Etavopivat is an oral, small-molecule activator of pyruvate kinase R (PKR) designed to increase red blood cell ATP production, thereby reducing the sickling of hemoglobin S-containing erythrocytes. Etavopivat demonstrated improvements in hemolytic markers (hemoglobin, bilirubin, reticulocyte count) and patient-reported outcomes in adults with sickle cell disease. Results of the phase III program HIBISCUS, etavopivat meet both co-primary substantially reducing vaso-occlusive crisis events and improving haemoglobin response in sickle cell disease. Novo Nordisk plans to submit for the first regulatory approval of etavopivat in the second half of 2026.