One of John Butler’s seminal moments as a professional came early in his career. He was working as a sales rep for Amgen’s Epogen, a drug for anemia chronic kidney disease patients on dialysis, with a territory that included broad swaths of Queens and Long Island. Upon walking into a dialysis center one day, he was greeted rapturously by the assembled throng.

“They hugged me and talked about how [Epogen] had changed their lives. It was like, ‘Oh my God, what I’m doing really matters,’” Butler recalls. He quickly acknowledges epiphanies of this nature aren’t unique among people who choose to work in healthcare, but says its memory has stayed with him over the past quarter-century.

“Having been a sales rep for as long as I was, I never forget what, and who, we’re doing this for. Sometimes you get into the ivory tower and lose sight of that,” he adds.

Five years into his tenure as president and CEO of Akebia Therapeutics, Butler’s career has come full circle. Akebia’s touted investigational drug vadadustat, fresh off a successful Phase II study, promises further relief for those same chronic kidney disease patients.

Coupled with the company’s pending merger with Keryx Biopharmaceuticals — which markets Auryxia, indicated for iron deficiency anemia in chronic kidney disease patients not on dialysis and the control of serum phosphorus levels in kidney disease patients on dialysis — the possible 2020 debut of vadadustat could position Akebia as one of the space’s true up-and-comers.

I never forget what, and who, we’re doing this for. Sometimes you get into the ivory tower and lose sight of that.

John Butler, Akebia Therapeutics

Not surprisingly, given his two decades of renal experience, Butler relishes the prospect of leading such an organization. “When Keryx got the second indication for Auryxia [last November], that created the synergy we were looking for. We can talk to HCPs about anemia from day one,” he enthuses.

The ability to facilitate those conversations has been one of Butler’s strengths since early in his career, according to longtime peer Ronald Renaud, the CEO of Translate Bio and a member of Akebia’s board of directors.

“John was the go-to person who could quote clinical data in what seemed like real-time but always seemed to have the best handle on the renal marketplace,” Renaud says. “Chronic kidney disease and, ultimately, end-stage renal disease are not just kidney issues. There are significant cardiovascular, hematologic, and metabolic components that are as relevant as the underlying disease. He is always thinking about that big picture and how to best treat patients.”

That big picture has Butler’s attention, given that the opportunity to “own” the kidney space hasn’t gone unnoticed by other organizations. Pharma behemoths have shown moderate interest at best, prompting smaller companies to double down on their pipeline bets.

Those bets are a long time coming, Butler notes. “When I joined Amgen, my oldest daughter wasn’t born yet, and now she’s almost 27,” he explains. “But for patients, nothing has changed. There hasn’t been much innovation at all.”

Assuming the merger with Keryx is completed successfully — ideally it will close before the year is out — Akebia should find itself in an enviable position among would-be aspirants to the renal throne.

“I have a development organization at Akebia running a 7,000-patient global program with 600 unique sites across the globe. Keryx has the commercial organization to sell it,” he says.

“There’s opportunity for us to be a real leader [in the renal space]. It’s a very simple choice to partner with somebody like us.”


John Butler

President and CEO, Akebia Therapeutics

CEO, Inspiration Biopharmaceuticals

Multiple positions including president, rare genetic diseases and president, cardiometabolic and renal, Genzyme