Optimism in drug discovery

I would like to share my optimism about two recent developments in the world of drug discovery. 

The first is drugs targeting GLP-1, first approved for Type II Diabetes, and now rapidly gaining market share for weight loss. My take is that, despite the substantial excitement both within our industry and in the popular press, we still aren’t making a big enough deal about it.

The second is the approval of Lecanemab for treatment of Alzheimer’s disease. While it’s not a cure, this drug at least slows disease progression – which is the best news the Alzheimer’s community has had in a very long time.

Concerns such as cost, meaningful access, side effects, fairness, and equity exist for both classes of drug. These are legit, but I’m going to set them aside for the moment. (Others have covered today’s challenges in great depth, and I will trust our industry to continue its frustratingly slow stumble in the direction of better outcomes.) Let’s assume specifically that the current shortages of Semaglutide and other GLP-1 agonists can be resolved, and that Lecanumab continues to delay progression in Alzheimer’s. Given that, the drug industry is going to do what it does: it will glom onto these mechanisms and develop a hundred lookalikes, refinements, and equivalents, leading to generics in a modest number of years. Access to these drugs, or something like them, will get easier – which means that at some point in the not too distant future folks will be able to take them earlier in disease progression, possibly preventing obesity entirely, and possibly delaying Alzheimer’s worst effects for years. 

These two things are great independently, but consider them in concert:

Obesity and diabetes are two of the major risk factors for the development of Alzheimer’s, to the extent that it is sometimes referred to as “Type III Diabetes.” Reducing the lifetime burden of metabolic disease with GLP-1 drugs may, in fact, reduce the incidence of Alzheimer’s at the root. Coupled with Lecanemab’s new foothold on a disease long thought to be intractable, this is cause for optimism.

The long-term impacts of new technologies are typically first overestimated and subsequently underestimated. You know the usual examples of this: the Internet, cars, antibiotics. The immediate impact of the new drugs coming on the market may be limited due to access issues, but in a slightly longer timeframe, I believe that the world’s disease profile (not to mention our literal profiles) may be very different. 

This is why we’re in drug discovery, folks. Slowly, haltingly, carefully, we’re all here to figure out how to improve people’s lives. And that makes me optimistic.