Instead of relying on finding novel targets, a key strategy in neuropsychiatry is to revisit failed compounds that showed efficacy signals. Companies use modern chemistry and delivery to engineer solutions that separate efficacy from the historical liabilities that halted development, turning past failures into new opportunities.

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.

A practical way to find potentially abandoned drug assets is to scan the public ClinicalTrials.gov database. Andrew Lo suggests identifying trials that are still listed as active but have not been updated for a significant period. This public data provides a scalable, low-cost starting point for discovering valuable candidates that pharma companies are no longer pursuing.

A-muto suggests many drug programs fail due to toxicity from hitting the wrong epitope, not a flawed biological concept. By identifying and targeting a structural epitope unique to the diseased state of the same protein, these previously abandoned but promising therapies could be salvaged.

Acquiring a Phase 1-complete drug is only the first step. Tortugas Neuroscience creates value by redirecting these assets into novel indications. They pivoted a neurosteroid toward tinnitus after seeing compelling external data, targeting an unmet need where the drug's mechanism could treat the entire syndrome.

The ultimate vision is a dynamic marketplace where pharma companies routinely list their shelved assets. This "eBay for drug candidates" would allow interested parties—from biotechs to patient advocacy groups—to access information, assess opportunities, and bid on developing these assets, creating a systematic and efficient repurposing pipeline.

Regeneron systematically expands the market for its drugs through "indication expansion." By identifying people in its database with a natural loss-of-function variant for a drug's target, they can scan thousands of diseases to see what other conditions these people are protected from, revealing new therapeutic opportunities.

R&D departments in large pharmaceutical companies often resist repurposing projects. Their leaders are rewarded for discovering new chemical entities, not for finding new applications for existing drugs, creating an internal funding barrier that business units must overcome.

After Opthea's ophthalmology drug failed in trials, the company re-examined the underlying science of its VEGF-C/D mechanism instead of liquidating. This led to discovering a new application in a rare lung disease, proving that scientific assets can have value far beyond their initial intended use.