Voyager CEO Al Sandrock outlines a focused strategy: remain specialists in neurology, but broaden the therapeutic modalities (gene therapy, proteins, oligonucleotides). This allows them to pursue well-validated CNS targets that are considered "undruggable" by traditional small molecules, which have historically been the only option for crossing the blood-brain barrier.

Breakthrough drugs aren't always driven by novel biological targets. Major successes like Humira or GLP-1s often succeeded through a superior modality (a humanized antibody) or a contrarian bet on a market (obesity). This shows that business and technical execution can be more critical than being the first to discover a biological mechanism.

While GLP-1s dominated the obesity narrative, the next wave of innovation is focused on novel mechanisms. Arrowhead's significant fundraise for its siRNA drug highlights investor enthusiasm for approaches that offer complementary benefits, such as preserving muscle mass, signaling a new chapter in obesity treatment.

To build investor confidence in the high-risk neuroscience field, Neurocrine employs a dual strategy. It highlights its own proven track record while simultaneously de-risking its pipeline by targeting biological pathways already validated by competitors, aiming to create superior, best-in-class medicines rather than pursuing unproven science.

The GSK3 inhibitor was developed for CNS diseases, requiring high specificity and the ability to cross the blood-brain barrier. These same pharmaceutical characteristics—potency and lipophilicity—proved highly advantageous for treating cancer, demonstrating an unexpected but effective therapeutic pivot from neuroscience to oncology.

Transgene pivoted from "off-the-shelf" to individualized cancer vaccines not by starting over, but by leveraging its deep, four-decade-long expertise in viral vectors and payload integration. This highlights how legacy know-how can be a critical asset in strategic company shifts.

Neurocrine mitigates the high risk of its late-stage psychiatry programs, which have uncertain outcomes until Phase 3, by investing in an obesity asset. This program offers the ability to see clear efficacy signals in early Phase 1B trials, providing faster data for decision-making and balancing portfolio risk and cost.

Neurocrine's strategy with its M4 agonist hinges on achieving superior safety and tolerability through high selectivity. The company believes that for chronic psychiatric disorders, long-term patient adherence—driven by fewer side effects—is a more critical factor for commercial success than marginal gains in efficacy.

A decade ago, Neurocrine made the difficult decision to pause development of a promising CRF2 agonist. This ruthless prioritization freed up essential capital and focus to successfully develop what became INGREZZA, their blockbuster drug, demonstrating a long-term strategy of sacrificing a good opportunity for a great one.