NeuroPerspective has released its Winter 2024 issue, featuring our comprehensive Review of 2023 and Preview of 2024 for the neurotherapeutics area. While some will consider the launch of Eisai/Biogen’s Leqembi to have been the premier event for 2023, we consider this a first step, a dress rehearsal, for the eventual availability of genuinely impactful disease-modifiers for Alzheimer’s. For the time being, lecanemab and donanemab will have their risks better quantified than their benefit, which we believe will be captured by the modal familial assessment:’ I can’t tell if it’s helping or not.’
Otherwise, disease-slowing in neurodegeneration is still a work in early stage, with promising, yet-to-be-validated research in neuroinflammation and protein clearance standing out. We are looking forward to 2024 PhII readouts from AbbVie/Alector in Alzheimer’s, and Roche/Prothena in Parkinson’s. Genetically-linked disorders would seem to be more accessible, but the travails of huntingtin-targeting in Huntington’s has shown that target specificity is not the panacea that had been hoped for.
Instead, the drama in neurotherapeutics is coming from an area that a decade ago, was being dismissed as hopelessly mire in genericized mediocrity, Psychiatry. December saw two major deals that were Psychiatry-centric: Bristol Myers Squibb’s $14 billion buyout of Karuna, and AbbVie’s $8.7 billion acquisition of Cerevel. While welcomed by the investors who benefited, these deals signaled a surge in the credibility and accomplishments of Psychiatry R&D, bringing back BMS, who had left Psychiatry years ago, while building upon AbbVie’s leadership role in neuroscience. Over the next two to four years, the clinical practice of Psychiatry is going to be revolutionized, first in schizophrenia, but then in depression, where treatments will be customized in a way that moves far beyond the trial-and-error of past practice. Sage/Biogen’s Zurzuvae for Post-Partum Depression is the first iteration of tailored therapies, with clinical successes for KarXT and MDMA representing the next step in Psychiatry. While the muscarinic class is front-and-center right now, there is a broad range of novel mechanisms in development. The Winter Issue looks at the companies involved and those which might constitute attractive acquisition and/or licensing opportunities for larger companies eager to not miss out.
The Winter Issue includes our customary ‘Psychedelics Update’, as that sector works to earn the excitement that has been generated in recent years: The coming approval of MDMA for PTSD represents a significant landmark, Compass will have its first PhIII results for psilocybin in Treatment-Resistant Depression later this year. But this remains the turf of small companies, the only large company to actively engage with Psychedelics is Otsuka.
There are some ‘Lowlights’ also discussed in the Winter Issue, none higher-profile than the devolution of Biogen’s role in CNS R&D, where their leadership in partnering from 2017-20 has vaporized as they downplay the importance of neuroscience in their history and their future. The return of large companies to prominent roles in neuroscience diminishes, but does not completely erase, the sting of Biogen’s withdrawal. It is reassuring to see companies like Teva, which had amputated its CNS R&D several years ago, citing neuro-innovation as a new focus for their resources.
The companies covered in the Winter Issue are include those that represent the best and most accomplished of current neuroscience, some that epitomize the risks and aspirations of R&D, and the inevitable bevy of companies for whom ‘post hoc’ is a way of life. Just a few of the 200+ programs with summaries of their progress and prospects are:
AbbVie, Acadia, Alector, Anavex, Atai, Bayer AG, Biogen, Bionomics, BMS, Cassava, Cybin, Engrail, Denali, Eisai, Intra-Cellular, Janssen/JNJ, Lilly, Longboard, Lundbeck, Maplight, Merck, MindMed, Neumora, Neuren, Neurocrine, Noema, NoNO, Otsuka, Ovid, Prothena, Reviva, Roche, Sage, Sosei Heptares, Takeda, Transposon, UCB, and Voyager.
There are reviews of significant clinical, fiscal, partnering/acquisition events and trends, valuation winners and losers, including our annual review of the IPO class of 2019-21. 43 pages.
Published since 1995, NeuroPerspective is the quarterly review of the neurotherapeutics area offering essential, unique, and comprehensive coverage of developments in the science and the business of the CNS sector. Among our 2024 Feature Reviews will be Depression, PTSD, Stroke, Epilepsy, and Alzheimer’s.
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The Winter issue is being made available as a single issue purchase, US$850.