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.
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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.
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.
Neurocrine's move from neuroscience into obesity is not a random leap but a calculated pivot. The company is leveraging its deep, historical expertise in the CRF biological system, a shared mechanism between the fields, to de-risk its entry into a new, high-growth therapeutic area.
Facing industry-wide skepticism in 2010, Alnylam implemented a highly disciplined R&D strategy. They focused exclusively on targets that met strict criteria: liver expression (where delivery worked), human genetic validation (to de-risk biology), and an early biomarker. This strategic focus was key to their survival and success.
Apogee built its strategy around known biological mechanisms, focusing innovation solely on antibody engineering. This allowed them to de-risk assets early and efficiently (e.g., proving half-life in healthy volunteers). This clear, stepwise reduction of risk proved highly attractive to capital markets, enabling them to raise significant funds for late-stage development.
ProKidney made the tough call to stop its second Phase 3 study to save $150-170M. This strategic trade-off allowed them to focus resources on the primary US trial under its RMAT designation and crucially extend their cash runway past the 2027 data readout, a vital move for survival in a tough biotech market.
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.
Drug development can take a decade, a timeframe that misaligns with typical investor horizons and employee careers. Success requires navigating fluctuating capital market cycles and implementing strategies to retain key scientific talent for the long haul.
To save money, Rhythm's leadership considered canceling a clinical study because the prevailing scientific logic suggested their drug wouldn't work. The study's unexpected, resounding success became the company's pivotal turning point, highlighting the value of pursuing scientifically contrarian ideas.
