Augurex's diagnostic test doesn't require new drug development. It identifies patients who can benefit from existing, approved rheumatoid arthritis drugs like Humira. This reveals a powerful strategy: creating value by connecting a previously undiagnosed patient population to already established, effective therapies, bypassing the need for novel drug R&D.

Investors often compare new drugs to the most effective treatments on efficacy alone. In practice, dermatologists will almost always choose a safer drug with lower efficacy first, creating a huge market for treatments that aren't "best-in-class" but have a superior safety profile.

Despite Dupixent's dominance, Apogee's CEO claims the atopic dermatitis market has so much unmet need that new drugs with even limited differentiation are achieving blockbuster status. This suggests the market is expanding to accommodate new entrants, rather than being a zero-sum game of stealing market share.

In a crowded market like atopic dermatitis, a safe oral drug can carve out a significant niche. Corvus's soquolitinib is positioned to compete against the injectable standard of care (Dupixent) and existing oral JAK inhibitors, which carry black box warnings. This 'safe oral' profile meets a major unmet need for both doctors and patients.

Protagonist believes its oral IL-23 blocker will not just compete with existing injectables but will capture a new market. They target the over 50% of eligible patients who currently take no therapy due to a dislike of injections or the safety profiles of other oral options, thereby expanding the total addressable market.

The company's strategy for its IL-23 inhibitor isn't just a single drug approval. They follow an established industry model where one successful drug becomes a pipeline for multiple related inflammatory indications like psoriasis, Crohn's, and ulcerative colitis, dramatically expanding its market potential over time.

The disappointing launch of Bristol-Myers' SoTic2 created skepticism around the entire Tic2 inhibitor class. However, strong new data from Alumis and Takeda showing biologic-level efficacy is reframing the narrative, proving the mechanism is potent and creating a major new opportunity in immunology for oral therapies.

Despite significant progress in managing symptoms for autoimmune conditions, very few treatments fundamentally alter the disease's course. The major unmet needs and investment opportunities lie in therapies that can induce remission or target common underlying pathologies like fibrosis, moving beyond mere symptom relief.

Beyond converting patients from existing injectable therapies, the company's core growth strategy for its oral IL-23 drug is to capture the 50%+ of eligible patients who currently refuse treatment altogether because they dislike injections. This transforms the strategy from market share capture to market creation.