Heart disease is still humanity’s top killer, which ought to make it a gold mine for drugmakers. Lately it’s been more of a sinkhole. Since late July, heart drugs from Novo Nordisk (NVO) and Novartis (NVS) each hit the biological target they were built for. Neither cut heart attacks or strokes. In a Heard on the Street column, David Wainer explains why this keeps happening, and why it’s so expensive.
Why winning got so hard
Part of the problem is old success. Statins and blood-pressure pills were blockbusters in their day, and they’re now cheap generics. Showing a new drug adds protection on top of them is, in Wainer’s image, like proving air bags matter to passengers who are already buckled up.
To show a difference, trials need enough heart attacks and strokes to count, so they keep getting bigger and longer. Picture thousands of patients, years of checkups and a bill in the hundreds of millions of dollars. “This isn’t a vaccine study, where you jab people and see them in a year,” says William Blair analyst Myles Minter.
Biology isn’t cooperating either. Lp(a) — a cholesterol-carrying particle in the blood, with levels largely set by genetics — drew billions from Novartis, Eli Lilly (LLY), Amgen (AMGN) and AstraZeneca (AZN). The column’s likely reason for the miss: a lifetime of inherited risk is hard to undo in a trial lasting a few years. Rival Lp(a) drugs haven’t reported yet and could still work. Investors didn’t wait, though. Amgen stock suffered its worst day in decades.
One blockbuster isn’t a plan
Success isn’t the finish line, either. Amgen’s Repatha, an injection, pushes LDL cholesterol far below what statins do alone and cuts the risk of heart attacks and strokes. Sales still lagged for years in a market of cheap generics. After insurers limited access, Amgen slashed the U.S. list price.
That’s the investing lesson in miniature. A blockbuster eventually meets cheap copies, and one company’s failed trial can drag down a rival’s stock in a day. Wainer still sees bright spots, including obesity drugs like Wegovy and treatments for rare genetic heart conditions. But he expects retrenchment — cutting back while companies rethink which targets to chase and which patients stand to benefit most. The easy oil’s been pumped, in his analogy, and what’s left sits in deep, pricey water.