Novartis AG

新适应症的获批将符合Pluvicto®治疗条件的患者人群扩大约三倍-用于在一种雄激素受体通路抑制剂（ARPI）治疗后、未经过化疗的mCRPC患者中全球III期PSMAfore临床研究中，相比更换ARPI方案，Pluvicto®可显著降低59%的疾病进展或死亡风险，并将中位影像学无进展生存期（rPFS）延长至两倍以上真实世界中，约半数mCRPC患者因生存期不足而无法接受二线治疗，早期使用有效且耐受性良好的疗法非常有必要1美国多个放射配体疗法（RLT）生产基地完全能够满足扩大适应症后的供应需求，协同其行业领先的基础设施可加速向患者提供放射配体疗法诺华近日宣布，美国食品药品监督管理局（FDA）批准Pluvicto®（lutetium Lu 177 vipivotide tetraxetan）用于接受过一种雄激素受体通路抑制剂（ARPI）治疗且被认为适合延迟化疗的前列腺特异性膜抗原（PSMA）阳性的转移性去势抵抗性前列腺癌（mCRPC）患者。此适应症获批基于III期PSMAfore临床研究的结果，将符合Pluvicto®治疗条件的患者人群扩大约三倍。研究结果显示，与更换ARPI方案相比，Pluvicto®将PSMA阳性mCRPC患者的影像学进展或死亡风险降低59%（HR=0.41；95%CI：0.29-0.56；p＜0.0001）。在更新的探索性分析中，Pluvicto®组的中位影像学无进展生存期延长了一倍以上（11.6个月 vs. 5.6个月）*。斯隆·凯特琳癌症中心泌尿肿瘤科前列腺癌部门主任、美国区研究主要研究者Michael Morris 博士Pluvicto®的早期使用可能彻底改变mCRPC患者的治疗模式。与更换第二种ARPI相比，它提供了一种能更有效延缓疾病进展的靶向疗法。该适应症的批准是极其重要的进展，这为接受过一种ARPI治疗但未接受过化疗的mCRPC患者开启了具有明确临床优势的治疗选择。在PSMAfore研究中，最终总生存期（OS）的分析在数值上有利于Pluvicto®组， 风险比为HR=0.91（95%CI：0.72-1.14），无统计学意义。该风险比结果因对照组有很高比例患者（60.3%）交叉至Pluvicto®治疗组而受到影响。当针对交叉进行调整后，使用逆概率删失加权法（IPCW）计算的总生存期（OS）风险比为0.59（95%CI：0.38-0.91）** 。PSMAfore研究的其他结果显示，Pluvicto®表现出一致的、更好的安全性特征。最常见的所有级别的不良事件主要为1-2级，包括口干（61%）、疲劳（53%）、恶心（32%）和便秘（22%）。Pluvicto®不影响患者后续接受化疗的能力。梅奥诊所泌尿生殖肿瘤疾病组主席、放射性药物临床试验主任Oliver Sartor 博士PSMA靶向放射配体疗法的临床研发为mCRPC治疗提供了重要方向。临床试验数据表明，Pluvicto®能为符合条件的患者带来延缓疾病进展的明确临床获益，为此类患者提供了新的治疗选择。美国每年有超过35,000名男性死于前列腺癌，且发病率持续上升2。约半数mCRPC患者因生存期不足无法接受二线治疗1。尽管激素疗法和化疗是mCRPC的重要治疗手段，但并非适用于所有患者3。许多患者和医生因副作用倾向于避免或延迟化疗，且指南建议避免连续使用多种ARPIs4-7。前列腺癌基金会CEO兼总裁Gina Carithers8随着治疗线数的增加，此类转移性前列腺癌患者的预后不断恶化，他们长期面临着选择有限和不确定的治疗结局。Pluvicto®适应症的扩大为前列腺癌患者群体带来了更多可能性，也在治疗早期为患者提供更多选择，使患者能够根据自身需求与肿瘤科医生或泌尿科医生共同制定最佳治疗方案。诺华美国总裁Victor Bultó此次Pluvicto®适应症的扩大为近三倍患者提供了更多选择，进一步确立了放射配体疗法在癌症治疗中的支柱地位。作为RLT领域的先驱，诺华致力于为医疗工作者提供教育、资源和实践方案，确保所有患者在这一严峻疾病中获得治疗机会。关于Pluvicto®（lutetium Lu 177 vipivotide tetraxetan） Pluvicto®是通过静脉注射的放射配体疗法（RLT），由靶向配体与治疗性放射性核素（镥-177）结合而成。进入血液后，Pluvicto®可靶向结合表达PSMA的前列腺癌细胞。结合后，放射性同位素释放的能量可破坏靶细胞，抑制其复制能力和/或引发肿瘤细胞死亡。基于两项III期研究，Pluvicto®是目前唯一在ARPI治疗后的PSMA阳性mCRPC患者中，无论是否接受过紫杉烷类治疗，均能显著改善rPFS并展现良好安全性的PSMA靶向药物。基于美国食品药品监督管理局（FDA）的批准，Pluvicto®是目前首个且唯一可在化疗前使用的PSMA阳性mCRPC靶向RLT。诺华正在探索Pluvicto®在疾病更早期阶段的应用，包括转移性激素敏感性前列腺癌（PSMAddition，NCT04720157）和寡转移性前列腺癌（PSMA-DC，NCT05939414）。诺华与放射配体疗法（RLT）诺华正通过放射配体疗法（RLT）重塑晚期癌症治疗格局。通过将治疗性辐射能直接精准递送至身体任何部位的靶肿瘤细胞，用于晚期癌症治疗。诺华正在开发广泛的RLT产品组合，探索新同位素、配体及联合疗法，以拓展适应症至胃肠胰神经内分泌肿瘤（GEP-NETs）和前列腺癌之外的乳腺癌、结肠癌、肺癌及胰腺癌。诺华已在全球建立专业供应链和生产网络，包括美国新泽西州米尔本、西班牙萨拉戈萨、意大利伊夫雷亚及印第安纳州印第安纳波利斯的先进生产基地。加州卡尔斯巴德的新生产基地将作为美国第三座RLT生产基地，支持RLT的广泛应用，增强生产网络，并优化西海岸患者的药物供应。免责声明 (滑动查看更多）本新闻稿包含符合 1995 年美国《私人证券诉讼改革法案》定义的前瞻性陈述。前瞻性陈述通常可以通过 “潜在的”“能够”“将”“计划”“可能”“可以”“将会”“预期”“预计”“期待”“相信”“致力于”“推出”“目标”“结果” 等类似词语来识别，或者通过明示或暗示讨论关于 Pluvicto 潜在的批准、新适应症，或者关于Pluvicto未来潜在的收入来识别。您不应过度依赖这些陈述。此类前瞻性陈述基于我们目前对未来事件的预期，并且受到重大的已知和未知风险及不确定性的影响。如果这些风险或不确定性中的一项或多项成为现实，或者新闻稿中的基础假设被证明是错误的，实际结果可能会与前瞻性陈述中阐述的结果存在重大差异。我们无法保证 Pluvicto 会在任何市场提交审批或获批销售，或获得任何额外的适应症，也无法保证会在特定时间获批，同样也无法保证 Pluvicto 在未来会取得商业成功。特别地，我们对 Pluvicto 的预期可能会受到多种因素的影响，其中包括但不限于：研发过程中固有的不确定性，包括临床试验结果以及对现有临床数据的进一步分析；监管行动或监管延迟，或一般的政府规定；全球医疗成本控制趋势，包括政府、支付方和普通公众对定价和报销的压力，以及对提高定价透明度的要求；我们获取或维持知识产权保护的能力；医生和患者的特定处方偏好；一般的政治、经济和商业状况，包括流行病的影响以及为减轻其影响所做的努力；安全、质量、数据完整性或生产问题；潜在的或实际的数据安全和数据隐私泄露，或我们信息技术系统的中断，以及诺华公司提交给美国证券交易委员会的当前 20-F 表格中提及的其他风险和因素。诺华仅在本新闻稿发布之日提供本新闻稿中的信息，并无义务因新信息、未来事件或其他原因更新本新闻稿中包含的任何前瞻性陈述。披露：Sartor博士参与了临床试验设计并担任试验指导委员会主席。Sartor博士是诺华的付费顾问，相关费用直接支付至梅奥诊所。* 在 PSMAfore （NCT04689828） 的第三次中期分析中（数据截止日期：2024年2月）观察到的结果。Pluvicto®在主要分析（数据截止日期：2022年10月）中达到以中心确认的rPFS事件为主要终点结果。* *IPCW为一种成熟的统计学方法，需基于多项假设。— 声明 — 1. 本新闻稿目的在于传递医药前沿信息和研究进展，非广告用途。2. 本新闻稿中所提及的产品Pluvicto®目前尚未在中国获批。3. 本新闻稿中涉及的信息仅供参考，请遵从医生或其他医疗专业人士的意见或指导。— 参考文献 — （滑动查看更多）1. Shore ND, Laliberté F, Ionescu-Ittu R, Yang L, Mahendran M, Lejeune D, et al. RealWorld Treatment Patterns and Overall Survival of Patients with Metastatic Castration Resistant Prostate Cancer in the US Prior to PARP Inhibitors. Adv Ther. 2021;38(8):4520-40.2. American Cancer Society. Key statistics for prostate cancer. Accessed January 21, 2025. https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html3. Shore N, Heidenreich A, Saad F. Predicting response and recognizing resistance: improving outcomes in patients with castration-resistant prostate cancer. Urology 2017;109:6–18. [https://pubmed.ncbi.nlm.nih.gov/28797685/]4. Broyelle A, Delanoy N, Bimbai AM, Le Deley MC, Penel N, Villers A, et al. Taxanes Versus Androgen Receptor Therapy as Second-Line Treatment for Castrate-Resistant Metastatic Prostate Cancer After First-Line Androgen Receptor Therapy. Clin Genitourin Cancer. 2023;21(3):349-56.e2.5. EAU-EANM-ESTRO-ESUR-SIOG. Guidelines on Prostate Cancer, 2024. [https://uroweb.org/guideline/prostate-cancer]6. NCCN. Clinical Practice Guidelines in Oncology. Prostate cancer, v4.2024. [https://www.nccn.org]7. ESMO. Pocket Guidelines. Urogenital Cancers, 2023. [https://www.esmo.org/guidelines/pocket-guidelines-mobile-app]8. Moreira DM, Howard LE, Sourbeer KN et al. Predicting time from metastasis to overall survival in castration-resistant prostate cancer: results from SEARCH. Clin Genitourin Cancer 2017;15(1):60–66.e2. [https://pubmed.ncbi.nlm.nih.gov/27692812/]

License out项目近年来，中国创新药企业通过对外授权、合作开发和NewCo等出海模式，与国际MNC达成BD交易，以此拓展全球市场。这种模式不仅加速了中国创新药的国际化进程，也为中国药企带来了可观的经济效益。对外授权(license out)模式由国内企业将产品的海外权益授予合作企业，获得首付款、进入注册临床或批准上市的里程碑付款、以及一定比例的销售分成;合作企业负责授权后的国际临床开发和商业化销售。对外授权可大幅降低创新药出海的投入门槛，同时缓解企业资金营运压力，成为目前创新药出海的主流模式。根据美柏资本、医药魔方及各大公司公告等公开数据显示，2024年中国创新药license out交易数量超过120起，交易总金额超500亿美元，超越2023年的披露交易总金额465亿美元，创新药出海增长势头仍在延续。据百英诺科技不完全统计，2024全年发生的药物授权许可的交易共计70笔，占整体license out的50%以上，以下数据分析只针对药物授权许可交易，不包括技术平台授权、合作开发等其他交易模式。恒瑞医药与Hercules就GLP-1类药物签订的60亿美元合同，成为2024年度国产创新药license out交易的领头羊。2024年国产创新药license out交易总金额TOP10如下：国际上，近年来，更多的国产创新药资产的价值得到阿斯利康、诺华、默沙东等诸多国际MNC认可，收购的权益包括小分子、ADC、单抗、多抗和小核酸等多个方向。此外，近期的license out交易不再仅限于百济神州、信达生物等Biotech企业。越来越多于近年来处于早期阶段的Biotech，如宜联生物、安锐生物、舶望制药等，也开始积极参与这一模式，寻求与国际市场的合作机会。同时，恒瑞医药等传统转型药企在license out交易中的出现频次也有所增加，这进一步证明了该模式在中国创新药出海战略中的重要地位。国内方面，国谈下创新药价格降幅明显，处于药品实际商业回报率普遍低于预期的承压环境。以2023年医保谈判为例，部分企业的明星产品虽然成功续约，但价格降幅明显，如翰森的培唑帕尼和辉凌的奥雷巴替尼等，续约价格分别下降45%和40%。医药产业下游的医疗终端同样面临控费压力，其中医院端受到“药占比”“零加成”DRG/DIP模式等政策影响进一步控制诊疗成本，零售端在药品比价系统、医保个账改革等措施实行后利润空间将被压缩。在此背景下，中国药企纷纷开始寻求新的发展之路，主动地参与到国外的竞合大循环中。与国内市场相比，部分海外市场的药品定价相对较高，且部分国家和地区的医保体系较为完善，能够为创新药提供较好的支付保障，使得国内创新药企看到了在海外市场获得更高回报的可能性。如今，出海成为中国药企消化供给、赢回市场回报的关键策略之一。图：2021年全球前25名畅销药在各国的相对价格水平（假设美国药价水平为100%）资料来源：头豹研究院，中国银河证券研究院高频领域从交易项目所在的疾病领域来看，肿瘤仍是2024年交易最火热的适应症，共产生44笔交易。同时，自免领域（10笔）、代谢性疾病（3笔）和心血管疾病（3笔）等领域的交易事件开始增多。企业的BD交易更加注重满足当前未满足的临床需求。对2024年中国创新药对外授权许可的药物类型进一步分析，抗体、小分子和ADC药物是交易的主要阵地。29笔抗体类药物交易中，包含单抗类药物20个，双抗药物11个，多抗药物2个。从已披露的项目研发阶段来看，license out呈现出显著的更早期的项目偏好性，其中临床前（包括IND）项目数量远超其他阶段管线，已上市的成熟项目也颇受关注。早期和后期临床研究的项目占比较小。结合药物类型和项目交易阶段分析，ADC项目和小分子项目以临床前为主要交易阶段，抗体类药物在临床前、I期、II期和上市阶段均有交易。创新技术不断推陈出新，不同于美国等发达国家在化学药、单抗药等领域布局早且具有显著的优势，新兴的双抗和ADC等为中国创新药出海提供了机会，海外企业也正积极将具有管线创新性与临床价值的产品收入囊中。活跃企业2024年，默沙东、阿斯利康和IDEAYA Biosciences是国际MNC活跃度TOP3，默沙东与4家中国药企分别签订了授权许可协议，位居第一，其中3笔交易在本年度国产创新药license out交易总金额TOP10榜上有名。阿斯利康和IDEAYA Biosciences均三度出手买入国内创新药权益。交易项目信息如下表所示:                                         国内创新药license out趋势分析岁末年初，创新药出海浪潮再起。2025刚开年，国内Biotech便接连达成了数笔BD交易，Roches对信达DLL3-ADC的全球独家许可；和正医药与强生在BTK Protac 赛道的全球研发战略合作；宜联与AZ在抗肿瘤ADC联合用药的临床研究合作；先声再明与艾伯维就T细胞衔接器技术平台在多发性抗骨髓瘤的临床开发进程的合作，都可圈可点。预计2025年国内创新药的出海在交易标的、合作模式和规模上都会有更大的突破和进展。（一）潜在BD交易标的1.1 中枢神经系统疾病阿尔兹海默症（AD）人群广、病程长、市场需求旺盛。国内已有至少983万AD患者，随着人口老龄化的发展，国内AD患者数量也将维持增长态势。AD病程可达12年，早诊断及治疗助于延缓疾病进展。2024年12月6日，Muna Therapeutics宣布与GSK达成一项研究合作，本次合作的核心是Muna的专有MiND-MAP平台，利用单细胞空间多组学和生物信息学技术来识别与特定疾病相关的遗传、细胞和其他分子机制，旨在发现和验证用于治疗阿尔茨海默病的创新药物靶点。Muna将从GSK获得3350万欧元（约2.57亿元人民币）的预付款。此外，Muna发现的每个靶点还可获得高达1.4亿欧元（约10.76亿元人民币）的里程碑付款，Muna将有权获得任何商业化产品的分层版税。1.2 放射性核素偶联药物（RDC）诺华的Pluvicto于2022年3月在美国获批，是首款用于治疗转移性去势抵抗性前列腺癌（mCRPC）患者的靶向放射性药物，2022年全球销售额2.71亿美元，2023年达到9.8亿美元，同比暴涨261%。除了诺华，礼来、阿斯利康，拜耳外，礼来、强生、BMS和罗氏等跨国药企巨头也在布局核药赛道。2024年6月，Radionetics Oncology宣布，已经与礼来达成战略合作，将共同推进靶向GPCR的小分子放射性药物。此次合作的预付款为1.4亿美元，礼来还拥有未来以10亿美元收购该公司的独家选择权。国内方面，辐联科技在今年7月达成1笔临床前的RDC项目的授权许可交易：1.3 小核酸药物2024年，国内小核酸BD不容小觑。舶望制药的近42亿美元出海，高居小核酸历年BD交易额榜首。瑞博生物与勃林格殷格翰的20亿美元合作，也挤进了历年交易额TOP10。其较高的转让金额也验证了其管线创新性与较高的临床价值，这也成为了继ADC、单抗等领域之后，本土创新药孕育又一得到全球市场认可的细分新药研发领域。医药魔方数据显示，国内小核酸在研管线主要集中在肝病、心血管疾病、抗病毒感染、抗肿瘤和代谢类疾病，相对应全球分别是抗肿瘤、神经系统疾病、肝病、心血管疾病和抗感染。中国和全球的管线所涉及的适应症整体较为一致，有利于国产相关创新药向海外有兴趣的公司出售。1.4 GLP-1类药物据GlobalData统计，2019年至2024年，针对GLP-1药物的全球交易金额增长595%，仅2024年就已达成超过62亿美元的交易额。从2019年至今，针对GLP-1的药物的许可交易总金额达到122亿美元。2024年5月，恒瑞医药更是以60.35亿美元的交易总金额向Hercules授权3款在研GLP-1药物。同年，翰森制药和先为达生物也纷纷出让GLP-1药物权益。（二）合作开发合作开发，也称联手出海，即中国药企与海外药企联合开发，分担成本和收益。主要通过股权授权、销售渠道合作等方式与海外当地成熟的企业合作来实现产品出海。在此模式下，中国药企能广泛筛选海外企业，寻找那些在海外商业化能力强且能助其在海外临床积累经验的合作伙伴。但同时，中国药企难以直接掌控海外市场销售策略及结果，商业化收益也可能受到合作伙伴的制约。2022年2月，传奇生物与合作伙伴强生旗下的杨森制药联合宣布:由传奇生物研发的CAR-T产品西达基奥仑赛获FDA批准上市，用于治疗终末线复发或难治性多发性骨瘤患者。2018年，传奇生物与强生达成合作协议，两家共同推进西达基奥仑赛的国际临床和商业化，截至目前，传奇生物已获得强生支付的3.5亿美元预付款和3亿美元里程碑付款，潜在里程碑金额仍有10亿美元。君实生物也同样是合作开发出海中的佼佼者，在特瑞普利单抗的商业化布局方面，公司除了与Coherus共同开发北美市场之外，也已经和Hikma、Dr.Reddys、康联达生技等，在中东、北非、拉丁美洲、印度、南非、东南亚、澳大利亚、新西兰等超过50个国家达成商业化合作。国内采用合作开发模式的相关企业案例如下表所示：（三）NewCoNewCo模式，即由国内生物医药企业与海外投资机构合作成立新公司，将企业的特定管线资产授权给新公司，以获取融资和海外市场拓展机会的交易方式。2024年先后有恒瑞、康诺亚、嘉和生物和岸迈生物成功利用NewCo吸引多元化投资，获得现金回报和管线股权。对于创新药企来说，研发和商业化过程需要大量资金投入。NewCo模式通过与海外投资机构合作成立新公司，能够引入海外资本，为企业发展提供新的资金来源，缓解企业的资金压力，有助于推动药物的研发、临床试验和市场推广等工作。同时，创新药研发存在较大的不确定性，临床试验结果可能不如预期。在NewCo模式下，国内药企将管线授权给NewCo公司后，部分研发风险转移给了NewCo公司及其投资者。如果临床试验失败，国内药企的损失相对减少；而如果研发成功，国内药企可以通过股权等方式分享收益。与传统的license out模式不同，NewCo模式下国内药企通常仍持有NewCo公司的一定股权，保留了对核心资产的部分掌控权。当NewCo公司发展壮大、价值提升时，国内药企可以分享其股权增值带来的收益。国内药企作为股东，有权参与NewCo公司的运营和决策过程，在一定程度上可以影响产品的开发方向、市场策略等，保障自身的利益和话语权，确保产品的研发和商业化符合企业的整体战略。NewCo模式凭借其资金与资源支持、风险分散、保留权益与控制权、提升企业估值以及灵活性与适应性等诸多优势，为创新药企提供了一种全新的发展路径。这种模式不仅能够帮助企业解决资金瓶颈问题，还能有效分散研发和市场风险，同时确保企业对核心资产的掌控权和决策参与权。国内采用NewCo模式的相关企业案例如下表所示：百英诺科技认为，无论是何种出海模式，作为国内的Biotech，想要吸引国际MNC的关注并与其开展合作，需要具备以下几点因素：第一，对于创新药的成功出海，创新疗法、独特的分子结构或给药方式等带来的临床价值是核心要素。开发出具有自主知识产权和核心竞争力的创新药产品，才能为出海奠定坚实的基础。第二，企业与购买方公司的管线和发展需求契合度较高。例如，作为国内CAR-T治疗法的领跑者，南京传奇生物与美国强生签订全球化合作协议，共同开发、生产和销售LCAR-B38M（西达基奥仑赛），一定程度上弥补了强生在多发性骨髓瘤管线中CAR-T疗法的缺口。第三，进度靠前的管线是国际MNC重点关注的对象，中国在双抗、ADC和小核酸等领域的发展使市场中有逐渐增多的全球研发进度靠前、有更高出海机会的管线。在IND或IND前进行出海交易可以尽早的抢占更多市场空间，从而获得更高的销售利润。综上所述，国内Biotech想要实现自身产品的出海，在加大在新药研发方面的投入，提高研发效率和创新能力的同时，要深入了解海外不同国家和地区的医药市场情况，包括市场规模、增长趋势、疾病谱分布、医疗保障体系、药品监管政策、竞争格局等，结合自身产品的特点和优势，确定目标市场和目标客户群体。研发与临床试验阶段，严格按照国际通行的药品研发规范和质量标准进行药物研发，在药物发现、先导化合物合成、药效评价以及毒理学研究等环节参照美国和欧盟对IND申报的要求，尽可能多地获取不同口径的数据。并在后期选择合适的国家和地区开展国际多中心临床试验，通过在不同地区的临床试验，可以更好地验证药物的疗效和安全性，同时也为产品在多个国家和地区的注册上市提供依据。注册审批方面，深入研究目标国家的药品注册法规、审批流程和要求，如美国的FDA审批、欧盟的EMA审批等，组建专业的注册团队或与专业的三方服务机构合作，确保注册申报工作的合法合规及申报材料的完整性、准确性和合规性。声明本微信公众号对所有原创、转载的内容、陈述、观点判断均保持中立，推送内容仅供公益性分享，部分转载作品、图片如有作者来源标记有误或涉及侵权，请联系小编删除。END▲点击图片了解 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Step back from the multitude of details that go into every big pharma pipeline, and you’ll see the influence that blockbusters have on the entire field. These days, making your mark in R&D at the level the top 15 spenders play requires not just one, two or three experimental drugs that can earn a billion dollars a year. It’s typically about a slate that includes candidates that can bring in $3 billion to $5 billion a year, preferably more. The numbers keep getting bigger. When Merck execs look at the $30 billion-plus hole they have to fill once Keytruda goes off-patent, they know that anything under a billion won’t count for much. And you can see the same math dominating discussions at J&J, Pfizer, Bristol Myers Squibb and more. On the plus side, the drive to move the dial on sales includes changing standards of care for large numbers of patients. That can open up some hard targets that have defied investigators for years. The hunt for first- and best-in-class drugs inspires truly innovative development work. But for patients — including me — who suffer from diseases that aren’t among the major league targets, it can be hard to find much interest among a set of companies that have to think big in order to survive. These days, with IPOs still out of favor, the blockbuster strategy of the big cap players is more influential than ever. Those R&D alliances that can sustain a biotech will be skewed to the companies that are breaking new ground where pharma sees the biggest upsides. And it will bend an entire global industry’s decision-making process. Success breeds success in this field. AstraZeneca, which once struggled to turn around the industry’s weakest pipeline, can now devote close to $14 billion a year for drug research in a variety of fields. And that has helped alter the landscape of the R&D 15, which once was long dominated by Roche. Other key themes emerge here. One of the most important is the emergence of China as a force in drug discovery. BD teams looking for R&D shortcuts have begun picking up drug candidates in bulk in China, presenting a thorny new reality for US and European biotechs that aren’t able to move as quickly. This year, I’m concentrating on public pharma companies, which have always dominated the list. But it excludes the privately-owned Boehringer Ingelheim, where it’s harder to find details on the pipeline. Takeda also drops off this year’s list, falling just short of the dollar mark needed. And Regeneron marks its arrival as the big biotech invests heavily in its pipeline. — John Carroll The big picture: During 2023, Merck bulked up on M&A deals that pumped up its R&D budget line to a whopping $30.5 billion. In 2024, the pharma giant continued shelling out the big bucks, but without a scale-tipping deal like the $10.8 billion Prometheus acquisition we saw included in the R&D line in 2023. Nevertheless, Merck easily held on to the top spot among the 15 biggest public company R&D spenders on the planet. By the end of last year, Merck had once again dwarfed the old R&D spending leaders like Basel-based Roche, where budget discipline remains a constant. Merck has been shoveling cash into the R&D engine because it’s three years away from a titanic collision with a key patent loss for Keytruda, the $30 billion — and counting — PD-1 behemoth that went a long way to changing the way cancer is treated. Merck continues to rack up big annual increases in Keytruda revenue, which has been essential as the company’s other big earner — Gardasil — fizzled in the face of some ambitious sales projections for the China market. There’s one ace in the hole, with analysts arguing over just how much Merck can make from their late-stage subcutaneous version of Keytruda, which will come with a whole new patent life to profit off of. But whether it’s $6 billion or $7 billion a year, that still leaves a Grand Canyon-sized gap in the budget that must be filled. And the rep of CEO Rob Davis and R&D chief Dean Li will be made or lost on their pipeline strategy for a Keytruda replacement. Or replacements. “The future is less monolithic Keytruda,” Davis said . “It’s going to be a lot of smaller, precision-based therapies aimed at specific tumors or indications.” It’s going to take a lot of smaller drugs to mend a rip that size. That means a long string of deals, including a move to elbow its way to the future of immunotherapy with a rival to Summit’s PD-1/VEGF combo. And that required a turn to China, following what is now a well-beaten path for new drugs that they’ve bet big on. Merck kept the focus on China when it inked a deal just days ago for an oral Lp(a) inhibitor from Hengrui . Novartis recently delayed the timeline for wrapping its Phase 3 study for an antisense candidate for Lp(a) (partnered with Ionis), pushing the results for data on 8,000 patients to the first half of 2026. Merck put up a $200 million down payment on a $2 billion deal for an oral treatment that will need to go through a global program. That’s a low-cost deal in front of a major trial expense, and it offers a chance to leap into a race where orals may well end up ruling the franchise. But it’s no Keytruda. Investors don’t care much for the overall picture. Merck’s shares have dwindled more than 21% over the past year, even as sales kept climbing. Wall Street wasn’t crazy about Merck’s decision to withdraw guidance on Gardasil, at all. And the Keytruda dilemma has created a narrative that has dominated the company for years now. Merck execs can project confidence, but R&D spending illustrates a high level of anxiety. The big picture: You can bet that Roche execs were paying particularly close attention to AstraZeneca’s recent release of a positive, preliminary slice of late-stage data for camizestrant, its oral SERD for hormone receptor-positive, HER2-negative breast cancer. The Basel-based pharma giant has been angling — alongside Eli Lilly — to beat a path to the market with a best-in-class oral SERD that can be expected to rack up billions a year, provided they get in early on a field that has been a primary concern for years. Roche CEO Thomas Schinecker has pegged giredestrant as one of its top late-stage drugs, putting it in the pole position of a chart of potential blockbusters as it waits for late-stage data from their persevERA and evERA trials. It’s in a group of seven pipeline therapies that Roche believes can pave the way to new franchises worth $3 billion or more. AstraZeneca has pegged its rival as a $5 billion-plus earner, offering some added insight here on where the market is focused. But the others include some high flyers that face daunting odds in the clinic, as well as a cluster of rivals that Roche has to race for best-in-class status. Take, for example, the amyloid buster trontinemab, which recently offered an early picture of its ability to target the plaque — cognition was not part of that study, though. And the road for Alzheimer’s drugs is long and frequently twisted, with a questionable marketing future if it fails to do more than slow progression. Prasinezumab has failed a couple of mid-stage studies for Parkinson’s, as investigators try to find a population where it works. Parkinson’s remains one of the toughest targets in the industry, with repeated setbacks for key players — including a rival with the mechanism as Roche’s drug. Trontinemab and prasinezumab are both up for Phase 3 enabling readouts this year. Astegolimab is a dark horse Phase 3 candidate in a group of drugs aimed at taking on Dupixent’s dominant role in COPD. That drug — which inhibits the IL-33 receptor ST2 — was flagged for pivotal readouts this year from the ALIENTO and ARNASA trials. A couple of years ago, Roche fronted $310 million to partner with Alnylam on the RNAi drug zilebesiran for hypertension, which has posted positive mid-stage data. That makes the cut as a major potential player. NXT007 offers a new shot at hemophilia A after Roche took a hit on its gene therapy out of the Spark buyout. Long term, Roche wants to keep building around the Hemlibra franchise, which brought in $5 billion in 2024. In the follow-up category of potential blockbusters, Roche counts four drugs with $2 billion to $3 billion in peak sales potential. That group includes their BTK inhibitor fenebrutinib, which has reportedly done well in Phase 2 for MS. That’s up for a pivotal readout this year, along with vamikibart, which is in two studies called SANDCAT and MEERKAT for uveitic macular edema. As one of the biggest R&D operators in the world, Roche can afford a big pipeline with a number of misses. It’s the one or two big successes in each group of contenders that sustain a company of this size, as it proved yet again with their Regeneron rival Vabysmo, which broke through the $4 billion barrier last year as Tecentriq flattened out and exhibited signs of erosion. Polivy also jumped into the blockbuster club, marking a key marketing success. The key thing for Roche R&D is putting up a slate of credible contenders, with a group of late-stage candidates tackling big diseases and at least one big prospect that looks competitive in the multibillion-dollar class. To that end, Roche continues to selectively snap up new candidates and forge new alliances around the globe. In recent months we’ve tracked an antibody pact with UK biotech Oxford BioTherapeutics, heavily weighted to biobucks as is common in discovery deals. And they went back to the China well for a new deal with Innovent on small cell lung cancer that cost $80 million in upfront cash. Paying $1 billion for the off-the-shelf CAR-T tech at Poseida amounted to a small bolt-on in this world. Roche paid $2.7 billion for Carmot, and had some positive early data to exhibit last year. A lot of this will sour or fizzle out. TIGIT was once a hot prospect, but it’s all been bad news on that front. You win some, you lose some in Big Pharma. Roche has been winning enough to stay on top, but the pressure is always on. The big picture: Pascal Soriot took plenty of painful shots during his early years as CEO of a woeful AstraZeneca — including more than a couple from me — with each setback cause for fresh concern. Slowly building a slate of giant franchises in oncology, and buying Alexion to beef up earnings, ended the fretting. By the end of 2024, AstraZeneca’s top execs could boast of full-year revenue growth of 21%. Industry buzz has Soriot spending big chunks of every year in China, where the company has been working to make a confrontation with the government into a commercial speed bump, hoping to continue to romp and stomp while using its international status and UK headquarters to steer clear of the showdown between the US and China. And it recently underscored the connection by unveiling plans for an expansion of its R&D work in China. Its growing commercial success with proven oncology drugs has spurred Soriot to invest heavily in the pipeline, stretching past cancer into other fields, like obesity. Five years ago, AstraZeneca shelled out $6 billion for R&D in 2019. In 2024, that tally had more than doubled as AstraZeneca surged from a cash-strapped player to an industry leader in research, trailing only Merck as the US outfit urgently tries to engineer a replacement set of drugs for an aging Keytruda franchise. Quite a few analysts are ready to offer their thumbs-up for AstraZeneca’s progress, but the question now is likely to center on whether AstraZeneca can keep its winning streak on track. Case in point: Camizestrant has been built into a $5 billion+ annual prospect. Some observers are ready to sign off on a blockbuster future for the oral SERD drug, especially after a recent Phase 3 win, but temper the enthusiasm with somewhat lower sales expectations. Baxdrostat also gets star billing, as Soriot touts “more than 90 late-stage trials underway with an average non-risk adjusted peak year revenue per trial of $1 billion.” The focus now is on performance in the clinic, but AstraZeneca’s financial results give it considerable range to consider more deals. Soriot picked up baxdrostat — exploring a new mechanism of action for hypertension that investigators have been exploring for close to 20 years — in a $1.8 billion deal for CinCor two years ago. And the pharma giant has helped blaze the BD path through China, leaving it in a position to scoop up fresh assets at discount prices. R&D risk is always huge, but investors have liked the odds. $AZN is up 16% over the past year. The big picture: With biosimilar competition ramping up this year for Stelara, one of J&J’s mainstay mega-franchises ($10.4 billion in 2024), the pharma giant needs to rack up some regulatory wins from the late-stage pipeline. The company’s R&D group breathed a sigh of relief when icotrokinra, its big program for IBD brought in from Protagonist, recently delivered — at least on the major points we could see in the company statement — in an important mid-stage trial of the oral IL-23 therapy. J&J execs, who have been slowly unfolding a pipeline-in-a-product strategy for this drug, believe icotrokinra can be a $5 billion-a-year earner, putting it at the tip of the big phalanx of R&D projects now in the pipeline. Another late-stage drug that gets a lot of attention at J&J is nipocalimab for generalized myasthenia gravis, which has nabbed breakthrough drug status at the FDA as it looks for an OK. And there’s a new fast-track designation for this drug in moderate-to-severe Sjögren’s disease. J&J is a behemoth with a long list of marketed drugs, a fact that comforts risk-averse investors. But the churn tends to deter anyone looking for some quick upside. Its medtech group spent $3.7 billion on R&D last year, helping maintain a stable of products that deliver on the bottom line. That helps keep the numbers steady. And it helps when one-time blockbusters-to-be — I’m talking about aticaprant here — flounders in its Phase 3. J&J had slated the anti-depressant in the $1 billion to $5 billion category, up until a few weeks ago when the drug giant wrote it off for insufficient efficacy. Anyone who’s been following depression R&D for the past 20 years wouldn’t have been too surprised to see yet another Phase 3 fail here. But neuro is still surging on increased confidence that scientists can deliver major drugs for unmet needs. For J&J, the belief helped inspire the Intra-Cellular Therapies buyout for $14.6 billion during JPM, finally breaking the year-plus drought of M&A deals that broke the $5 billion barrier. That deal, like the top drugs in its pipeline, underscores a well-known fact about J&J. The company is a global player in R&D — helping break the mold on China deals when it picked up the cancer drug Carvykti. But while the company can be a world-class drug picker, it’s not known for discovery work. J&J has also long been operating under a cloud brought on by its talc settlement talks, where the numbers people have set aside billions and appear to be close to finally completing a deal to shunt talc into a subsidiary and settle up with the bulk of the lawsuits. It’s manageable, but after 16 years and thousands of suits, J&J’s investors would like to move on. Following its spinout of the consumer division, J&J is on an R&D path — sticking with diseases its researchers understand well — it’s likely to follow for years. And that will keep BD busy. The big picture: AbbVie’s story in recent years has centered primarily around its fierce development and then commercialization of Rinvoq and Skyrizi to bridge its way past the revenue gorge created by Humira’s slow-motion loss of exclusivity. Once the biggest drug in the world, Humira is being steadily eclipsed by biosimilars, but the R&D group has kept the ball rolling with new studies to expand their pair of cash cows. The Botox buyout remains another key storyline as AbbVie proves yet again that it has an excellent set of marketing skills. Mission accomplished on the big moves, which isn’t to be underestimated. That may not add up to be the most exciting R&D story in biopharma in 2025, but it has certainly kept investors happy as AbbVie worked through a top-level executive transition and began to try kickstarting some fresh enthusiasm with a few ambitious deals. AbbVie took a major stab at neuroscience when it bought out Cerevel a couple of years ago for $8.7 billion , landing a lead asset in the field. But that strategy largely came a cropper recently with the failure of emraclidine, once intended to help change the standard for treating schizophrenia. Big Pharma has been making a few careful moves in neuro, but the unknowns are still legion, and the risks are extremely high. Roche’s setback on prasinezumab for Parkinson’s in late 2024 underscored that universal truth. AbbVie is still talking up the prospects of tavapadon as it racks up Phase 3 wins, but the upside isn’t as great, as far as the analysts are concerned. AbbVie was a late arrival to the obesity scene, talking up its potential for less frequent dosing and relatively competitive weight loss data with Gubra’s amylin drug. The BD team brought that in for $350 million upfront. There are some ADCs that the R&D group thinks highly of and a host of low-cost early-stage deals intended to raise its prospects for the future. For now, though, AbbVie is clearly relying on its marketing muscle and experienced research groups to keep building key franchises — which it is really, really good at. The jury’s out on whether AbbVie can add some major new franchises to grow the company faster. But they have time now. The big picture: Every time a CEO or biotech investor starts making the case for more M&A, often on background, they inevitably point to Bristol Myers as the poster child for Big Pharma pipeline demand. It faces huge looming patent losses — let’s start with Opdivo — and has a couple of years to wait for the kind of registrational data needed for its most promising late-stage drugs. The pharma giant has certainly been a player in the M&A club, snapping up Karuna ( $14 billion ), RayzeBio ( $4.1 billion for a radiopharmaceutical drug in a hotly contested arena) and Mirati ( $5.8 billion for KRAS) along the way. But recent moves aimed at cutting costs while boosting work in Phase 3 underscore just how tricky this can be. And all the buzz about its need for pricey buyouts hummed right along through a muted year of dealmaking in 2024. By all accounts, a few analysts on the Street seem satisfied that Cobenfy — out of Karuna — is on track to a blockbuster future, starting with schizophrenia and potentially expanding into Alzheimer’s. But its launch late last year didn’t come close to satisfying the skeptics rooting for more BD — which has been encouraged by a set of execs ready and willing to talk up their expectations on the acquisitions side of the business. Among the drugs in late-stage work, you’ll find new multiple myeloma therapies, which Samit Hirawat talked up in the last quarterly run-down. “ … It is very important to continue to develop small molecules, which are easy to deliver and can be combined with the standard of care therapies. And that’s exactly where iberdomide, mezigdomide sit,” he added, highlighting head-to-heads with pomalidomide (Pomalyst) — facing near-term generic competition — and Revlimid — already losing ground to copycats. Overall, costs have been headed up in R&D at Bristol Myers, and with all hands on deck for a Phase 3 revival of the portfolio, the pharma giant is poised to keep pouring money into drug development. The big picture: The CEO/R&D chief duo of David Ricks and Daniel Skovronsky took home the big prize with the successful launch of the drug juggernaut Zepbound/Mounjaro, which has emerged as the leading obesity/type 2 diabetes treatment in a world hungry for effective fat busters. They aced the main prize in the GLP-1+ field with their own particular take, and they are following up with additional studies to prove efficacy where it can gain reimbursements — while following up with an oral that is aimed at cementing this category in its favor for years to come. That storyline has proved enormously persuasive with investors, as Eli Lilly’s share price has grown 64% over the past two years and its biggest supporters among the analysts glow with enormous projections. But with that much money on the table, it’s no major surprise to see Novo Nordisk double down on its own obesity franchise — a story that’s had a few problems — while the competition aims at doing it better with fewer side effects and a more appealing form of administration has grown into a mob of biopharma companies. It does make you wonder where peak obesity lies. But Lilly is determined to hold onto the lead, no matter how rough this ride may get. And it promises to pay off in the tens of billions per year. To that end is a prospective 2026 launch of orforglipron, an oral GLP-1. Analysts have been on high alert for upcoming T2 data, which Lilly forecasts should look good in comparison to Novo’s semaglutide. That’s the key competitive number they’re looking for. There’s also the multi-targeted retatrutide in the pipeline to consider, where investigators tracked a 12% weight loss in a mid-stage study. Novo certainly has, inking a deal with China’s United Laboratories for an early-stage rival treatment as it looks to be competitive in a range of targets aside from GLP-1. That deal also underscores how Big Pharma can steal a march on a rival drug by scouting R&D programs in China. There’s also remternetug for Alzheimer’s, a quarterly injection to remove amyloid plaque, versus the monthly injection their approved drug donanemab (Kisunla) uses. Analysts once projected billions in upside for the new Alzheimer’s drugs making their way into the market, but skeptics wonder if their modest benefits for patients will win doctors and large numbers of patients over. Lilly’s late-stage cardio drug lepodisiran often earns a mention from leadership, along with their oral follow-up muvalaplin. Then there’s the KRAS contender olomorasib. Add in the occasional buyout — like Morphic — and you’ll get a picture of an ambitious pipeline funded with growing revenue from an effectively marketed drug with the kind of legs that can sustain a company like this for years to come. Given the company’s credibility in drug development, you’re likely to agree that Eli Lilly should never be underestimated. The big picture: By the end of 2022, Pfizer’s rep was pure gold. There was a king’s ransom in revenue for the multinational operation as it capitalized big time on its rapidly successful alliance with BioNTech for their mega-franchise mRNA vaccine to combat Covid. And CEO Albert Bourla basked in the glow of accolades for helping save the world — with the exception of some stray trolls. Then the world turned, vaccine demand plummeted far past most projections and Pfizer was left to pick up the pieces with a revised R&D game plan and revenue that only modestly improved in 2024 after bottoming out at $59.5 billion in ’23. Now, instead of continuing accolades for a truly historic vaccine rollout, analysts were reminded of Pfizer’s long track record for hit-and-miss performance in R&D and commercial ops. And it remains a big player in vaccines, where the long reach of the new Trump administration and its vaccine critics has extended to scrubbing out references to mRNA. Those persistent doubts led Pfizer to recruit Citi analyst — and longtime Pfizer doubter — Andrew Baum to help sell the company’s innovation plans. And he likely is more aware than most of just how hard that is as Pfizer looks to largely tread water on the numbers side this year. Buying Seagen set its course for a higher profile in oncology, which was on display as Bourla cheered their late-stage programs in his recent assessment of what’s ahead. Bourla earlier tapped oncology chief Chris Boshoff to take over R&D from Mikael Dolsten, signaling that it’s relying on a slate of cancer drugs to help replace Ibrance and Xtandi as those big blockbusters lose exclusivity in a couple of years — mere ticks of the clock in drug development cycles. So it’s no surprise to see company execs talking up prospects for the CDK4 inhibitor atirmociclib, now in a Phase 3 breast cancer study. But they took a nasty hit a few weeks ago when vepdegestrant, its protein degrader partnered with Arvinas, fell short in another breast cancer study. Baum also has his work cut out for him talking up Pfizer’s big plans for their oral obesity drug danuglipron, with analysts shaking their heads over a twice-daily dosing as rivals make progress on that front with drugs that may be much better positioned. Its cachexia drug ponsegromab, meanwhile, has had its late-stage development plan trimmed. Underscoring the doubts about Pfizer, analysts haven’t liked watching its sales of RSV vaccine Abrysvo plunge in a turbulent market for everyone involved. The pharma player has to perform consistently on sales if it expects to overcome the skeptics at this point. Add it all up and Pfizer looks like it will continue to operate under a cloud for some time to come, needing to establish a solid track record of significant new approvals and reliable marketing success. In the meantime, look for the company to keep shelling out big dividends to keep investors happy. The big picture: Under the watchful eye of chairman Joerg Reinhardt, Novartis CEO Vas Narasimhan has always proved ready to bring out the scalpel — or the axe — to trim away at its enormous global structure. So no analyst would have been surprised to see Novartis cutting away at its commercial ops in anticipation of a looming patent loss for its heavyweight therapy Entresto. A cliff like that would make many pharmas amp up R&D spending in a big way. Novartis actually cut back in 2024. The other Basel-based pharma giant is playing this one carefully for Wall Street, defending what’s left of patent exclusivity while signaling an LOE for Entresto in the middle of the year. It’s boosted revenue from Entresto in advance of the inevitable decline of its star drug — like pumping money from a dying well — and it’s pushing its other portfolio drugs hard, looking to make up for its blockbuster losses. That push includes building the franchises for Fabhalta, which just won its third approval, along with other drugs like Leqvio and Scemblix. Novartis has maintained a big focus in R&D on its radioligand portfolio, along with cell and gene therapies and RNA. Its late-stage pipeline includes OAV101 IT for spinal muscular atrophy, using a new delivery method aimed at widening the patient population for Zolgensma and now lining up for regulatory approvals. And there’s a big emphasis on votoplam (PTC518) for Huntington’s, in-licensed from PTC. Earlier this year Narasimhan and his execs spent a fair amount of time talking up the prospects of votoplam, which has to complete a mid-stage program successfully before Novartis takes over Phase 3. Huntington’s is wide open for anyone who can move the bar on this fatal neurodegenerative disease. But it’s also incredibly difficult to master, as Novartis knows from its own recent failure in the field with branaplam. Sage has also hit the wall here. But Novartis feels it’s learned a lot from its own setback — enough to believe that they can take the command here. Novartis, despite a busy pipeline overall, has a pretty thin set of late-stage drugs to tout, which led the Wall Street Journal to ask where Narasimhan expects to get its next round of drugs as Novartis sets out to perform with annual revenue increases in the mid-single digit range. Novartis spent a billion in cash on its Huntington’s alliance, underscoring just how careful they are with the R&D budget, which fell year-over-year in 2024. Not surprisingly, he centered on “smaller deals” while insisting he won’t make a move in obesity unless the BD team can line up something particularly distinctive. He also counts himself happy with their 2022/2023 reorganization. Happy, though, doesn’t mean content to leave things be. Novartis is always turning over stones to see where else it can cut. It adds up. And it’s shown zero interest in doing anything splashy. Its recent buyouts underscore that careful approach: MorphoSys was on the outer edge of the $1 billion to $3 billion range where Novartis prefers to play in M&A. At Novartis, financial discipline is a core value. And it’s part of the buttoned-down Swiss approach that isn’t expected to change. The big picture: There are a lot of moving parts at GSK, and not all are headed in the right direction. Its RSV vaccine sales have been on a roller coaster ride. The UK pharma’s big bet on Shingrix was dinged by slipping sales last quarter, all while the Trump administration helped cast a pall over vaccines in general that may well endure for four years. The vaccine market in China has also been wobbly, as Merck can attest to with Gardasil. On the other hand, GSK once again has high hopes for Blenrep, which was yanked from the market in 2022 after flunking a confirmatory study. The IL-5 therapy depemokimab has excited great expectations for £3 billion in annual sales, following up on the success of their asthma drug Nucala. All the while the BD group keeps turning up new deals that bolster their case without weighing heavily on the numbers side. And CEO Emma Walmsley, now an eight-year veteran in the top spot, is promising to move its top line to $50 billion, moving from £31.4 billion last year to 40 billion — a 27% increase in seven years. A lot of that increase will depend on how GSK’s commercial arm can capitalize on new therapeutics like their newly approved antibiotic gepotidacin. Commercial chief Luke Miels has cited analysts’ estimates for up to $1.25 billion for that program, but not everyone is nearly that enthusiastic about the near-term chances for a new antibiotic that could take years to gain a firm footing in the market. GSK has never been flashy. The stock is down about 10% over the past year. If you pull back over a three-year timeline, since GSK spun off its commercial group, the stock is down 19%, all of which has some analysts wondering if the large-cap company may once again become a target of the activist crowd. The big picture: I met Paul Hudson in Paris five years ago, when he stepped in as the new Sanofi CEO after a lengthy dry spell in R&D. Since then, he’s proven time and again that he’s ready and willing to invest in drug research, despite the inevitable ups and downs associated with bigger pipelines. A bit more than two years ago he was concentrating on what he called three major blockbuster candidates (€5 billion-plus): The OX40 drug amlitelimab, frexalimab and SAR441566, an oral TNFR1. And he was ready to sacrifice some profitability to move a pipeline where he counted another nine blockbuster candidates, mostly in immunology and inflammation. He kept that promise, with a boost in R&D spending of 14% in 2024 as Sanofi joined the industry migration out of consumer — staking its future on its ability to push new drugs to big futures. A few days ago Leerink noted that Sanofi was still juggling OX40 drugs to see whether amlitelimab, or its OX40L/TNF bispecific nanobody, would go into Phase 3 for hidradenitis suppurativa. That drug is in Phase 3 in atopic dermatitis and in Phase 2 in asthma and several other indications. Frexalimab failed a Phase 2 for Sjögren’s syndrome last year, narrowing its potential. That came with a Phase 3 failure of venglustat — another one of Hudson’s original top prospects — which nicked off part of its attraction as well. The next tier, where Hudson forecasts sales of €2 billion to €5 billion includes: Sanofi had one huge ace in the hole when Hudson took over the hand. It could rely on big sales of Dupixent ($13 billion in global sales last year) to keep it going in search of a new portfolio. And their marketing expertise in the field — built thanks to their alliance with Regeneron, which did the heavy lifting on the innovation side — would benefit any new drugs to warrant a regulatory approval while easing Aubagio out as generics took hold. The big picture: After hustling its way to the front of the GLP-1 line, Novo Nordisk is now all about the fierce rivalry it’s facing from Eli Lilly while positioning itself against any other entries that could sap its brilliant future in obesity. And that is no easy task, as execs have learned over the past year, while its stock plummeted 45% after peaking out as an obesity darling last summer. It turns out that superheating the stock price set up a supercooling series of events. After seeing explosive growth in revenue last year, Novo’s executive team is counseling analysts about a more modest growth path in 2025 as Eli Lilly brings the heat and pricing pressure grows. One of the big jobs they had to complete ASAP was being able to make enough semaglutide to satisfy the market and get off the drug shortage list — battling back against compounders who were carving up market share. While Novo Nordisk hasn’t been keeping up with average R&D spend among the top 15 — which generally comes in around the low 20s as a percentage of revenue — even 16.5% allowed for a 50% hike in R&D spending last year. In recent weeks Novo not only reorganized its growing R&D ops, it also struck back-to-back deals for new obesity drugs in an effort to stay ahead of the mob out to grab a share of the action. Now diabetes/obesity/MASH will be one R&D cluster focus, with cardio/chronic kidney disease and rare diseases making up the other two legs of its three-pronged research strategy. And like every other company in the R&D 15, it will rely on AI to make better bets on experimental drugs. Normally, that might make an intriguing proposition for investors, but analysts have been more focused on repeated setbacks in the clinic than the prospective benefits of a revised strategy. Novo Nordisk recently aired lackluster data for CagriSema, its follow-up drug that is a combination of the amylin analog cagrilintide and GLP-1. One of the big downsides to GLP-1 is the side effects of the drug, which the amylin analog is thought to limit while building weight loss. But it barely edged a high dose of Zepbound, leaving Lilly in the lead of the expectations game. And it earlier fell far short of the company’s stated expectation that it could trigger 25% weight loss. There’s lots more on the way, but Novo Nordisk has a lot riding on a head-to-head between CagriSema and Zepbound. Those data will come later this year, and failure is not an option. The big picture: Amgen has added a meaningful amount to its R&D budget, but it’s still hanging on in the second tier of the R&D 15. As always with CEO Bob Bradway, there’s a well-thought-out strategy that he’s pursuing — and selling to investors as the best path forward. And as always, the stakes are incredibly high. While looking to build on some existing drug franchises, Bradway once again used his Q4/2024 call with analysts to put the spotlight squarely on Amgen’s top prospect in the pipeline. This year it’s MariTide, an obesity drug that is looking to find a patch of marketing sun in the Big Kahuna of all drug rivalries. But it’s one tough sale. A few months ago, in a story covered by Max Bayer at Endpoints News , Amgen saw its stock take a dive on positive mid-stage data that illustrated a 20% weight loss for the drug. Once upon a time, you could have parlayed that into star status on Wall Street. But no more. It looked a little second-rate compared to the megablockbuster leaders in obesity, Novo Nordisk and a romping, stomping Eli Lilly, even if it can be effective at lower dosing. Amgen has a new take on the glucose-dependent insulinotropic polypeptide (GIP) receptor, blocking it instead of activating it. But it may just be the amped-up GLP-1 component that is delivering the benefit. Amgen has a huge Phase 3 for this one to answer all its questions, but you can see a few analysts are taking to the sidelines on this one, not quite won over by the dosing and design. On the upside: Any significant piece of obesity can be huge, even if in this case it’s relatively small compared to the leaders’ market share. On the downside: A big lead counts for a lot when you’re breaking new ground in therapeutic research, and Amgen definitely does not have the lead here. Amgen, though, will stick to its story. While it’s far from the top 10 in terms of R&D spending, the company has always punched above its weight when it comes to touting an experimental drug. So it was no surprise to see ex-Novartis vet Jay Bradner pick up his first Q4 call at Amgen by keeping his sights set on MariTide. But Bradner is also quick to highlight other late-stage prospects, topped by its Lp(a) drug olpasiran — now one of several drugs in the mix for this target — while waiting on the FDA decision for Uplizna. There’s also the Phase 3 program for rocatinlimab in atopic dermatitis, which has the potential to pursue other pathways, provided the data are strong. That could prove a major caveat, though, While Tim Anderson sees Amgen as 12 to 18 months ahead of Sanofi’s rival OX40 mab amlitelimab, he called one of the mid-stage data cuts “underwhelming” compared to Dupixent, hampered by some safety concerns. The big picture: Gilead has been anchored by HIV for years now, able to take multiple hits on the R&D side without triggering too much angst among investors. And Gilead CEO Daniel O’Day — who celebrated six years in the top post — has been winning over some mild converts to the cause recently, including Tim Anderson. Anderson, like the rank-and-file investor group, is comforted by Biktarvy’s big role in the HIV arena, where Gilead mints money. And he’s intrigued by the upside of a couple of late-stage plays, including anito-cel, which Gilead — partnered with Arcellx — believes can cut down Carvykti from J&J and Legend. That depends a lot on the safety profile that has been emerging in clinical trials. But at this stage, Gilead has seen a slate of oncology prospects go down in flames, which hasn’t done much to increase confidence in a cancer drug now. On the other hand, maybe they are due for a win. If they can cut into line with Carvykti, which is linked with Parkinson’s and other serious side effects, it has the potential to earn billions. And that would push them to their goal of getting 30% of revenue from oncology, rather than continue to rely so heavily on its longtime dominance in HIV. But there are some big ifs along the way, including the developers’ plans to look for an accelerated approval of the CAR-T. The big picture: Regeneron was close to making the R&D 15 in 2023, and it made it through last year with a surge of research spending in 2024 that slipped ahead of Takeda, based on their last four quarters. Regeneron arrives as the only company that still counters its two remarkable founders in the top posts: Science chief George Yancopoulos and CEO Len Schleifer. They got to this point by creating a company that is frequently held up as the gold standard of biotech startups, building two giant franchises in Dupixent (partnered with Sanofi) and Eylea. Now Eylea has biosimilar trouble, but Dupixent is still romping and stomping on the numbers side, giving Regeneron a nice runway to build new drugs. Tim Anderson at Bank of America counts two key drugs in the late-stage pipeline, and one to watch now in Phase 2. There’s fianlimab, a LAG3 treatment in frontline melanoma that hasn’t received a ton of attention. Anderson notes that Regeneron is several years behind Bristol Myers in LAG3, with 2030 sales set under the $900 million mark. LAG3 has had a number of problems in the clinic, though, and the jury is definitely out on what the potential is here. And there’s IL-33 mAB itepekimab, also partnered with Sanofi. Not the next-gen successor to Dupixent as once billed, Anderson still sees blockbuster potential. Then there’s trevogrumab — an anti-myostatin — and the anti-activin A garetosmab for obesity, in Phase 2 development with a host of rivals in the clinic. Of more immediate importance commercially, Regeneron has tagged linvoseltamab , its BCMAxCD3 drug delayed for manufacturing reasons, as a likely near-term entry for multiple myeloma. Sales projections are relatively muted, though. There’s also a CRISPR drug partnered with Intellia, NTLA-2001 for ATTR amyloidosis . Of everyone on the R&D 15, Regeneron is reinvesting a larger percentage of its revenue than any other player. Thirty-seven years after the biotech was created, the founders still see themselves on the cutting edge of drug research.