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  • Chiesi expands rare disease footprint with $1.9B KalVista acquisition & Teva bets $700M on late-stage Tourette drug

Chiesi expands rare disease footprint with $1.9B KalVista acquisition & Teva bets $700M on late-stage Tourette drug

AuthorAuthor

Joachim Eeckhout & Eduardo Longoria
April 30, 2026

Good morning. After a messy breakup over drug pricing, AstraZeneca and the UK appear to be back on speaking terms. The pharma giant has revived its plan to invest £300m in the country, months after talks soured over pricing negotiations. Since then, the UK government has struck a deal with Trump to reduce pharma tariffs and introduced a rebate rate for certain medicines – enough, it seems, to bring AstraZeneca back to the table. The relationship status has officially moved from “it’s complicated” to “back together.”

— Joachim E.

PS: tomorrow is a public holiday here in Germany and most of Europe, so we’ll be back on Monday!

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SNAPSHOT

Chiesi expands rare disease footprint with $1.9B acquisition of KalVista

Italy’s Chiesi Group will acquire KalVista Pharmaceuticals for $1.9 billion, gaining control of Ekterly, a newly approved oral treatment for hereditary angioedema (HAE).

Why it matters: The deal strengthens Chiesi’s position in rare diseases, a high-growth, high-margin sector, while adding a first-in-class oral, on-demand HAE therapy that could improve patient access and outcomes.

Backstory: Ekterly, also known as sebetralstat, won FDA approval in July 2025 after a regulatory delay. It became KalVista’s first commercial product and generated $49 million in 2025 sales, reflecting roughly half a year on the market.

Zoom in: Ekterly treats hereditary angioedema, a rare genetic disease that causes painful and potentially life-threatening swelling attacks. Unlike preventive HAE therapies, Ekterly is the first oral medicine approved specifically for on-demand treatment of attacks. It has also been approved in the U.K., Japan and the EU.

Big picture: The deal includes a 36% premium to KalVista’s prior share price and is expected to close in Q3 2026. The KalVista buyout is the largest transaction in Chiesi’s nearly 100-year history and follows a recent deal-making streak, including a €430M investment in manufacturing and $115M upfront in a gene therapy partnership with Arbor Biotechnologies.

What’s next: Chiesi will take over commercialization and scale global access. The company expects Ekterly to help it reach €6 billion in revenue by 2030.

SNAP AGAIN

Teva bets $700M on near-approval Tourette drug to disrupt limited treatment landscape

Teva will acquire Emalex Biosciences for $700 million upfront (plus up to $200M in milestones) to gain ecopipam, a late-stage Tourette syndrome drug nearing FDA submission.

Why it matters: Tourette treatment options are limited by trade-offs between safety and effectiveness. Ecopipam could fill a major gap, especially for children needing long-term therapy.

Backstory: Ecopipam is a dopamine D1 receptor antagonist that showed significant tic reduction in phase 3 trials. Current treatments include behavioral therapy, alpha-2 adrenergic agonists, and antipsychotics.

Zoom in: The treatment is likely to serve ~100,000 children with Tourette syndrome. Teva expects ecopipam to offer a better balance of efficacy and tolerability, as Alpha-2 agonists are safe but often less effective, while antipsychotics are more effective but carry serious metabolic and neurological side effects.

Big picture: Teva is doubling down on neuroscience, aiming to replicate the strong growth of its existing drugs (Austedo, Uzedy) and expand into underserved chronic, pediatric neurological conditions with high unmet need.

What’s next: The FDA submission is expected in H2 2026. If approved, Teva will launch ecopipam and position it as a preferred later-line therapy.

SNIPPETS

What’s happening in biotech today?

🚀 FDA fast-track: The FDA has launched a pilot initiative to review clinical trial data in real time, allowing regulators to monitor safety and efficacy signals as they emerge rather than waiting for full trial completion, with AstraZeneca and Amgen already participating. The effort aims to reduce lengthy drug development timelines, nearly half of which are spent on administrative tasks, and improve responsiveness to public health needs.

🔄 Pipeline pivot: GSK has ended its 2022 agreement with Mersana Therapeutics for the STING-agonist antibody-drug conjugate XMT-2056 after reviewing clinical data, despite previously investing $100 million for an option and the potential for up to $1.36 billion in milestone payments. The decision follows safety concerns, including serious bleeding events and deaths in early trials, which had already prompted an FDA partial hold.

🚫 FLAP flop: AstraZeneca has discontinued development of its FLAP inhibitor atuliflapon after it failed to demonstrate efficacy in a phase 2 trial involving patients with moderate-to-severe asthma. The drug targeted the leukotriene pathway, a key mechanism in inflammation, but joins a class of FLAP inhibitors that have yet to succeed commercially.

⚠️ FDA doubts: The FDA has raised concerns about AstraZeneca’s cancer drugs camizestrant and Truqap ahead of an advisory committee review, questioning both clinical benefit and trial design. For camizestrant, an oral SERD for HR-positive, HER2-negative breast cancer, regulators argued that the study design does not clearly show whether early treatment switching improves outcomes compared to standard care, and flagged uncertainties around progression-free survival metrics, immature overall survival data, and potential heart safety risks. For Truqap, an AKT inhibitor for prostate cancer, the FDA acknowledged statistically significant results but said the modest benefit may not be clinically meaningful without stronger survival data, especially given the patient population.

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