Shares of Sarepta Therapeutics have plunged again after the drugmaker reported a second death in connection with its gene therapy for muscular dystrophy.

A second patient receiving its experimental gene therapy Elevidys has died from liver failure, raising serious questions on the drug’s outlook.

Shares of Sarepta Therapeutics closed down as much as 42% to hit a nine-year low of $18.30 on Monday after a second death of a male teenage patient who had received its gene therapy, Elevidys, raising doubts on the safety and future demand for the treatment.