to repair of which is $10,000 or less, and, in such event, Lessor shall make any applicable insurance proceeds available to Lessee on a reasonable basis for that purpose. Notwithstanding the foregoing, if
the required insurance was not in force or the insurance proceeds are not   Initials 2017 AIR CRE. All Rights Reserved.  Initials  Page 9 of 20 Last Edited: 2/26/2018 3:14 PM MTN-26 00, Revised 01-03-2017  

 
 
sufficient to effect such repair, the Insuring Party shall promptly contribute the shortage in proceeds as and when required to complete said repairs. In the event, however, such shortage was due to the fact that, by reason of the unique nature of the improvements, full replacement cost insurance coverage was not commercially reasonable and available, Lessor shall have no obligation to pay for the shortage in insurance proceeds or to fully restore the unique aspects of the Premises unless Lessee provides Lessor with the funds to cover same, or adequate assurance thereof, within 10 days following receipt of written notice of such shortage and request therefor. If Lessor receives said funds or adequate assurance thereof within said 10 day period, the party responsible for making the repairs shall complete them as soon as reasonably possible and this Lease shall remain in full force and effect. If such funds or assurance are not received, Lessor may nevertheless elect by written notice to Lessee within 10 days thereafter to: (i) make such restoration and repair as is commercially reasonable with Lessor paying any shortage in proceeds, in which case this Lease shall remain in full force and effect, or (ii) have this Lease terminate 30 days thereafter. Lessee shall not be entitled to reimbursement of any funds contributed by Lessee to repair any such damage or destruction. Premises Partial Damage due to flood or earthquake shall be subject to Paragraph 9.3, notwithstanding that there may be some insurance coverage, but the net proceeds of any such insurance shall be made available
for the repairs if made by either Party. 9.3 Partial Damage- Uninsured Loss. If a Premises Partial Damage that is not an Insured Loss occurs, unless caused by a negligent or willful act of Lessee (in which event Lessee shall make the repairs at Lessee's expense), Lessor may either: (i) repair such damage as soon as reasonably possible at Lessor's expense (subject to reimbursement pursuant to Paragraph 4.2), in which event this Lease shall continue in full force and effect, or (ii) terminate this Lease by giving written notice to Lessee within 30 days after receipt by Lessor of knowledge of the occurrence of such damage. Such termination shall be effective 60 days following the date of such notice. In the event Lessor elects to terminate this Lease, Lessee shall have the right within 10 days after receipt of the termination notice to give written notice to Lessor of Lessee's commitment to pay for the repair of such damage without reimbursement from Lessor. Lessee shall provide Lessor with said funds or satisfactory assurance thereof within 30 days after making such commitment. In such event this Lease shall continue in full force and effect, and Lessor shall proceed to make such repairs as soon as reasonably possible after the required funds are available. If Lessee does not make the required commitment, this Lease shall terminate as of the date specified in the termination notice. 9.4  Total Destruction. Notwithstanding any other provision hereof, if a Premises Total Destruction occurs, this Lease shall terminate 60 days following such Destruction. If the damage or destruction
was caused by the gross negligence or willful misconduct of Lessee, Lessor shall have the right to recover Lessor's damages from Lessee, except as provided in Paragraph 8.6. 9.5 Damage Near End of Term. If at any time during the last 6 months of this Lease there is damage for which the cost to repair exceeds one month's Base Rent, whether or not an Insured Loss, Lessor may terminate this Lease effective 60 days following the date of occurrence of such damage by giving a written termination notice to Lessee within 30 days after the date of occurrence of such damage. Notwithstanding the foregoing, if Lessee at that time has an exercisable option to extend this Lease or to purchase the Premises, then Lessee may preserve this Lease by, (a) exercising such option and (b) providing Lessor with any shortage in insurance proceeds (or adequate assurance thereof) needed to make the repairs on or before the earlier of (i) the date which is 10 days after Lessee's receipt of Lessor's written notice purporting to terminate this Lease, or (ii) the day prior to the date upon which such option expires. If Lessee duly exercises such option during such period and provides Lessor with funds (or adequate assurance thereof) to cover any shortage in insurance proceeds, Lessor shall, at Lessor's commercially reasonable expense, repair such damage as soon as reasonably possible and this Lease shall continue in full force and effect. If Lessee fails to exercise such option and provide such funds or assurance during such period, then this Lease shall terminate on the date specified in the
termination notice and Lessee's option shall be extinguished. 9.6 Abatement of Rent; Lessee's Remedies. (a) Abatement. In the event of Premises Partial Damage or Premises Total Destruction or a Hazardous Substance Condition for which Lessee is not responsible under this Lease, the Rent payable by Lessee for the period required for the repair, remediation or restoration of such damage shall be abated In proportion to the degree to which Lessee's use of the Premises is impaired, but not to exceed the proceeds received from the Rental Value insurance. All other obligations of Lessee hereunder shall be performed by Lessee, and Lessor shall have no liability for any such damage, destruction, remediation, repair or restoration except as provided herein. (b) Remedies. If Lessor is obligated to repair or restore the Premises and does not commence, in a substantial and meaningful way, such repair or restoration within 90 days after such obligation shall accrue, Lessee may, at any time prior to the commencement of such repair or restoration, give written notice to Lessor and to any Lenders of which Lessee has actual notice, of Lessee's election to terminate this Lease on a date not less than 60 days following the giving of such notice. If Lessee gives such notice and such repair or restoration is not commenced within 30 days thereafter, this Lease shall terminate as of the date specified in said notice. If the repair or restoration is commenced within such 30 days, this Lease shall continue in full force and effect. "Commence" shall mean either the unconditional authorization of the
preparation of the required plans, or the beginning of the actual work on the Premises, whichever first occurs. 9.7 Termination; Advance Payments. Upon termination of this Lease pursuant to Paragraph 6.2(g) or Paragraph 9, an equitable adjustment shall be made concerning advance Base Rent and any other advance payments made by Lessee to Lessor. Lessor shall, in addition, return to Lessee so much of Lessee's Security Deposit as has not been, or is not then required to be, used by Lessor. 9.8 Waive Statutes. Lessor and Lessee agree that the terms of the Lease shall govern the effect or any damage to or destruction of the Premises with respect to termination of this Lease and hereby waive the provisions of any present or future statute to the extent inconsistent herewith. including, but not limited to. Section 1932(2) and 1933(4) of the California Civil Code (as may be amended or supplemented from time to time). 10. Real Property Taxes. 10.1 Definition. As used herein, the term "Real Property Taxes" shall include any form of assessment; real estate, general, special, ordinary or extraordinary, or rental levy or tax (other than inheritance, personal income or estate taxes); improvement bond; and/or license fee imposed upon or levied against any legal or equitable interest of Lessor in the Project, Lessor's right to other income therefrom, and/or Lessor's business of leasing, by any authority having the direct or indirect power to tax and where the funds are generated with reference to the Project address. The term "Real Property Taxes" shall also include any tax, fee, levy,
assessment or charge, or any increase therein: (i) imposed by reason of events occurring during the term of this Lease, including but not limited to, a change in the ownership of the Project, (ii) a change in the improvements thereon, and/or (iii) levied or assessed on machinery or equipment provided by Lessor to Lessee pursuant to this Lease. In calculating Real Property Taxes for any calendar  INITIALS 2017 AIR CRE. All Rights Reserved.  Page 10 of 20 Last Edited: 2/26/2018 3:14 PM  INITIALS  MTN-26 00, Revised 01-03-2017    

 
 
year, the Real Property Taxes for any real estate tax year shall be included in the calculation of Real Property Taxes for such calendar year based upon the number of days which such calendar year and tax year have in common. 10.2 Payment of Taxes. Except as otherwise provided in Paragraph 10.3, Lessor shall pay the Real Property Taxes applicable to the Project, and said payments shall be included in the calculation of Common Area Operating Expenses in accordance with the provisions of Paragraph 4.2. 10.3 Additional Improvements. Common Area Operating Expenses shall not include Real Property Taxes specified in the tax assessor's records and work sheets as being caused by additional Improvements placed upon the Project by other lessees or by Lessor for the exclusive enjoyment of such other lessees. Notwithstanding Paragraph 10.2 hereof, Lessee shall, however, pay to Lessor at the time Common Area Operating Expenses are payable under Paragraph 4.2, the entirety of any increase in Real Property Taxes if assessed solely by reason of Alterations, Trade Fixtures or Utility Installations placed upon the Premises by Lessee or at Lessee's request or by reason of any alterations or improvements to the Premises made by lessor subsequent to the execution of this Lease by the Parties. 10.4 Joint Assessment. If the Building is not separately assessed, Real Property Taxes allocated to the Building shall be an equitable proportion of the Real Property Taxes for all of the land and improvements included within the tax parcel assessed, such proportion to be determined
by Lessor from the respective valuations assigned in the assessor's work sheets or such other information as may be reasonably available. Lessor's reasonable determination thereof, in good faith, shall be conclusive. 10.5 Personal Property Taxes. Lessee shall pay prior to delinquency all taxes assessed against and levied upon Lessee Owned Alterations and Utility Installations, Trade Fixtures, furnishings, equipment and all personal property of Lessee contained in the Premises. When possible, Lessee shall cause its Lessee Owned Alterations and Utility Installations, Trade Fixtures, furnishings, equipment and all other personal property to be assessed and billed separately from the real property or Lessor. If any of Lessee's said property shall be assessed with Lessor's real property, Lessee shall pay Lessor the taxes attributable to Lessee's property within 10 days after receipt of a written statement setting forth the taxes applicable to Lessee's property. 11. Utilities and Services. Lessee shall pay for all water, gas, heat, light, power, telephone, trash disposal and other utilities and services supplied to the Premises, together with any taxes thereon. Notwithstanding the provisions of Paragraph 4.2, if at any time in Lessor's sole judgment, Lessor determines that Lessee is using a disproportionate amount of water, electricity or other commonly metered utilities, or that Lessee is generating such a large volume of trash as to require an increase in the size of the trash receptacle and/or an increase in the number of times per month that it is emptied, then Lessor may increase Lessee's Base
Rent by an amount equal to such increased costs. There shall be no abatement of Rent and Lessor shall not be liable in any respect whatsoever for the inadequacy, stoppage, interruption or discontinuance of any utility or service due to riot, strike, labor dispute, breakdown, accident, repair or other cause beyond Lessor's reasonable control or in cooperation with governmental request or directions. 12. Assignment and Subletting. 12.1 Lessor's Consent Required. (a) Lessee shall not voluntarily or by operation of law assign, transfer, mortgage or encumber (collectively, "assign or assignment") or sublet all or any part of Lessee's interest in this Lease or in the Premises without Lessor's prior written consent; provided that Lessor's consent shall not be required for any assignment or sublease between Lessor and any entity controlled by, controlling or under common control with Lessee (a "Lessee Affiliate"). (b) Unless Lessee, or a Lessee Affiliate controlling Lessee, is a corporation and its stock is publicly traded on a national stock exchange, a change in the control of Lessee (or such Lessee Affiliate) shall constitute an assignment requiring consent, provided that neither of the following transactions or series of transactions shall constitute an assignment requiring Lessor's consent: (i) an initial public offering of the stock of Lessee on a national exchange; or (ii) a merger, sale acquisition or other transfer of substantially all of Lessee's shares or assets which does not result in the Net Worth of Lessee being reduced in excess of the maximum amount permitted pursuant to
Paragraph 12.1(c) below, as long as the. The surviving entity (if Lessee is not the surviving entity) assumes the Lessee's obligations under this Lease. Without limiting the foregoing, the transfer, on a cumulative basis, of 50% 25% or more of the voting control of Lessee (provided that reasonable restrictions placed on the transfer or Lessee's stock or voting control pursuant to a bona fide financing transaction shall not be considered a transfer of voting control for the purposes hereof) shall constitute a change in control for this purpose. (c) The involvement of Lessee or its assets in any transaction. or series of transactions (by way of merger, sale, acquisition, financing, transfer, leveraged buy-out or otherwise), whether or not a formal assignment or hypothecation of this Lease or Lessee's assets occurs, which results or will result in a reduction of the Net Worth of Lessee by an amount greater than 25% of such Net Worth as it was represented at the time of the execution of this Lease or at the time of the most recent assignment to which Lessor has consented, or as it exists immediately prior to said transaction or transactions constituting such reduction , whichever was or is greater, shall be considered an assignment of this Lease to which Lessor may withhold its consent. "Net Worth of Lessee" shall mean the net worth of Lessee (excluding any guarantors) established under generally accepted accounting principles. (d)  An assignment or subletting without Lessor's consent as required herein shall, at Lessor's option, be a Default curable after notice per Paragraph 13.1(d). or a
non curable Breach without the necessity of any notice and grace period. If Lessor elects to treat such unapproved assignment or subletting as a non-curable Breach, Lessor may either: (i) terminate this Lease, or (ii) upon 30 days written notice, increase the monthly Base Rent to 110% of the Base Rent then in effect. Further, in the event of such Breach and rental adjustment, (i) the purchase price of any option to purchase the Premises held by Lessee shall be subject to similar adjustment to 110% of the price previously in effect, and (ii} all fixed and non-fixed rental adjustments scheduled during the remainder of the Lease term shall be increased to 110% of the scheduled adjusted rent. (e) Lessee's remedy for any breach of Paragraph 12.1 by Lessor shall be limited to compensatory damages and/or injunctive relief. (f) Lessor may reasonably withhold consent to a proposed assignment or subletting if Lessee is in Default at the time consent is requested. (g) Notwithstanding the Foregoing, allowing a de minimis portion of the Premises, i.e. 20 square feet or less, to be used by a third party vendor in connection with the installation of a vending machine or payphone shall not constitute a subletting. 12.2 Terms and Conditions Applicable to Assignment and Subletting. (a) Regardless of Lessor's consent, no assignment or subletting shall: (i) be effective without the express written INITIALS 2017 AIR CRE. All Rights Reserved. Page 11 of 20 Last Edited: 2/26/2018 3:14 PM  INITIALS MTN-26 00, Revised 01-03-2017  

 
 
assumption by such assignee or sublessee of the obligations of Lessee under this Lease, (ii) release Lessee of any obligations hereunder, or (iii) alter the primary liability of Lessee for the payment of Rent or for the performance of any other obligations to be performed by Lessee. (b) Lessor may accept Rent or performance of Lessee's obligations from any person other than Lessee pending approval or disapproval of an assignment. Neither a delay in the approval or disapproval of such assignment nor the acceptance of Rent or performance shall constitute a waiver or estoppel of Lessor's right to exercise its remedies for Lessee's Default or Breach. (c) Lessor's consent to any assignment or subletting shall not constitute a consent to any subsequent assignment or subletting. (d) In the event of any Default or Breach by Lessee, Lessor may proceed directly against Lessee, any Guarantors or anyone else responsible for the performance of Lessee's obligations under this Lease, including any assignee or sublessee, without first exhausting Lessor's remedies against any other person or entity responsible therefor to Lessor, or any security held by Lessor. (e) Each request for consent to an assignment or subletting shall be in writing, accompanied by information relevant to Lessor's determination as to the financial and operational responsibility and appropriateness of the proposed assignee or sublessee, including but not limited to the intended use and/or required modification of the Premises, if any, together with a fee of $500 as consideration for Lessor's considering and processing
said request. Lessee agrees to provide Lessor with such other or additional information and/or documentation as may be reasonably requested. (See also Paragraph 36) (f) Any assignee of, or sublessee under, this Lease shall, by reason of accepting such assignment, entering into such sublease ,or entering into possession of the Premises or any portion thereof, be deemed to have assumed and agreed to conform and comply with each and every term, covenant, condition and obligation herein to be observed or performed by Lessee during the term of said assignment or sublease, other than such obligations as are contrary to or inconsistent with provisions of an assignment or sublease to which Lessor has specifically consented to in writing. (g) Lessor's consent to any assignment or subletting shall not transfer to the assignee or sublessee any Option granted to the original Lessee by this Lease unless such transfer is specifically consented to by Lessor in writing. (See Paragraph 39.2) 12.3 Additional Terms and Conditions Applicable to Subletting. The following terms and conditions shall apply to any subletting by Lessee of all or any part of the Premises and shall be deemed included in all subleases under this Lease whether or not expressly incorporated therein: (a) Lessee hereby assigns and transfers to Lessor all of Lessee's interest in all Rent payable on any sublease, and Lessor may collect such Rent and apply same toward Lessee's obligations under this Lease; provided, however, that until a Breach shall occur in the performance of Lessee's obligations, Lessee may collect
said Rent. In the event that the amount collected by Lessor exceeds Lessee's then outstanding obligations any such excess shall be refunded to Lessee. Lessor shall not, by reason of the foregoing or any assignment of such sublease, nor by reason of the collection of Rent, be deemed liable to the sublessee for any failure of Lessee to perform and comply with any of Lessee's obligations to such sublessee. Lessee hereby irrevocably authorizes and directs any such sublessee, upon receipt of a written notice from Lessor stating that a Breach exists in the performance of Lessee's obligations under this Lease, to pay to lessor all Rent due and to become due under the sublease. Sublessee shall rely upon any such notice from Lessor and shall pay all Rents to Lessor without any obligation or right to inquire as to whether such Breach exists, notwithstanding any claim from Lessee to the contrary. (b) In the event of a Breach by Lessee, Lessor may, at its option, require sublessee to attorn to lessor, in which event Lessor shall undertake the obligations of the sublessor under such sublease from the time of the exercise of said option to the expiration of such sublease ; provided , however, lessor shall not be liable for any prepaid rents or security deposit paid by such sublessee to such sublessor or for any prior Defaults or Breaches of such sublessor. (c) Any matter requiring the consent of the sublessor under a sublease shall also require the consent of Lessor. (d) No sublessee shall further assign or sublet all or any part of the Premises without Lessor's prior written consent. (e) Lessor shall
deliver a copy of any notice of Default or Breach by Lessee to the sublessee, who shall have the right to cure the Default of Lessee within the grace period, if any, specified in such notice. The sublessee shall have a right of reimbursement and I offset from and against Lessee for any such Defaults cured by the sublessee. (f) Notwithstanding anything to the contrary herein, for an approved sublease or the entire Premises for the entire remainder of the term, if the Net Worth of the sublessee is equal to or greater than the Net Worth of Lessee, the Lessee shall be released from any obligations under the Lease that accrues after the effective date of the sublease. 13. Default; Breach; Remedies. 13.1 Default; Breach. A "Default" is defined as a failure by the Lessee to comply with or perform any of the terms, covenants, conditions or Rules and Regulations under this Lease. A "Breach" is defined as the occurrence of one or more of the following Defaults, and the failure of Lessee to cure such Default within any applicable grace period: (a) The abandonment of the Premises; or the vacating of the Premises without providing a commercially reasonable level of security, or where the coverage of the property insurance described in Paragraph 8.3 is jeopardized as a result thereof, or without providing reasonable assurances to minimize potential vandalism . (b) The failure of Lessee to make any payment of Rent or any Security Deposit required to be made by Lessee hereunder, whether to lessor or to a third party, when due, to provide reasonable evidence of insurance or surety bond, or
to fulfill any obligation under this lease which endangers or threatens life or property, where such failure continues for a period of 3 business days following written notice to lessee. THE ACCEPTANCE BY LESSOR OF A PARTIAL PAYMENT OF RENT OR SECURITY DEPOSIT SHALL NOT CONSTITUTE A WAIVER OF ANY OF LESSOR'S RIGHTS, INCLUDING LESSOR'S RIGHT TO RECOVER POSSESSION OF THE PREMISES. (c) The failure of lessee to allow Lessor and/or its agents access to the Premises or the commission of waste, act or acts constituting public or private nuisance, and/or an illegal activity on the Premises by Lessee, where such actions continue for a period of 3 business days following written notice to Lessee. In the event that Lessee commits waste, a nuisance or an illegal activity a second time then, the lessor may elect to treat such conduct as a non-curable Breach rather than a Default. (d) The failure by Lessee to provide (i) reasonable written evidence of compliance with Applicable Requirements, (ii) the service contracts, (iii) the rescission of an unauthorized assignment or subletting, (iv) an Estoppel Certificate or financial statements, (v) a requested subordination, (vi) evidence concerning any guaranty and/or Guarantor, (vii) any document requested under Paragraph 41, (viii) material safety data sheets (MSDS), or (ix) any other documentation or information which Lessor may reasonably require of Lessee under the terms of this Lease, where any such failure continues for a period of 10 days following written notice to
Lessee   Initials 2017 AIR CRE. All Rights Reserved.  Initials  Page 12 of 20 Last Edited: 2/26/2018 3:14 PM MTN-26 00,Revised 01-03-2017    

 
 
(e) A Default by Lessee as to the terms, covenants, conditions or provisions of this Lease, or of the rules adopted under Paragraph 2.9 hereof, other than those described in subparagraphs 13.1(a). (b), (c) or (d), above, where such Default continues for a period of 30 days after written notice; provided, however, that if the nature of Lessee's Default is such that more than 30 days are reasonably required for its cure, then it shall not be deemed to be a Breach if Lessee commences such cure within said 30 day period and thereafter diligently prosecutes such cure to completion. (f) The occurrence of any of the following events: (i) the making of any general arrangement or assignment for the benefit of creditors; (ii) becoming a "debtor" as defined in 11 U.S.C. § 101 or any successor statute thereto (unless, in the case of a petition filed against Lessee, the same is dismissed within 60 days); (iii) the appointment of a trustee or receiver to take possession of substantially all of Lessee's assets located at the Premises or of Lessee's interest in this Lease, where possession is not restored to Lessee within 30 days; or (iv) the attachment, execution or other judicial seizure of substantially all of Lessee's assets located at the Premises or of Lessee's interest in this Lease, where such seizure is not discharged within 30 days; provided, however, in the event that any provision of this subparagraph is contrary to any applicable law, such provision shall be of no force or effect, and not affect the validity of the remaining provisions. (g) The discovery that any financial statement of Lessee or of any
Guarantor given to Lessor was materially false. (h) If the performance of Lessee's obligations under this Lease is guaranteed: (i) the death of a Guarantor, (ii) the termination of a Guarantor's liability with respect to this Lease other than in accordance with the terms of such guaranty, (iii) a Guarantor's becoming insolvent or the subject of a bankruptcy filing, (iv) a Guarantor's refusal to honor the guaranty, or (v) a Guarantor's breach of its guaranty obligation on an anticipatory basis, and Lessee's failure, within 60 days following written notice of any such event, to provide written alternative assurance or security, which, when coupled with the then existing resources of Lessee, equals or exceeds the combined financial resources of Lessee and the Guarantors that existed at the time of execution of this Lease. 13.2 Remedies. If Lessee fails to perform any of its affirmative duties or obligations, within 10 days after written notice (or in case of an emergency, without notice), Lessor may, at its option, perform such duty or obligation on Lessee's behalf, including but not limited to the obtaining of reasonably required bonds, insurance policies, or governmental licenses, permits or approvals. Lessee shall pay to Lessor an amount equal to 115% of the costs and expenses incurred by Lessor in such performance upon receipt of an invoice therefor. In the event of a Breach, Lessor may, with or without further notice or demand, and without limiting Lessor in the exercise of any right or remedy which Lessor may have by reason of such Breach: (a) Terminate Lessee's right to possession
of the Premises by any lawful means, in which case this Lease shall terminate, and Lessee shall immediately surrender possession to Lessor. In such event Lessor shall be entitled to recover from Lessee: (i) the unpaid Rent which had been earned at the time of termination; (ii) the worth at the time of award of the amount by which the unpaid rent which would have been earned after termination until the time of award exceeds the amount of such rental loss that the Lessee proves could have been reasonably avoided; (iii) the worth at the time of award of the amount by which the unpaid rent for the balance of the term after the time of award exceeds the amount of such rental loss that the Lessee proves could be reasonably avoided; and (iv) any other amount necessary to compensate Lessor for all the detriment proximately caused by the Lessee's failure to perform its obligations under this Lease or which in the ordinary course of things would be likely to result therefrom, including but not limited to the cost of recovering possession of the Premises, expenses of reletting, including necessary renovation and alteration of the Premises, reasonable attorneys' fees, and that portion of any leasing commission paid by Lessor in connection with this Lease applicable to the unexpired term of this Lease. The worth at the time of award of the amount referred to in provision (iii) of the immediately preceding sentence shall be computed by discounting such amount at the discount rate of the Federal Reserve Bank of the District within which the Premises are located at the time of award
plus one percent. Efforts by Lessor to mitigate damages caused by Lessee's Breach of this Lease shall not waive Lessor's right to recover any damages to which Lessor is otherwise entitled. If termination of this Lease is obtained through the provisional remedy of unlawful detainer, Lessor shall have the right to recover in such proceeding any unpaid Rent and damages as are recoverable therein, or Lessor may reserve the right to recover all or any part thereof in a separate suit. If a notice and grace period required under Paragraph 13.1 was not previously given, a notice to pay rent or quit, or to perform or quit given to Lessee under the unlawful detainer statute shall also constitute the notice required by Paragraph 13.1. In such case, the applicable grace period required by Paragraph 13.1 and the unlawful detainer statute shall run concurrently, and the failure of Lessee to cure the Default within the greater of the two such grace periods shall constitute both an unlawful detainer and a Breach of this Lease entitling Lessor to the remedies provided for in this Lease and/or by said statute. (b) Continue the Lease and Lessee's right to possession and recover the Rent as it becomes due, in which event Lessee may sublet or assign, subject only to reasonable limitations. Acts of maintenance, efforts to relet, and/or the appointment of a receiver to protect the Lessor's interests, shall not constitute a termination of the Lessee's right to possession. (c) Pursue any other remedy now or hereafter available under the laws or judicial decisions of the state wherein the Premises are located. The
expiration or termination of this Lease and/or the termination of Lessee's right to possession shall not relieve Lessee from liability under any indemnity provisions of this Lease as to matters occurring or accruing during the term hereof or by reason of Lessee's occupancy of the Premises. 13.3 Inducement Recapture. Any agreement for free or abated rent or other charges, the cost of tenant improvements for Lessee paid for or performed by Lessor, or for the giving or paying by lessor to or for Lessee of any cash or other bonus, inducement or consideration for Lessee's entering into this Lease, all of which concessions are hereinafter referred to as "Inducement Provisions," shall be deemed conditioned upon Lessee's full and faithful performance of all of the terms, covenants and conditions of this Lease. Upon Breach of this Lease by Lessee, any such Inducement Provision shall automatically be deemed deleted from this Lease and of no further force or effect, and any rent, other charge, bonus, inducement or consideration theretofore abated, given or paid by Lessor under such an Inducement Provision shall be immediately due and payable by Lessee to Lessor, notwithstanding any subsequent cure of said Breach by Lessee. The acceptance by Lessor of rent or the cure of the Breach which initiated the operation of this paragraph shall not be deemed a waiver by Lessor of the provisions of this paragraph unless specifically so stated in writing by Lessor at the time of such acceptance. 13.4 Late Charges. Lessee hereby acknowledges that late payment by Lessee of Rent will
cause lessor to incur costs not contemplated by this Lease, the exact amount of which will be extremely difficult to ascertain. Such costs include, but are not limited to, processing and accounting charges, and late charges which may be imposed upon lessor by any Lender. Accordingly, if any Rent shall not be received by Lessor within 5 days after such amount shall be due, then, without any requirement for notice to Lessee, Lessee shall immediately pay to Lessor a one•time late charge equal to 10% of each such overdue amount or $100, whichever is greater. The parties hereby agree that such late charge represents a fair and reasonable estimate of the costs Lessor will incur by reason of such late payment. Acceptance of such late charge by Lessor shall in no event constitute a waiver of Lessee's Default or Breach with respect to such overdue amount, nor prevent the exercise of any of the other rights and remedies granted hereunder. In  INITIALS 2017 AIR CRE. All Rights Reserved.  Page 13 of 20 Last Edited: 2/26/2018 3:14 PM  INITIALS  MTN-26 00, Revised 01-03-2017  

 
 
the event that a late charge is payable hereunder, whether or not collected, for 3 consecutive installments of Base Rent, then notwithstanding any provision of this lease to the contrary, Base Rent shall, at Lessor's option, become due and payable quarterly in advance. 13.5 Interest. Any monetary payment due Lessor hereunder, other than late charges, not received by lessor, when due shall bear interest from the 31st day after it was due. The interest ("Interest") charged shall be computed at the rate of 10% per annum but shall not exceed the maximum rate allowed by law. Interest is payable in addition to the potential late charge provided for in Paragraph 13.4. 13.6 Breach by Lessor. (a) Notice of Breach. Lessor shall not be deemed in breach of this lease unless lessor fails within a reasonable time to perform an obligation required to be performed by Lessor. For purposes of this Paragraph, a reasonable time shall in no event be less more than 30 days after receipt by lessor, and any lender whose name and address shall have been furnished to Lessee in writing for such purpose, of written notice specifying wherein such obligation of lessor has not been performed; provided, however, that if the nature of lessor's obligation is such that more than 30 days are reasonably required for its performance, then Lessor shall not be in breach if performance is commenced within such 30 day period and thereafter diligently pursued to completion. (b) Performance by Lessee on Behalf of Lessor. In the event that neither Lessor nor Lender cures said breach within 30 days after receipt of said
notice, or if having commenced said cure they do not diligently pursue it to completion, then Lessee may elect to cure said breach at lessee's expense and offset from Rent the actual and reasonable cost to perform such cure, provided however, that such offset shall not exceed an amount equal to the greater of one month's Base Rent or the Security Deposit, reserving lessee's right to reimbursement from lessor for any such expense in excess of such offset. Lessee shall document the cost of said cure and supply said documentation to lessor. 14. Condemnation. If the Premises or any portion thereof are taken under the power of eminent domain or sold under the threat of the exercise of said power (collectively "Condemnation"), this Lease shall terminate as to the part taken as of the date the condemning authority takes title or possession, whichever first occurs. If more than 10% of the floor area of the Unit, or more than 25% of the parking spaces is taken by Condemnation, Lessee may, at lessee's option, to be exercised in writing within 10 days after Lessor shall have given Lessee written notice of such taking (or in the absence of such notice, within 10 days after the condemning authority shall have taken possession) terminate this lease as of the date the condemning authority takes such possession. If Lessee does not terminate this Lease in accordance with the foregoing, this Lease shall remain in full force and effect as to the portion of the Premises remaining, except that the Base Rent shall be reduced in proportion to the reduction in utility of the Premises caused by such
Condemnation. Condemnation awards and/or payments shall be the property of lessor, whether such award shall be made as compensation for diminution in value of the leasehold, the value of the part taken, or for severance damages; provided, however, that lessee shall be entitled to any compensation paid by the condemnor for Lessee's relocation expenses, loss of business goodwill and/or Trade Fixtures, without regard to whether or not this Lease is terminated pursuant to the provisions of this Paragraph. All Alterations and Utility Installations made to the Premises by lessee, for purposes of Condemnation only, shall be considered the property of the lessee and lessee shall be entitled to any and all compensation which is payable therefor. In the event that this Lease is not terminated by reason of the Condemnation, Lessor shall repair any damage to the Premises caused by such Condemnation. 15. Brokerage Fees. 15.1 additional commission. In addition to the payments owed pursuant to paragraph 1.10 above, lessor agrees that: (a) if lessee exercises any option, (b) if lessee or anyone affiliated with lessee acquires from lessor any rights to the premises or other premises owned by lessor and located within the project, (c) if lessee remains in possession of the premises, with the consent of lessor, after the expiration of this lease, or (d) if base rent is increased, whether by agreement or operation of an escalation clause herein, then, lessor shall pay brokers a fee in accordance with the fee schedule of the brokers in effect at the time the lease was executed. 15.2 Assumption of
obligations, Anu buyer or transferee of lessor’s interest in this lease shall be deemed to have assumed lessor’s obligation hereunder brokers shall be third party beneficiaries of the provisions of paragraphs 1.10,15, 22 and 31. If lessor fails to pay to brokers any amounts due as and for brokerage fees pertaining to this lease when due, then such amounts shall accrue interest. In addition, If lessor fails to pay any amounts within 10 days after said notice, lessee shall pay said monies to its broker and offset such amounts against rent. In addition, lessee’s broker shall be deemed to be a third party beneficiary of any commission agreement entered into by and/or between lesser and lessor’s broker for the limited purpose of collecting any brokerage fee owed. 15.3 Representations and Indemnities of Broker Relationships. lessee and Lessor each represent and warrant to the other that it has had no dealings with any person, firm, broker or finder (other than the Brokers, if any) in connection with this Lease, and that no one other than said named Brokers is entitled to any commission or finder's fee in connection herewith. lessee and lessor do each hereby agree to indemnify, protect, defend and hold the other harmless from and against liability for compensation or charges which may be claimed by any such unnamed broker, finder or other similar party by reason of any dealings or actions of the indemnifying Party, including any costs, expenses, attorneys' fees reasonably incurred with respect thereto. 16. Estoppel Certificates. (a) Each Party (as ''Responding Party") shall within 10 days
after written notice from the other Party (the "Requesting Party") execute, acknowledge and deliver to the Requesting Party a statement in writing in form similar to the then most current "Estoppel Certificate" form published BY AIR CRE, plus such additional information, confirmation and/or statements as may be reasonably requested by the Requesting Party. (b) If the Responding Party shall fail to execute or deliver the Estoppel Certificate within such 10 day period, the Requesting Party may execute an Estoppel Certificate stating that: (i) the lease is in full force and effect without modification except as may be represented by the Requesting Party, (ii) there are no uncured defaults in the Requesting Party's performance, and (iii) if Lessor is the Requesting Party, not more than one month's rent has been paid in advance. Prospective purchasers and encumbrancers may rely upon the Requesting Party's Estoppel Certificate, and the Responding Party shall be estopped from denying the truth of the facts contained in said Certificate. In addition, Lessee acknowledges that any failure on Its part to provide such an Estoppel Certificate will expose lessor to risks and potentially cause lessor to incur costs not contemplated by this Lease, the extent of which will be extremely difficult to ascertain. Accordingly, should the lessee fail to execute and/or deliver a requested Estoppel Certificate in a timely fashion the monthly Base Rent shall be automatically increased, without any requirement for notice to Lessee, by an amount     INITIALS © 2017 AIR CRE. All Rights Reserved.
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equal to 10% of the then existing Base Rent or $100, whichever is greater for remainder of the lease. The Parties agree that such increase in Base Rent represents fair and reasonable compensation for the additional risk/costs that lessor will incur by reason of Lessee's failure to provide the Estoppel Certificate. Such increase in Base Rent shall in no event constitute a waiver of lessee's Default or Breach with respect to the failure to provide the Estoppel Certificate nor prevent the exercise of any of the other rights and remedies granted hereunder. (c) If Lessor desires to finance, refinance, or sell the Premises, or any part thereof, Lessee and all Guarantors shall within 10 days after written notice from Lessor deliver to any potential lender or purchaser designated by Lessor such financial statements as may be reasonably required by such lender or purchaser, including but not limited to Lessee's financial statements for the past 3 years. All such financial statements shall be received by Lessor and such lender or purchaser in confidence and shall be used only for the purposes herein set forth. 17. Definition of Lessor. The term "Lessor" as used herein shall mean the owner or owners at the time in question of the fee title to the Premises, or, if this is a sublease, of the Lessee's interest in the prior lease. In the event of a transfer of Lessor's title or interest in the Premises or this lease, lessor shall deliver to the transferee or assignee (in cash or by credit) any unused Security Deposit held by lessor. Upon such transfer or assignment and delivery of the Security Deposit, as aforesaid, the
prior lessor shall be relieved of all liability with respect to the obligations and/or covenants under this lease thereafter to be performed by the Lessor. Subject to the foregoing, the obligations and/or covenants in this Lease to be performed by the Lessor shall be binding only upon the Lessor as hereinabove defined. 18. Severability. The invalidity of any provision of this Lease, as determined by a court of competent jurisdiction, shall in no way affect the validity of any other provision hereof. 19. Days. Unless otherwise specifically indicated to the contrary, the word "days" as used in this Lease shall mean and refer to calendar days. 20. Limitation on liability. The obligations of Lessor under this Lease shall not constitute personal obligations of lessor, or its partners, members, directors, officers or shareholders, and Lessee shall look to the Premises, and to no other assets of Lessor, for the satisfaction of any liability of lessor with respect to this lease, and shall not seek recourse against Lessor's partners, members, directors, officers or shareholders, or any of their personal assets for such satisfaction. 21. Time of Essence. Time is of the essence with respect to the performance of all obligations to be performed or observed by the Parties under this lease. 22. No Prior or Other Agreements; broker disclaimer. This lease contains all agreements between the Parties with respect to any matter mentioned herein, and no other prior or contemporaneous agreement or understanding shall be effective. Lessor and lessee each represent and warrants to the brokers that it has made and is
relying solely upon its own investigation as to the nature, quality, character and financial responsibility of the other party to this lease and as to the use, nature, quality and character of the premise, brokers have no responsibility with respect thereto or with respect to any default or breach hereof by either party. 23. Notices. 23.1 Notice Requirements. All notices required or permitted by this lease or applicable law shall be in writing and may be delivered in person (by hand or by courier) or may be sent by regular, certified or registered mail or U.S. Postal Service Express Mail, with postage prepaid, or by facsimile transmission, or by email, and shall be deemed sufficiently given if served in a manner specified in this Paragraph 23. The addresses noted adjacent to a Party's signature on this lease shall be that Party 's address for delivery or mailing of notices. Either Party may by written notice to the other specify a different address for notice, except that upon lessee's taking possession of the Premises, the Premises shall constitute lessee's address for notice. A copy of all notices to lessor shall be concurrently transmitted to such party or parties at such addresses as Lessor may from time to time hereafter designate in writing. (See also Paragraph 60.) 23.2 Date of Notice. Any notice sent by registered or certified mail, return receipt requested, shall be deemed given on the date of delivery shown on the receipt card, or if no delivery date is shown, the postmark thereon. If sent by regular mail the notice shall be deemed given 72 hours after the same is addressed as required herein
and mailed with postage prepaid. Notices delivered by United States Express Mail or overnight courier that guarantees next day delivery shall be deemed given 24 hours after delivery of the same to the Postal Service or courier. Notices delivered by hand or transmitted by facsimile transmission or by email shall be deemed delivered upon actual receipt. If notice is received on a Saturday, Sunday or legal holiday, it shall be deemed received on the next business day. 24. Waivers. (a) No waiver by lessor of the Default or Breach of any term, covenant or condition hereof by lessee, shall be deemed a waiver of any other term, covenant or condition hereof, or of any subsequent Default or Breach by lessee of the same or of any other term, covenant or condition hereof. lessor's consent to, or approval of, any act shall not be deemed to render unnecessary the obtaining of lessor's consent to, or approval of, any subsequent or similar act by lessee, or be construed as the basis of an estoppel to enforce the provision or provisions of this Lease requiring such consent. (b) The acceptance of Rent by lessor shall not be a waiver of any Default or Breach by Lessee  Any payment by lessee may be accepted by lessor on account of monies or damages due Lessor, notwithstanding any qualifying statements or conditions made by Lessee in connection therewith, which such statements and/or conditions shall be of no force or effect whatsoever unless specifically agreed to in writing by lessor at or before the time of deposit of such payment. (c) The Parties Agree That The Terms Of This Lease
Shall Govern With Regard To All Matters Related Thereto And Hereby Waive The Provisions Of Any Present Or Future Statute To The Extent That Such Statute Is Inconsistent With This Lease. 25. Disclosures Regarding The Nature of a Real Estate Agency Relationship. (a) When entering into a discussion with a real estate agent regarding a real estate transaction, a Lessor or Lessee should from the outset understand what type of agency relationship or representation it has with the agent or agents in the transaction. lessor and lessee acknowledge being advised by the Brokers in this transaction, as follows: (i) lessor’s Agent. A Lessor's agent under a listing agreement with the Lessor acts as the agent for the lessor only. A lessor agent or subagent has the following affirmative obligations: To the Lessor: A fiduciary duty of utmost care, integrity, honesty and loyalty in dealings with the lessor, To the Lessee and the Lessor: (a) Diligent exercise of reasonable skills and care in  INITIALS ©2017 AIR CRE. All Rights Reserved.  Page 15 of 20 Last Edited: 2/26/2018 3:14 PM  INITIALS MTN-26 00,Revised 01-03-2017    

 
 
performance of the agent's duties. (b) A duty of honest and fair dealing and good faith. (c) A duty to disclose all facts known to the agent materially affecting the value or desirability of the property that are not known to, or within the diligent attention and observation of, the Parties. An agent is not obligated to reveal to either Party any confidential information obtained from the other Party which does not Involve the affirmative duties set forth above. (ii) Lessee's Agent. An agent can agree to act as agent for the Lessee only. In these situations, the agent is not the Lessor's agent, even if by agreement the agent may receive compensation for services rendered, either in full or in part from the Lessor. An agent acting only for a Lessee has the following affirmative obligations. To the Lessee: A fiduciary duty of utmost care, integrity, honesty, and loyalty in dealings with the Lessee. To the Lessee and the Lessor: (a) Diligent exercise of reasonable skills and care in performance of the agent's duties. (b) A duty of honest and fair dealing and good faith. (c) A duty to disclose all facts known to the agent materially affecting the value or desirability of the property that are not known to, or within the diligent attention and observation of, the Parties. An agent is not obligated to reveal to either Party any confidential information obtained from the other Party which does not involve the affirmative duties set forth above. (iii) Agent Representing Both Lessor and Lessee. A real estate agent, either acting directly or through one or more associate licenses, can legally be the agent of both
the Lessor and the Lessee in a transaction, but only with the knowledge and consent of both the Lessor and the Lessee. In a dual agency situation, the agent has the following affirmative obligations to both the Lessor and the Lessee: (a) A fiduciary duty of utmost care Integrity, honesty and loyalty in the dealings with either Lessor or the Lessee. (b) Other duties to the Lessor and the Lessee as stated above in subparagraphs (i) or (ii). In representing both Lessor and Lessee, the agent may not without the express permission of the respective Party, disclose to the other Party that the Lessor will accept rent in an amount less than that indicated in the listing or that the Lessee is willing to pay a higher rent than that offered. The above duties of the agent in a real estate transaction do not relieve a Lessor or Lessee from the responsibility to protect their own interests. Lessor and Lessee should carefully read all agreements to assure that they adequately express their understanding of the transaction. A real estate agent is a person qualified to advise about real estate. If legal or tax advice is desired, consult a competent professional. (b) Brokers have no responsibility with respect to any default or breach hereof by either party The parties agree that no lawsuit or other legal proceeding involving any breach of duty, error or omission relating to this lease may be brought against broker more than one year  after the start date and that the liability (including court costs and attorneys’ feel), of any Broker with respect to any such lawsuit and/or legal preceding shall not exceed the fee received
by such Broker pursuant to this lease: provided, however, that the foregoing limitation on each Broker’s liability shall not be applicable to any gross negligence or willful misconduct of such Broker. (c) lessor and lessee agree to identify agree to identify to Broker as “Confidential” any communication or information given broker that is considered by such party to be confidential 26. No Right To Holdover. Lessee has no right to retain possession of the Premises or any part thereof beyond the expiration or termination of this Lease. In the event that Lessee holds over, then the Base Rent shall be increased to 150% of the Base Rent applicable immediately preceding the expiration or termination. Holdover Base Rent shall be calculated on monthly basis. Nothing contained herein shall be construed as consent by Lessor to any holding over by Lessee. 27. Cumulative Remedies. No remedy or election hereunder shall be deemed exclusive but shall, wherever possible, be cumulative with all other remedies at law or in equity. 28. Covenants and Conditions; Construction of Agreement. All provisions of this Lease to be observed or performed by Lessee are both covenants and conditions. In construing this Lease all headings and titles are for the convenience of the Parties only and shall not be considered a part of this Lease. Whenever required by the content, the singular shall include the plural and vice versa. This Lease shall not be construed as if prepared by one of the Parties, but rather according to its fair meaning as a whole, as if both Parties had prepared it. 29. Binding
Effect; Choice of Law. This Lease shall be binding upon the parties, their personal representatives, successors and assigns and be governed by the laws of the State in which the Premises are located. Any litigation between the Parties hereto concerning this Lease shall be initiated In the county in which the Premises are located. 30. Subordination; Attornment; Non-Disturbance. 30.1 Subordination. This Lease and any Option granted hereby shall be subject and subordinate to any ground lease, mortgage, deed of trust, or other hypothecation or security device (collectively, "Security Device"), now or hereafter placed upon the Premises, to any and all advances made on the security thereof, and to all renewals, modifications, and extensions thereof. Lessee agrees that the holders of any such Security Devices (in this Lease together referred to as "Lender") shall have no liability or obligation to perform any of the obligations of Lessor under this Lease. Any Lender may elect to have this Lease, and/or any Option granted hereby superior to the lien of its Security Device by giving written notice thereof to Lessee, whereupon this Lease and such Options shall be deemed prior to such Security Device, notwithstanding the relative dates of the documentation or recordation thereof. 30.2 Attornment. In the event that Lessor transfers title to the Premises, or the Premises are acquired by another upon the foreclosure or termination of a Security Device to which this Lease is subordinated (I) Lessee shall, subject to the non-disturbance provisions of Paragraph 30.3, attorn to such new
owner, and upon request, enter into a new lease, containing all of the terms and provisions of this Lease, with such new owner for the remainder of the term hereof, or, at the election of the new owner, this Lease will automatically become a new lease between Lessee and such new owner, and (ii) Lessor shall thereafter be relieved of any further obligations hereunder and such new owner shall assume all of Lessor's obligations, except that such new owner shall not: (a) be liable for any act or omission of any prior lessor or with respect to events occurring prior to acquisition of ownership; (b) be subject to any offsets or defenses which Lessee might have against any prior lessor, (c) be bound by prepayment of more than one month's rent, or (d) be liable for the return of any security deposit paid to any prior lessor which was not paid or credited to such new owner. 30.3 Non-Disturbance. With respect to Security Devices entered into by Lessor after the execution of this Lease, Lessee's subordination of this Lease shall be subject to receiving a commercially reasonable non-disturbance agreement (a "Non-Disturbance Agreement”) from the Lender which Non-Disturbance Agreement provides that Lessee's possession of the Premises, and this Lease, including any options to extend the term hereof, will not be disturbed so long as Lessee is not in Breach hereof and attorns to the record owner of the Premises. Further, within 60 days after the execution of this Lease, Lessor shall, if requested by Lessee, use its commercially reasonable efforts to obtain a Non-Disturbance
Agreement from the holder of any pre-existing Security Device which is secured by the Premise. In the event that Lessor is unable to provide the Non-Disturbance Agreement within said 60 days, then  INITIALS ©2017 AIR CRE. All Rights Reserved.  Page 15 of 20 Last Edited: 2/26/2018 3:14 PM  INITIALS MTN-26 00,Revised 01-03-2017    

 
 
Lessee may, at Lessee's option, directly contact Lender and attempt to negotiate for the execution and delivery of a Non-Disturbance Agreement  30.4 Self-Executing. The agreements contained in this Paragraph 30 shall be effective without the execution of any further documents; provided, however, that, upon written request from Lessor or a Lender in connection with a sale, financing or refinancing of the Premises, Lessee and Lessor shall execute such further writings as may be reasonably required to separately document any subordination, attornment and/or Non-Disturbance Agreement provided for herein. 31. Attorneys' Fees. If any Party or Broker brings an action or proceeding involving the Premises whether founded in tort, contract or equity, or to declare rights hereunder, the Prevailing Party (as hereafter defined) in any such proceeding, action, or appeal thereon, shall be entitled to reasonable attorneys' fees. Such fees may be awarded in the same suit or recovered in a separate suit, whether or not such action or proceeding is pursued to decision or judgment. The term, "Prevailing Party" shall include, without limitation, a Party or Broker who substantially obtains or defeats the relief sought, as the case may be, whether by compromise, settlement, judgment, or the abandonment by the other Party or Broker of its claim or defense. The attorneys' fees award shall not be computed in accordance with any court fee schedule, but shall be such as to fully reimburse all attorneys' fees reasonably incurred. In addition, Lessor shall be entitled to attorneys' fees, costs and
expenses incurred in the preparation and service of notices of Default and consultations in connection therewith, whether or not a legal action is subsequently commenced in connection with such Default or resulting Breach ($200 is a reasonable minimum per occurrence for such services and consultation). 32. Lessor's Access; Showing Premises; Repairs. Lessor and Lessor's agents shall have the right to enter the Premises at any time, in the case of an emergency, and otherwise at reasonable times after reasonable prior notice for the purpose of showing the same to I prospective purchasers, lenders, appraisers, or tenants, and making such alterations, repairs, improvements or additions to the Premises as Lessor may deem necessary or desirable and the erecting, using and maintaining of utilities, services, pipes and conduits through the Premises and/or other premises as long as there is no material adverse effect on Lessee's use of the Premises. All such activities shall be without abatement of rent or liability to Lessee. 33. Auctions. Lessee shall not conduct, nor permit to be conducted, any auction upon the Premises without Lessor's prior written consent. Lessor shall not be obligated to exercise any standard of reasonableness in determining whether to permit an auction. 34. Signs. Lessor may place on the Premises ordinary "For Sale" signs at any time and ordinary "For Lease" signs during the last 6 / months of the term hereof. Expect for ordinary “for sublease” signs which may be placed only on the premises lessee shall not place any sign upon the Project without Lessor's
prior written consent. All signs must comply with all Applicable Requirements. 35. Termination; Merger. Unless specifically stated otherwise in writing by Lessor, the voluntary or other surrender of this Lease by Lessee, the mutual termination or cancellation hereof, or a termination hereof by Lessor for Breach by Lessee, shall automatically terminate any sublease or lesser estate in the Premises; provided, however, that Lessor may elect to continue any one or all existing subtenancies. Lessor's failure within 10 days Following any such event to elect to the contrary by written notice to the holder of any such lesser interest, shall constitute Lessor's election to have such event constitute the termination of such interest. 36. Consents. All requests for consent shall be in writing. Except as otherwise provided herein, wherever in this Lease the consent I of a Party is required to an act by or for the other Party, such consent shall not be unreasonably withheld, conditioned or delayed. Lessor's actual reasonable costs and expenses (including but not limited to architects', attorneys', engineers' and other consultants' fees) incurred in the consideration of, or response to, a request by Lessee for any Lessor consent, including but not limited to consents to an assignment, a subletting or the presence or use of a Hazardous Substance, shall be paid by Lessee upon receipt of an invoice and supporting documentation therefor. lessor's consent to any act, assignment or subletting shall not constitute an acknowledgment that no Default or Breach by Lessee of this Lease exists, nor shall such
consent be deemed a waiver of any then existing Default or Breach, except as may be otherwise specifically stated in writing by Lessor at the time of such consent. The failure to specify herein any particular condition to Lessor's consent shall not predude the imposition by Lessor at the time of consent of such further or other conditions as are then reasonable with reference to the particular matter for which consent is being given. In the event that either Party disagrees with any determination made by the other hereunder and reasonably requests the reasons for such determination, the determining party shall furnish its reasons in writing and in reasonable detail within 10 business days following such request. 37. Guarantor. 37.1 Execution. The Guarantors, if any, shall each execute a guaranty in the form most recently published BY AIR CRE. 37.2 Default. It shall constitute a Default of the Lessee if any Guarantor fails or refuses, upon request to provide: (a) evidence of the execution of the guaranty, including the authority of the party signing on Guarantor's behalf to obligate Guarantor, and in the case of a corporate Guarantor, a certified copy of a resolution of its board of directors authorizing the making of such guaranty, (b) current financial statements, (c) an Estoppel Certificate, or (d) written confirmation that the guaranty is still in effect. 38. Quiet Possession. Subject to payment by Lessee of the Rent and performance of all of the covenants, conditions and provisions on lessee's part to be observed and performed under this lease, Lessee shall have quiet possession and
quiet enjoyment of the Premises during the term hereof. 39. Options. If Lessee is granted any option, as defined below, then the following provisions shall apply. 39.1 Definition. "Option" shall mean: (a) the right to extend or reduce the term of or renew this Lease or to extend or reduce the term of or renew any lease that Lessee has on other property of Lessor; (bl the right of first refusal or first offer to lease either the Premises or other property of Lessor; (c) the right to purchase, the right of first offer to purchase or the right of first refusal to purchase the Premises or other property of Lessor. 39.2 Options Personal To Original Lessee. Any Option granted to Lessee in this Lease is personal to the original Lessee, and cannot be assigned or exercised by anyone other than said original Lessee and only while the original Lessee is in full possession of the Premises and, if requested by Lessor, with lessee certifying that Lessee has no intention of thereafter assigning or subletting. 39.3 Multiple Options. In the event that Lessee has any multiple Options to extend or renew this lease, a later Option cannot be exercised unless the prior Options have been validly exercised. 39.4 Effect of Default on Options. (a) Lessee shall have no right to exercise an Option: (i) during the period commencing with the giving of any notice of Default and continuing until said Default is cured, (ii) during the period of time any Rent is unpaid (without regard to whether notice there of is given Lessee), (iii) during the time Lessee is in Breach of this Lease, or (iv) in the event that Lessee has been given 3
or  

 
 
more notices of separate default, whether or not the defaults are cured, during the 12 month period immediately preceding the exercise of the option . (b) the period of time within which an option may be exercised shall not be extended or enlarged by reason of Lessee's inability to exercise an Option because of the provisions of paragraph 39.4(a). (c) An Option shall terminate and be of no further force or effect, notwithstanding Lessee's due and timely exercise of the Option, if, after such exercise and prior to the commencement of the extended term or completion of the purchase, (i) Lessee fails to pay rent for a period of 30 days after such Rent becomes due (without any necessity of Lessor to give notice thereof), or (ii) if Lessee commits a Breach of this Lease. 40. Security Measures. Lessee hereby acknowledges that the Rent payable to Lessor hereunder does not include the cost of guard service or other security measures, and that Lessor shall have no obligation whatsoever to provide same. Lessee assumes all responsibility for the protection of the Premises, Lessee, its agents and invitees and their property from the acts of third parties. 41. Reservations. Lessor reserves the right: (i) to grant, without the consent or joinder of Lessee, such easements, rights and dedications that Lessor deems necessary, (ii) to cause the recordation of parcel maps and restrictions, and (iii) to create and/or install new utility raceways , so long as such easements, rights, dedications, maps, restrictions, and utility raceways do not unreasonably interfere with the use of the Premises by Lessee.
Lessee agrees to sign any documents reasonably requested by Lessor to effectuate such rights. 42. Performance Under Protest. if at any time a dispute shall arise as to any amount or sum of money to be paid by one party to the other under the provisions hereof, the party against whom the obligation to pay the money is asserted shall have the right to make payment "under protest" and such payment shall not be regarded as a voluntary payment and there shall survive the right on the part of said party to institute suit for recovery of such sum. if it shall be adjudged that there was no legal obligation on the part of said party to pay such sum or any part thereof, said party shall be entitled to recover such sum or so much thereof as it was not legally required to pay. a party who does not initiate suit for the recovery of sums paid "under protest" within 6 months shall be deemed to have waived its right to protest such payment. 43. Authority; Multiple Parties; Execution. (a) if either party hereto is a corporation, trust, limited liability company, partnership, or similar entity, each individual executing this lease on behalf of such entity represents and warrants that he or she is duly authorized to execute and deliver this lease on its behalf. each party shall, within 30 days after request, deliver to the other party satisfactory evidence of such authority. (b) if this lease is executed by more than one person or entity as "lessee", each such person or entity shall be jointly and severally liable hereunder. it is agreed that any one of the named lessees shall be empowered to execute any amendment to
this lease, or other document ancillary thereto and bind all of the named lessees, and lessor may rely on the same as if all of the named lessees had executed such document. (c) this lease may be executed by the parties in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument. 44. Conflict. any conflict between the printed provisions of this lease and the typewritten or handwritten provisions shall be controlled by the typewritten or handwritten provisions. 45. Offer. preparation of this lease by either party or their agent and submission of same to the other party shall not be deemed an offer to lease to the other party. this lease is not intended to be binding until executed and delivered by all parties hereto. 46. Amendments. this lease may be modified only in writing, signed by the parties in interest at the time of the modification as long as they do not materially change lessee's obligations hereunder, lessee agrees to make such reasonable non-monetary modifications to this lease as may be reasonably required by a lender in connection with the obtaining of normal financing or refinancing of the premises. 47. Waiver of jury trial. THE PARTIES HEREBY WAIVE THEIR RESPECTIVE RIGHTS TO TRIAL BY JURY IN ANY ACTION OR PROCEEDING INVOLVING THE PROPERTY OR ARISING OUT OF THIS AGREEMENT. 48. Arbitration of disputes. an addendum requiring the arbitration of all disputes between the parties and/or brokers arising out of this lease ☐ is ☒ is not attached to this
lease. 49. Accessibility; Americans with disabilities act.  (a) the premises: ☒ have not undergone an inspection by a certified access specialist (CASp). note: a certified access specialist (CASp) can inspect the subject premises and determine whether the subject premises comply with all of the applicable construction-related accessibility standards under state law. although state law does not require a CASp inspection of the subject premises, the commercial property owner or lessor may not prohibit the lessee or tenant from obtaining a CASp inspection of the subject premises for the occupancy or potential occupancy of the lessee or tenant, if requested by the lessee or tenant. the parties shall mutually agree on the arrangements for the time and manner of the CASp inspection, the payment of the fee for the CASp inspection, and the cost of making any repairs necessary to correct violations of construction-related accessibility standards within the premises. ☒ have undergone an inspection by a certified access specialist (CASp) and it was determined that the premises met all applicable construction-related accessibility standards pursuant to California civil code §55.51 et seq. lessee acknowledges that it received a copy of the inspection report at least 48 hours prior to executing this lease and agrees to keep such report confidential. ☒ have undergone an inspection by a certified access specialist (CASp) and it was determined that the premises did not meet all applicable construction-related accessibility standards pursuant to California civil code §55.51 et seq. lessee
acknowledges that it received a copy of the inspection report at least 48 hours prior to executing this lease and agrees to keep such report confidential except as necessary to complete repairs and corrections of violations of construction related accessibility standards. In the event that the premises have been issued an inspection report by a CASp the lessor shall provide a copy of the disability access inspection certificate to lessee within 7 days of the execution of this lease . (b) since compliance with the Americans with disabilities act (ADA) and other state and local accessibility statutes are dependent upon lessee's specific use of the premises, lessor makes no warranty or representation as to whether or not the premises comply with ADA or any similar legislation. In the event that lessee's use of the premises requires modifications or. INITIALS 2017 AIR CRE. All Rights Reserved.  Page 18 of 20 Last Edited: 2/26/2018 3:14 PM  INITIALS MTN-26 00,Revised 01-03-2017  

 
 
additions to the premises in order to be in compliance with ada or other accessibility statutes, lessee agrees to make any such necessary modifications and/or additions at lessee's expense.  lessor and lessee have carefully read and reviewed this lease and each term and provision contained herein, and by the execution of this lease show their informed and voluntary consent thereto. the parties hereby agree that, at the time this lease is executed, the terms of this lease are commercially reasonable and effectuate the intent and purpose of lessor and lessee with respect to the premises. attention: no representation or recommendation is made by air cre or by any broker as to the legal sufficiency, legal effect, or tax consequences of this lease or the transaction to which it relates. the parties are urged to: 1. seek advice of counsel as to the legal and tax consequences of this lease. 2. retain appropriate consultants to review and investigate the condition of the premises. said investigation should include but not be limited to: the possible presence of hazardous substances, the zoning of the premises, the structural integrity, the condition of the roof and operating systems, compliance with the Americans with disabilities act and the suitability of the premises for lessee's intended use.  warning: if the premises are located in a state other than California, certain provisions of the lease may need to be revised to comply with the laws of the state in which the premises are located.  the parties hereto have executed this lease at the place and on the dates specified above their respective signatures.
Executed at: on: by lessor: sr22 carlsbad oaks distribution, llc, a california limited liability company by: Name Printed: adam s, robinson title: manager phone: (858) 814-3116 fax: (760) 496-2847 email: by: name printed: title: phone: fax: email: address: 111 c street, suite 200, Encinitas, ca 92024 federal id no.: apg Carlsbad I, llc, a california limited liability company By: smb I group, l.p., a Delaware limited partnership its: managing Member by: k associates, a california general partnership its: general partner by: /s/Bonnie l name: Bonnie l its: managing member pre IV coaks, llc. A california limited liability company by: pacifica real estate IV, llc, a california limited liability company its: member by: /s/ steven c, leonard, manager Executed at: on: by lessee: ionis pharmaceuticals, inc., a delaware corporation by: /s/ Elizabeth L. Hougen name printed: Elizabeth L. Hougentitle: manager phone: fax: email: legalnotices@ionisph.com by: /s/ Brett P. Monia name printed: Brett P. Monia title: phone: fax: email: address: 2855 gazella court, Carlsbad, ca 92010 federal id no.: INITIALS ©2017 AIR CRE. All Rights Reserved.  Page 19 of 20 Last Edited: 2/26/2018 3:14 PM  INITIALS MTN-26 00,Revised 01-03-2017  

 
 
BROKER Cushman & wakefield Attn: aric starck/dennis visser Title: Senior managing director/managing director address: 1000 aviara parkwav, suite 100, Carlsbad, ca 92011 phone: (760) 431-4211 fax: email: federal ID no.: broker/agent BRE license #: 01325461 / 0125595 Broker CBRE attn: roger Carlson title: senior vice president Address: 5780 Fleet Street. Suite 100 Carlsbad, CA 92008 Phone: (760) 438-8533 Fax: (760) 438-8577 Email: roger. carlson@cbre .com Federal id No.: Broker/Agent BRE License #: 01236185 AIR CRE. 500 North Brand Blvd, Suite 900, Glendale, CA 91203, Tel 213-687-8777, Email contracts@aircre.com NOTICE: No part of these works may be reproduced in any form without permission In writing. INITIALS ©2017 AIR CRE. All Rights Reserved.  Page 20 of 20 Last Edited: 2/26/2018 3:14 PM  INITIALS MTN-26 00,Revised 01-03-2017  

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ADDENDUM TO THAT CERTAIN STANDARD INDUSTRIAL/COMMERCIAL MULTI-TENANT LEASE-NET DATED JANUARY 25,2018, BY AND BETWEEN SR22 CARLSBAD OAKS DISTRIBUTION, LLC, ETC. ("LESSOR") AND IONIS PHARMACEUTICALS, INC. ("LESSEE")   This Addendum amends the provisions of the above-referenced lease including any attached exhibits or addenda thereto (collectively, the "Lease"), it being the intent and agreement that the provisions of the Lease are hereby affirmed by the parties, but, to the extent that the provisions of this Addendum conflict with or differ from the terms of the Lease, the provisions of this Addendum shall control. Capitalized terms not defined herein shall have the definitions that are given to such terms in the Lease.  50. Base Rent. During the Original Term, the monthly Base Rent shall be as follows:  Months: Months 1 through 12 Months 13 through 24 Monthly Base Rent: $20,196.00 $20,801.88 Months 25 through 36 $21,425.94 Months 37 through 48 $22,068.71 Months 49 through 60 $22,730.78 Months 61 through 63 $23,412.70  51. Abatement of Rent.  (a) For so long as Lessee is not in Breach under the terms of this Lease, the Base Rent payable by Lessee as scheduled in Paragraph 50 above shall be fully abated for months two (2) through four (4) of the Original Term, for a total of three months. Lessee shall continue to pay Lessee's Share of Common Area Operating Expenses during such abatement period.  (b) The abatements set forth in this Paragraph 51 shall be considered
an Inducement Provision subject to the provisions of Paragraph 13.3 of this Lease.  52. Condition of Premises. Lessor shall deliver the Premises to Lessee on the Commencement Date in its "AS IS" condition with the existing interior improvements in place, subject to the warranties set forth in Paragraph 2 of the Lease, and Lessor shall not be responsible to construct any additional improvements.  53. [Intentionally Omitted.]  54. Operating Expenses. Lessor estimates that the Lessee's Share of Common Area Operating Expenses will initially be $4,677.50 per month. Lessee understands that this is an estimate only and the actual amount may vary from the estimate.  55. Audit Rights. Lessee shall have the right, at its expense, and upon written notice given to Lessor no later than ninety (90) days after Lessee's receipt of any statement of actual Operating Expenses as provided in Paragraph 4.2(d) of the Lease (the "Reconciliation") to make an audit of all of Lessor's bills, records, receipts, insurance certificates and policies relating to Operating Expenses for the preceding calendar year. Within fifteen (I 5) business days of Lessor's receipt of such written request of Lessee, Lessor shall make available to Lessee, during normal business hours, at the location where Lessor's books and records are kept, such information as Lessee shall reasonably request. Lessor shall cooperate with Lessee in its explanation of its bills and records. Lessee, at Lessee's sole cost and expense, reserves the right to retain the services of an independent certified public accountant for such audit provided
that such accountant is not retained by Lessee on a contingency fee basis. Lessee shall diligently complete any such audit of Operating Expenses and shall deliver to Lessor the written results of such audit within fifteen (15) business days after Lessee •receives the same. If Lessor disagrees with the results of Lessee's audit, Lessor and Lessee shall meet and attempt, in good faith, to resolve the dispute. If Lessor and Lessee are unable to   Initials  Initials

 
 
resolve the dispute within thirty (30) days after Lessor's receipt of Lessee's audit, then Lessee shall have the right to submit the dispute to arbitration; this right shall be exercised, if at all, by delivering a written notice of election to arbitrate to Lessor not later than 180 days after receipt of the Reconciliation. Lessor and Lessee shall agree, within 15 days after Lessee's delivery of the arbitration election, to retain an arbitrator, who shall be a mutually acceptable independent certified public accountant with experience in operating expenses for commercial/industrial buildings, who shall make a determination as to the correct amount of Lessee's share of Operating Expenses . The decision shall be delivered simultaneously to Lessor and Lessee and shall be final and binding on Lessor and Lessee. If the arbitrator determines that the amount of the Operating Expenses billed to the Lessee was incorrect , the appropriate party shall pay to the other party the deficiency or overpayment , as applicable, within thirty (30) days following delivery of the arbitrator's decision, without interest. All costs and expenses of the arbitration shall be paid by Lessee unless the final determination in the arbitration is that Lessor overstated Operating Expenses by more than five percent (5%) of the originally reported Operating Expenses, in which case Lessor shall pay all such costs and expenses of the arbitration. Lessee and its auditor shall keep all of Lessor's records strictly confidential and shall not disclose any information gained from its review of Lessor's records to any third party, except as
required by law.  56. Signage. Lessee, with the approval of Lessor (which approval shall not be unreasonably withheld) pursuant to the Lessor's sign criteria and the City of Carlsbad, shall be allowed to install exterior identity signage, the exact location and size of any signs to be approved by Lessor, which approval shall not be unreasonably withheld or delayed. Lessee shall be responsible to construct, install and maintain such signage at its sole cost, and shall remove such signage upon expiration or earlier termination of the Lease and repair any damage caused by such removal.  57. Security System. Lessee shall have the right to install a security system for the perimeter and interior of the Premises. Lessee shall be responsible to construct, install and maintain such security system at its sole cost, and shall remove such security system upon expiration or earlier termination of the Lease and repair any damage caused by such removal.  58. Payment to Brokers. Lessor shall pay to the Brokers for the brokerage services rendered by the Brokers in connection with the Lease an amount pursuant to the terms of a separate agreement . Such amounts shall be paid fifty percent (50%) upon full execution of this Lease and fifty percent (50%) on the Commencement Date .  59. Lessee Access. Lessee shall have access to the Premises and use of Lessee's parking spaces seven days a week, 24 hours per day, subject to any reasonable Rules and Regulations established by Lessor.  60. Notices to Lessee. A copy of all notices to Lessee shall be concurrently sent via electronic mail to:
legalnotices@ionisph.com.  [Signatures are on next page.) Initials  Initials  

 
 
IN WITNESS THEREOF, Lessor and Lessee have executed this Addendum concurrently with the lease of even date herewith. Lessor: SR22 CARLSBAD OAKS DISTRIBUTION, LLC, a California limited liability company By: Adam S Robinson, Manager APG CARLSBAD I, LLC, a California limited liability company By: SMB I GROUP, L.P., a Delaware limited partnership its: Managing Member By: K ASSOCIATES, a California general partnership Its: General Partner By: /s/ Bonnie L Name: Bonnie L Its: Managing Member PRE IV C OAKS, LLC. A California limited liability company By: PACIFICA REAL ESTATE IV, LLC, A California limited liability company Its: Member By: /s/ Steven C. Leonard, Manager LESSEE: IONIS PHARMACEUTICALS, INC., a Delaware corporation By:              Name:             Title:           By:                 Name:                Title:                 a    

 
 
Exhibit a – site plan el e vate initials initials

 
 
AIRCR OPTION(S) TO EXTEND STANDARD LEASE ADDENDUM Dated: By and Between Lessor: SR22 CARLSBAD OAKS DISTRIBUTION, LLC, a California limited liability comoany; APG CARLSBAD L , LLC, a California limited liabilitv comoanv; and PRE TV C: O.Z>$S, J,J,C, 3 Californii'l limited liabi1it:v comoan•/ lessee: IONIS PHARf• ACEUTICALS, INC., a De1a\•lare corporation Property Address : 2870 Whiptail Loop. Suite 102, Carlsbad, CA 92010 (street address, city, state, zip}  Paragraph:  A. OPTION(S) TO EXTEND: Lessor hereby grants to Lessee the option to extend the term of this Lease for one (1) additional six tv (60) month period(s} commencing when the prior term expires upon each and all of the following terms and conditions: (i) In order to exercise an option to extend, Lessee must give written notice of such election to Lessor and Lessor must receive the same at least 9 but not more than 12 months prior to the date that the option period would commence, time being of the essence. If proper notification of the exercise of an option is not given and/or received, such option shall automatically expire. Options (if there are more than one) may only be exercised consecutively. (ii) The provisions of paragraph 39, including those relating to Lessee's Default set forth in paragraph 39.4 of this Lease, are conditions of this Option. (iii) Except for the provisions of this Lease granting an option or options to extend the term, all of the terms and conditions of this Lease except where specifically modified by this option shall apply. (iv) This
Option is personal to the original Lessee, and cannot be assigned or exercised by anyone other than said original Lessee and only while the original Lessee is in full possession of the Premises and without the intention of thereafter assigning or subletting. (v) The monthly rent for each month of the option period shall be calculated as follows, using the method(s) indicated below: (Check Method(s) to be Used and Fill in Appropriately) ☐ I.Cost of living Adjustment(s) (COlA) a.On (Fill In COLA Dates): the base rent shall be adjusted by the change, if any, from the base Month specified below, in the consumer price index of the bureau of labor statics of the U.S department of labor for (sleect one):☐CPI w(urban wage earners and clerical workers) or☐ cpi u (All Urban consumers), for (Fill in Urban Area): All items(1982-1984-100), herein referred to as ‘’cpi’’.  b. the monthly base rent payble in accordance with paragraph A,I,a: of this Addendum shall be calculated as follows: the base rent forth in paragraph 1.5 of the attached lease, shall be multipled by a fraction the numerator of which shall be the CPI of the calendar month 2 months prior to the month(s) specified in paragraph A,I,a above during which the adjustment is to take effect, ant the denominator of which shall be the cpi of the calendar month which is 2 months prior to (select one): ☐ the first month of the term of this lease as set forth in paragraph 1.3 (‘base month’) or ☐ (fill in other ‘base month’): the sum so calculated shall constt=itute the new monthly base rent hereunder, but in no event, shall any such
new monthly base rent be less than the base rent payble for the month immediately preceding the rent adjustment. c in the event the compilation and/or publication of the cpi shall be transferred to any other governmental department or bureau or agency or shall be discontinued, then the index most nearly the same as the CPI shall be used to make such calculation, in the event that the parties cannot agree on such alternative index, then the matter shall be submitted for decision to the American Arbitration Association in accordane with the them rules of said association ant the arbitrators shall be binding upon the parties.the codt of said Arbitration shall be paid equally by the parties ☑ II.Market Rental llalue Adjustment(s) (MRV) a.On (Fill in MRV Adjustment Date(s)) the date on which the option period commences the Base Rent I shall be adjusted to the lesser of (a) the Base Rent for the month immediately preceding the option period, or (b) "Market Rental Value" of the property as follows: 1)Four months prior to each Market Rental Value Adjustment Date described above, the Parties shall attempt to agree upon what the new MRV will be on the adjustment date. If agreement cannot be reached, within thirty days, then: (a} Lessor and Lessee shall immediately appoint a mutually acceptable appraiser or broker to establish the new MRV within the next 30 days. Any associated costs will be split equally between the Parties, or (b)Both Lessor and Lessee shall each immediately make a reasonable determination of the MRV and submit such determination, in writing, to
arbitration in accordance with the following provisions: (i)Within 15 days thereafter, Lessor and Lessee shall each select an independent third party☐ appraiser or ☑ broker ("Consultant"- check one) of their choice to act as an arbitrator (Note: the parties may not select either of the Brokers that was involved in negotiating the lease). The two arbitrators so appointed shall immediately select athird mutually acceptable. INITIALS 2017 AIR CRE ALL Rights Reserved. Page 1 of 2 Last Edited:2/26/2018 3:14 pm INITIALS OE-6.00, Revised 01-03-2017

 
 
Consultant to act as a third arbitrator. (ii) The 3 arbitrators shall within 30 days of the appointment of the third arbitrator reach a decision as to what the actual MRV for the Premises is, and whether Lessor’s or Lessee’s submitted MRV is the closest thereto. The decision of a majority of the arbitrators shall be binding on the Parties. The submitted MRV which is determined to be the closest to the actual MRV shall thereafter be used by the Parties. (iii) If either of the Parties fails to appoint an arbitrator within the specified 15 days, the arbitrator timely appointed by one of them shall reach a decision on his or her own, and said decision shall be binding on the Parties. (iv) The entire cost of such arbitration shall be paid by the party whose submitted MRV is not selected, ie the one that is NOT the closest to the actual MRV. 2) When determining MRV, the Lessor, Lessee and Consultants shall consider the terms of comparable market transactions which shall include, but not limited to, rent, rental adjustments, abated rent, lease term and financial condition of tenants. 3) Notwithstanding the foregoing, the new Base Rent shall not be less than the rent payable for the month immediately preceding the rent adjustment. b. Upon the establishment of each New Market Rental Value: 1) the new MRVwill become the new “Base Rent” for the purpose of calculating any further Adjustments, and 2). the first month of each Market Rental Value term shall become the new “Base Month” for the purpose of calculating any further Adjustments. 3). the Base Rent shall increase by three percent
(3%) on each anniversary of the MRV Adjustment Date during the remainder of the option period.  ☐III. Fixed Rental Adjustments(s) (FRA)  The Base Rent shall be increased to the following amounts on the dates set forth below:    On (Fill in FRA Adjustment Date(s)):     The New Base Rent shall be:        ☐IV. Initial Term Adjustments  The formula used to calculate adjustments to the Base Rate during the original Term of the lease shall continue to be used during the extended term.   B. NOTICE:  Unless specified otherwise herein, notice of any rental adjustments, other than Fixed Rental Adjustments, shall be made as specified in paragraph 23 of the Lease.   C. BROKER’S FEE:  The Brokers shall be paid a Brokerage Fee for each adjustment specified above in accordance with paragraph 15 of the Lease or if applicable, paragraph 9 of the Sublease.    AJR CRE. 500 North Brand Blvd, Suite 900, Glendale, CA 91203, Tel 213-687-8777, Email contracts@aircre.com NOTICE: No part of these works may be reproduced in any form without permission In writing.            INITIALS © 2017 AIR CRE. All Rights Reserved. Page 2 of 2 Last Edited: 2/26/2018 3:14 PM  INITIALS OE-6.00, Revised 01-03-2017  

 
 
Exhibit B – Subleased Premises

FLOOR PLAN 2870 WHIPTAIL LOOP, SUITE 102, CARLSBAD 18,710 SF 1st Floor 2nd Floor 0 • -Warehouse '' /

 
 
 
 
 
 
 
Exhibit C – Rent Schedule

Ionis Pharmaceuticals, Inc.
2870 Whiptail Loop Building Lease
Operating Lease

Debit/ (Credit)

2870 Whiptail Loop Building Lease SCHEDULED RENT & CAM PAYMENTS

IONIS

AKCEA

Beg Bal.
17 days
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63

Date

Rent Payments

CAM CHARGES

TOTAL RENT AND CAM
CHARGES

March-18
April-18
May-18
June-18
July-18
August-18
September-18
October-18
November-18
December-18
January-19
February-19
March-19
April-19
May-19
June-19
July-19
August-19
September-19
October-19
November-19
December-19
January-20
February-20
March-20
April-20
May-20
June-20
July-20
August-20
September-20
October-20
November-20
December-20
January-21
February-21
March-21
April-21
May-21
June-21
July-21
August-21
September-21
October-21
November-21
December-21
January-22
February-22
March-22
April-22
May-22
June-22
July-22
August-22
September-22
October-22
November-22
December-22
January-23
February-23
March-23
April-23
May-23
June-23

-
20,196.00
-
-
-
20,196.00
20,196.00
20,196.00
20,196.00
20,196.00
20,196.00
20,196.00
20,801.88
20,801.88
20,801.88
20,801.88
20,801.88
20,801.88
20,801.88
20,801.88
20,801.88
20,801.88
20,801.88
20,801.88
21,425.94
21,425.94
21,425.94
21,425.94
21,425.94
21,425.94
21,425.94
21,425.94
21,425.94
21,425.94
21,425.94
21,425.94
22,068.71
22,068.71
22,068.71
22,068.71
22,068.71
22,068.71
22,068.71
22,068.71
22,068.71
22,068.71
22,068.71
22,068.71
22,730.78
22,730.78
22,730.78
22,730.78
22,730.78
22,730.78
22,730.78
22,730.78
22,730.78
22,730.78
22,730.78
22,730.78
23,412.70
23,412.70
23,412.70
23,412.70

4,677.50

24,873.50

4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50
4,677.50

24,873.50
24,873.50
24,873.50
24,873.50
24,873.50
24,873.50
24,873.50
25,479.38
25,479.38
25,479.38
25,479.38
25,479.38
25,479.38
25,479.38
25,479.38
25,479.38
25,479.38
25,479.38
25,479.38
26,103.44
26,103.44
26,103.44
26,103.44
26,103.44
26,103.44
26,103.44
26,103.44
26,103.44
26,103.44
26,103.44
26,103.44
26,746.21
26,746.21
26,746.21
26,746.21
26,746.21
26,746.21
26,746.21
26,746.21
26,746.21
26,746.21
26,746.21
26,746.21
27,408.28
27,408.28
27,408.28
27,408.28
27,408.28
27,408.28
27,408.28
27,408.28
27,408.28
27,408.28
27,408.28
27,408.28
28,090.20
28,090.20
28,090.20
28,090.20

75%

-
18,655.13
-
-
-
18,655.13
18,655.13
18,655.13
18,655.13
18,655.13
18,655.13
18,655.13
19,109.54
19,109.54
19,109.54
19,109.54
19,109.54
19,109.54
19,109.54
19,109.54
19,109.54
19,109.54
19,109.54
19,109.54
19,577.58
19,577.58
19,577.58
19,577.58
19,577.58
19,577.58
19,577.58
19,577.58
19,577.58
19,577.58
19,577.58
19,577.58
20,059.66
20,059.66
20,059.66
20,059.66
20,059.66
20,059.66
20,059.66
20,059.66
20,059.66
20,059.66
20,059.66
20,059.66
20,556.21
20,556.21
20,556.21
20,556.21
20,556.21
20,556.21
20,556.21
20,556.21
20,556.21
20,556.21
20,556.21
20,556.21
21,067.65
21,067.65
21,067.65
21,067.65
1,185,147.39

25%

-
6,218.38
-
-
-
6,218.38
6,218.38
6,218.38
6,218.38
6,218.38
6,218.38
6,218.38
6,369.85
6,369.85
6,369.85
6,369.85
6,369.85
6,369.85
6,369.85
6,369.85
6,369.85
6,369.85
6,369.85
6,369.85
6,525.86
6,525.86
6,525.86
6,525.86
6,525.86
6,525.86
6,525.86
6,525.86
6,525.86
6,525.86
6,525.86
6,525.86
6,686.55
6,686.55
6,686.55
6,686.55
6,686.55
6,686.55
6,686.55
6,686.55
6,686.55
6,686.55
6,686.55
6,686.55
6,852.07
6,852.07
6,852.07
6,852.07
6,852.07
6,852.07
6,852.07
6,852.07
6,852.07
6,852.07
6,852.07
6,852.07
7,022.55
7,022.55
7,022.55
7,022.55
395,049.13

TOTAL LEASE PAYMENTS

1,299,546.52 

1,580,196.52

TOTAL LEASE AND CAM PAYMENTS

1,580,196.52

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
VENDOR

AMAZON
SAN DIEGO GAS & ELECTRIC

COVERALL OF SAN DIEGO

SIGNA SOLUTIONS, INC.

MONTHLY BILLS

DESCRIPTION
CONFERENCE ROOM ELETRONICS

UTILITIES

MONTHLY
ESTIMATED
AMOUNT

VARIOUS

VARIOUS

COMMERCIAL CLEANING OF FLOORS

3 - MONTH MAINTENANCE CONTRACT FOR COPIER

$556.00 

$795.97 

DE LAGE LANDEN FINANCIAL SERVICES,
INC.

CANON COPIER

 VARIOUS

 
 
 
 
 
 
 
Exhibit 10.12

Akcea Therapeutics, Inc.
55 Cambridge Parkway, Suite 100
Cambridge, MA 02142

Date:
To:
From:
Subject:

 March 9, 2018
 Akcea Board of Directors
 Paula Soteropoulos, President & CEO
 Board of Director Compensation

MEMORANDUM

Akcea values the contributions made by its Board of directors.  In recognition of these valuable contributions, Akcea will provide each non-
employee Director1 with the compensation described in this memo.

Cash Compensation

Each non-employee Director will receive cash compensation based on his/her role on the Board and Board committees:

Role
Board Member (Base retainer)
Chairman of the Board (Additional)
Committee Chairs (Additional)

-Audit
-Compensation
-Nominating & Gov.

Committee Member (Additional)

-Audit
-Compensation
-Nominating & Gov.

Cash Compensation
$40,000
$25,000

$18,000
$12,500
$8,000

$9,000
$6,000
$4,500

Equity Compensation

Each non-employee Director will receive an initial stock option award upon joining the Board, and will receive an annual stock option award
for each year of continued service, as follows:

Stock Option Award
Initial Stock Option Equity Grant
Annual Stock Option Equity Grant

No. of Shares
53,000
26,400

The exercise price of each option will be the fair market value of Akcea’s common stock on the date of grant.

The options will vest over a four-year period in equal annual installments and be subject to the terms of Akcea’s 2015 Equity Incentive
Plan.  The vesting of the options will accelerate in the case of a change of control of Akcea, as further described your option agreement and the
2015 Equity Incentive Plan.

Akcea reserves the right to amend this compensation policy at any time

1 Employees of Ionis who serve on the Akcea Board are not eligible for compensation as Akcea Board members.

 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
LIST OF SUBSIDIARIES

Exhibit 21.1

Akcea Therapeutics UK Limited, a United Kingdom Limited Private Company
Akcea Therapeutics Canada, Inc., a Canadian Corporation
Akcea Therapeutics France SAS, a French Company
Akcea Therapeutics Germany GmbH, a German Corporation
Akcea Therapeutics Securities Corporation, a Massachusetts Corporation
Akcea Therapeutics Ireland Limited

 
Exhibit 23.1

We consent to the incorporation by reference in the following Registration Statements:

Consent of Independent Registered Public Accounting Firm

(1) Registration statement (Form S-3ASR No. 333-227403) pertaining to Akcea Therapeutics, Inc.’s shelf registration statement for common stock,

preferred stock, debt securities, warrants or any combination of the foregoing;

(2) Registration Statement (Form S-8 No. 333-228969) pertaining to the 2015 Equity Incentive Plan of Akcea Therapeutics, Inc.,
(3) Registration  Statement  (Form  S-8  No.  333-225730)  pertaining  to  the  2015  Equity  Incentive  Plan  and  2017  Employee  Stock  Purchase  Plan  of

Akcea Therapeutics, Inc., and

(4) Registration  Statement  (Form  S-8  No.  333-219290)  pertaining  to  the  2015  Equity  Incentive  Plan  and  2017  Employee  Stock  Purchase  Plan  of

Akcea Therapeutics, Inc;

of our report dated March 1, 2019 with respect to the consolidated financial statements of Akcea Therapeutics, Inc., included in this Annual Report (Form 10-
K) of Akcea Therapeutics, Inc. for the year ended December 31, 2018.

/s/ Ernst & Young LLP

Boston, Massachusetts
March 1, 2019

 
 
 
 
 
 
 
 
 
 
 
 
Exhibit 31.1

CERTIFICATION PURSUANT TO
RULES 13a-14(a) AND 15d-14(a) UNDER THE SECURITIES EXCHANGE ACT OF 1934,
AS ADOPTED PURSUANT TO SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002

I, Paula Soteropoulos, certify that:

1.

2.

3.

4.

I have reviewed this Annual Report on Form 10-K of Akcea Therapeutics, Inc.;

Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the
statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this
report;

Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the
financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

The registrant's other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in
Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f))
for the registrant and have:

(a)

(b)

(c)

(d)

Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to
ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those
entities, particularly during the period in which this report is being prepared;

Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our
supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for
external purposes in accordance with generally accepted accounting principles;

Evaluated the effectiveness of the registrant's disclosure controls and procedures and presented in this report our conclusions about the
effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

Disclosed in this report any change in the registrant's internal control over financial reporting that occurred during the registrant's most recent
fiscal quarter (the registrant's fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to
materially affect, the registrant's internal control over financial reporting; and

5.

The registrant's other certifying officer(s) and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the
registrant's auditors and the audit committee of the registrant's board of directors (or persons performing the equivalent functions):

(a)

(b)

All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably
likely to adversely affect the registrant's ability to record, process, summarize and report financial information; and

Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant's internal control
over financial reporting.

Dated: March 1, 2019

  By: /s/ Paula Soteropoulos

Paula Soteropoulos
Chief Executive Officer

 
 
 
 
 
 
 
 
   
 
   
 
Exhibit 31.2

CERTIFICATION PURSUANT TO
RULES 13a-14(a) AND 15d-14(a) UNDER THE SECURITIES EXCHANGE ACT OF 1934,
AS ADOPTED PURSUANT TO SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002

I, Michael MacLean, certify that:

1.

2.

3.

4.

I have reviewed this Annual Report on Form 10-K of Akcea Therapeutics, Inc.;

Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the
statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this
report;

Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the
financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

The registrant's other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in
Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f))
for the registrant and have:

(a)

(b)

(c)

(d)

Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to
ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those
entities, particularly during the period in which this report is being prepared;

Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our
supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for
external purposes in accordance with generally accepted accounting principles;

Evaluated the effectiveness of the registrant's disclosure controls and procedures and presented in this report our conclusions about the
effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

Disclosed in this report any change in the registrant's internal control over financial reporting that occurred during the registrant's most recent
fiscal quarter (the registrant's fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to
materially affect, the registrant's internal control over financial reporting; and

5.

The registrant's other certifying officer(s) and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the
registrant's auditors and the audit committee of the registrant's board of directors (or persons performing the equivalent functions):

(a)

(b)

All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably
likely to adversely affect the registrant's ability to record, process, summarize and report financial information; and

Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant's internal control
over financial reporting.

Dated: March 1, 2019

  By: /s/ Michael MacLean
    Michael MacLean

Chief Financial Officer

 
 
 
 
 
 
 
 
 
   
 
CERTIFICATION PURSUANT TO
18 U.S.C. SECTION 1350, AS ADOPTED PURSUANT TO
SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

Exhibit 32.1

Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, Paula Soteropoulos, the Chief Executive Officer of Akcea Therapeutics, Inc., (the

“Company”), and Michael MacLean, the Chief Financial Officer of the Company, each hereby certifies that, to the best of his or her knowledge:

(1)

(2)

The Company’s Annual Report on Form 10-K for the period ended December 31, 2018, to which this Certification is attached as Exhibit 32.1
(the “Periodic Report”), fully complies with the requirements of Section 13(a) or Section 15(d) of the Securities Exchange Act of 1934, as
amended; and

The information contained in the Periodic Report fairly presents, in all material respects, the financial condition and results of operations of the
Company.

Dated: March 1, 2019

By: /s/ Paula Soteropoulos

Paula Soteropoulos
Chief Executive Officer

  By: /s/ Michael MacLean
  Michael MacLean

Chief Financial Officer

A signed original of this written statement required by Section 906 has been provided to Akcea Therapeutics, Inc. and will be retained by Akcea

Therapeutics, Inc. and furnished to the Securities and Exchange Commission or its staff upon request.