Core Viewpoint - Ironwood Pharmaceuticals is required by the FDA to conduct a confirmatory Phase 3 trial for apraglutide to gain approval for treating short bowel syndrome with intestinal failure [1][2][5] Group 1: FDA Requirements and Trials - The FDA has indicated that a confirmatory Phase 3 trial is necessary for the approval of apraglutide, following a recent dialogue with the company [2][3] - Pharmacokinetic analysis revealed that the exposure and dose delivered in the STARS Phase 3 trial were lower than planned due to issues in dose preparation and administration [2] - Ironwood plans to collaborate with the FDA to design the confirmatory Phase 3 trial and outline the regulatory path forward [3] Group 2: Clinical Data and Efficacy - Apraglutide demonstrated strong safety and efficacy data in the STARS Phase 3 trial, with 27 patients dependent on parenteral support achieving enteral autonomy, which is a key goal for these patients [4] - The company intends to continue the long-term extension trial, believing that data from the STARS trial will be crucial for the new drug application (NDA) submission [4] Group 3: Company Response and Market Impact - The CEO of Ironwood expressed disappointment regarding the FDA's requirement for an additional trial, emphasizing the potential value of apraglutide for patients suffering from short bowel syndrome with intestinal failure [5] - Ironwood has initiated a rolling NDA submission for apraglutide, with completion expected in Q3 2025 [5] - Following the announcement, Ironwood's stock price fell by 30.28%, trading at 66 cents [5]