The failure of Novartis's antisense drug Pella Carson, contrasted with the potential success of Amgen's siRNA targeting the same pathway, could have a profound negative impact on the entire antisense field, favoring siRNA technology for large population diseases.

The current market prefers funding drugs for clinically validated targets, reducing 'biology risk'. However, this floods popular targets with dozens of competitors, creating immense 'commercial risk' where only one or two can truly succeed in a crowded field, a potentially worse gamble.

Progress in drug development often hides inside failures. A therapy that fails in one clinical trial can provide critical scientific learnings. One company leveraged insights from a failed study to redesign a subsequent trial, which was successful and led to the drug's approval.

The catastrophic failure rate in drug development isn't just bad luck; it's a structural problem. It originates from the very first decision: researchers, biased by existing literature and simplistic models, fixate on a single biochemical target, ignoring the body's complex, multi-faceted nature.

Novartis's cardio drug failure in a secondary prevention trial highlights a critical development challenge: even for genetically-validated targets, intervening late in a chronic disease's progression may be ineffective. The damage may already be too extensive, suggesting earlier treatment is needed to show a benefit.

Novartis's Lp(a) drug may have failed not because the target is wrong, but because patients were already so well-treated with existing drugs like statins. This highlights a growing challenge: new therapies must demonstrate significant added value over an increasingly effective standard of care.

Even while its antisense drug Pella Carson was in a major Phase 3 trial, Novartis proactively licensed a competing siRNA technology for the same target. This suggests a sophisticated hedging strategy or internal doubts about the original drug's prospects, a move made years before the trial's failure.

Following the costly trial failures of Novartis and Novo Nordisk, investors are expected to become highly risk-averse toward cardiovascular drug development. This will create a challenging funding environment for startups in the space as capital shifts to less risky therapeutic areas.

While the industry success rate for drugs entering the clinic is only about 10%, programs with human genetics backing have a 2-3x higher probability of approval. Regeneron reports its success rate is even higher, at four to five times the baseline, due to its strict focus on large-effect genetic signals.