It’s been a busy year for Chronic Obstructive Pulmonary Disease (COPD), which is on track to become a $14Bn+ market by 2028 surpassing Cystic Fibrosis (CF) as the 3rd-largest within Respiratory—here’s what’s leading the charge:

➡️ Sanofi/Regeneron’s Dupixent: In September, Dupixent’s label expansion into COPD was approved, making it the first biologic (mAb) ever approved for the disease. Assuming a 30% uptake among eligible patients, the drug is expected to generate $3 billion+ in incremental sales, becoming a market-leading therapy in COPD.

➡️ Ohtuvayre (Verona Pharma): A landmark approval this past summer, Ohtuvayre is a selective PDE3 and PDE4 inhibitor that helps open airways and reduce inflammation. It's been a long road for the drug, but projections suggest it could be a $2Bn+ blockbuster.

➡️ Breztri/Trixeo (AstraZeneca): AstraZeneca’s triple-combination inhaler continues to perform well and is expected to reach around $2 billion in sales by 2028.

Additional label expansions could bring more options to COPD patients:

➡️ Nucala (GSK): Already approved for severe eosinophilic asthma, Nucala is in Phase 3 trials to expand its label to COPD. If approved, it would offer a targeted treatment for COPD patients with elevated eosinophil counts, addressing inflammation linked to exacerbations.

➡️ Tezspire (Amgen/AstraZeneca): Currently approved for asthma, Tezspire is in Phase 2 trials to explore its potential in COPD. Targeting thymic stromal lymphopoietin (TSLP), Tezspire could bring a unique MOA to COPD by addressing the upstream drivers of inflammation, potentially benefiting a broader subset of COPD patients.

Several more biologics are in the pipeline:

➡️ Tozorakimab (AstraZeneca): An IL-33-targeting mAb currently in Phase 3 trials, Tozorakimab aims to reduce COPD exacerbations by focusing on IL-33. This could provide more effective control of inflammation-driven exacerbations.

➡️ Astegolimab (Genentech/Roche): An IL-33 receptor ST2-targeting mAb currently in Phase 3 trials, Astegolimab is designed to inhibit inflammatory signaling in the lungs. It may offer a refined approach to managing exacerbations, with early trials showing promise in reducing frequency.

➡️ Itepekimab (Sanofi/Regeneron): An IL-33-targeting mAb currently in late-stage Phase 2 trials, Itepekimab has also shown promise in improving lung function and reducing exacerbations. 

➡️ APG808 (Apogee Therapeutics): A Phase 1 IL-4Rα-targeting antibody administered subcutaneously, APG808 aims to control inflammation with less frequent dosing, which could enhance patient adherence. It has blockbuster potential.

With limited innovation over the past decade, the outlook is positive with lots of promising new options now on the horizon.

Did you know that after small molecules, the second largest drug modality in Prostate Cancer isn’t antibodies, cell therapies, gene therapies, or nucleic acids? It’s radiopharmaceuticals. 

Small molecules still dominate in 2024, with Xtandi holding over 40% of the market. And we're about to see significant growth from several others:

➡️ Erleada (J&J), which recently demonstrated a survival edge over Xtandi, is forecasted to reach $5Bn+ in 2028

➡️ Nubeqa (Bayer), with its second win in the metastatic hormone-sensitive prostate cancer (mHSPC) subtype, is projected to reach $2Bn+ in 2028

➡️ With its novel combination of a PARP inhibitor and androgen receptor inhibitor, Akeega (J&J) is also anticipated to grow quickly, becoming a $1Bn+ drug by decade’s end

➡️ Cabozantinib + atezolizumab (Exelixis), a Phase 3 combination therapy, could also potentially gain approval

After small molecules, however, radiopharmaceuticals are expected to make the biggest gains:

➡️ Pluvicto (Novartis), which delivers radiation precisely to PSMA-expressing prostate cancer cells, recently crossed the blockbuster threshold and is on track to exceed $3Bn in sales by 2028.

➡️ With its recent acquisition of Fusion Pharma, AstraZeneca's FPI-2265 is anticipated to reach $1Bn+ in sales next decade if approved, a Phase 2 targeted alpha therapy designed to deliver potent, localized radiation.

➡️ TLX591 (Telix Pharmaceuticals), currently in Phase 3, is a promising PSMA-targeted radiopharmaceutical therapy that aims to deliver precision radiotherapy to prostate cancer cells.

 Beyond FPI-2265 and TLX591, the pipeline gets ever more interesting with other modalities emerging:

➡️ Vobra Duo (MacroGenics) is a Phase 2 Antibody–Drug Conjugate (ADC) that could be one of the first ADCs in Prostate Cancer, offering a targeted approach by delivering cytotoxic agents directly to tumor cells. The company announced a pause on the drug today pending more mature progression-free survival (PFS) data but if eventually approved, it has the potential to achieve $1Bn+ in sales.

➡️ Vudalimab (Xencor) is a pioneering Phase 2 Bispecific Antibody which engages both T-cells and cancer cells simultaneously. If successful, it is projected to reach over $500M in sales.

 With November's annual Movember fundraiser bringing awareness to Prostate Cancer, it’s an ideal moment to spotlight these advancements. The evolving pipeline shows how targeted innovations are driving forward Prostate Cancer treatment, offering new hope for patients through more precise and powerful options.

November is American Diabetes Month, which raises the question: Did you know that some of the most exciting innovations in this field are expected in Type 1 Diabetes Mellitus in the coming years, not Type 2?

Amid the buzz around GLP-1s, the Type 2 Diabetes market is on a remarkable growth path. Ozempic and Mounjaro are projected to add a whopping $28Bn in sales alone in the coming years, reaching ~$45Bn+ in combined sales by 2028. These drugs are making waves not only for Diabetes management but also in Obesity through off-label use.

But it’s in Type 1 Diabetes where we're seeing some of the more exciting drug innovation. Two clinical therapeutics stand out in particular:

➡️ VX-880 by Vertex Pharmaceuticals: A phase 1/2 cell therapy aimed at restoring insulin production by transplanting insulin-producing pancreatic cells, potentially reducing the need for insulin injections. The first trial participant needed 91% less insulin 90 days after receiving an infusion.

➡️ CTX-211 by CRISPR Therapeutics: A phase 1/2 gene-editing therapy designed to create immune-evasive insulin-producing cells, addressing the autoimmune nature of Type I Diabetes.

Endocrinologists are cautiously optimistic, with equity research projecting both VX-880 and CTX-211 to each reach over $500M in sales by 2030.

As these therapies advance, they hold the promise of changing the way we approach Type 1 Diabetes, potentially transforming lives and redefining what effective care looks like. Keep an eye on this space moving forward.