Dr. Daniel Skovronsky believes a big leap in Alzheimer’s disease treatment may be just around the corner–and that an overlooked class of medicines could become the GLP-1 drugs of the future.
If he’s right, Eli Lilly & Co.’s
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remarkable winning streak won’t fizzle any time soon. As Lilly’s chief scientific and medical officer, Skovronsky has been in the vanguard of innovations that have propelled the 147-year-old Indianapolis company to the top of the stock-market charts this year. Fueled by major advances in Alzheimer’s and obesity treatments, Lilly is now the world’s most valuable pharmaceutical company, with a market cap that nearly reaches $540 billion– bigger than Pfizer Inc.
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bigger than Merck & Co. Inc.
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bigger even than Johnson & Johnson
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At the same time, Wall Street is thinking about how GLP-1 weight-loss and diabetes drugs could impact everything from airline stocks to the shares of snack makers. As a result, Skovronsky lands on The MarketWatch 50 list of the most influential people in markets.
The rapid-fire innovations from Lilly and its closest competitors have stirred controversy as well as headlines. Researchers, policymakers and industry players are debating whether the benefits of next-generation Alzheimer’s treatments can justify their considerable costs and risks–and whether Medicare and employers can cover pricey new weight-loss drugs without going broke.
While the stock market cheers and health economists grumble, Skovronsky is quietly working toward an innovation that could silence some of the naysayers and dramatically improve the health of many older adults. “I’m extremely optimistic,” Skovronsky told MarketWatch in a late October interview, about the potential for Lilly’s experimental Alzheimer’s therapy to prevent the onset of Alzheimer’s symptoms–rather than just slowing the progression of the disease, as shown in clinical trial data released earlier this year.
For Skovronsky, such an achievement would cap a career-long pursuit of earlier diagnosis and effective treatment of the devastating disease, which affects about 6.7 million people in the U.S. age 65 and older. Skovronsky published research in the field back in 1998, when he was at the University of Pennsylvania School of Medicine, and went on to start a company, Avid Radiopharmaceuticals, that developed a diagnostic agent to help evaluate patients for Alzheimer’s.
“This is actually my life’s work,” Skovronsky said. Lilly is now testing its experimental therapy donanemab in patients who have the pathology of Alzheimer’s in their brains but don’t yet have symptoms of the disease. Skovronsky is hopeful the drug can prevent the onset of symptoms, he said, based on the patterns seen in late-stage trials of donanemab in people who already have symptoms. “The treatment effect was the largest in the patients who had the earliest stage of disease,” he said. “So now we’re going even earlier, and we extrapolate out that maybe the effect will be bigger.”
While it will take time to see results of the newer trial, he said, “we can’t wait to see the data in a couple of years and hopefully for the first time have something that can offer the possibility of preventing this disease for some people.”
Such a decisive step forward could quiet some concerns about donanemab, which may get U.S. Food and Drug Administration approval in the coming months. A regulatory green light would put donanemab up against Biogen Inc.
BIIB,
and Eisai Co. Ltd.’s
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Leqembi, which hit the market earlier this year and has also been found to slow Alzheimer’s progression. But some geriatricians are tepid on both drugs, saying it’s not clear that their disease-slowing benefits are enough to outweigh their significant costs and risks–including potential brain swelling or bleeding.
Skovronsky said that donanemab’s disease-slowing effect “is really quite significant.” Nearly half the patients treated with donanemab in a clinical trial, for example, had not lost any cognition a year later, he said. For those patients to have a full year without any decline to spend with their families, he said, is “hugely impactful.”
What’s not debatable is the impact–on wallets as well as waistlines–of the new class of drugs widely used for weight loss, including Lilly’s Mounjaro and Novo Nordisk’s
NVO,
Wegovy and Ozempic. Mounjaro is approved for treatment of type 2 diabetes and is currently under review at the FDA for obesity.
The popularity and effectiveness of these drugs, along with their costs, have raised questions about whether and how Medicare and employers should cover the treatments–and whether patients will be able to stay on the injectable medicines long term. Some analysts are looking to obesity pills, now in development at Lilly, Pfizer, and other companies, to make this class of medicines more accessible.
“I think it will have the same efficacy as some of the best injectables out there,” Skovronsky said of Lilly’s experimental weight-loss pill orforglipron. With 1 billion people globally likely to benefit from the drugs, “it’s sort of inconceivable to imagine addressing the global burden of obesity with a once-a-week injectable,” he said. “It’s not something the world’s supply chains can handle, so we’re definitely going to need pills” to fight the obesity epidemic.
As the new class of weight-loss treatments, generally categorized as GLP-1 drugs, make waves in the market, Skovronsky said that 10 years down the road, the drugs having a similar impact on the industry and patients will probably be “things that no one is working on today.” He cites medications for chronic pain, an area that Lilly is now researching but where the industry has made few advances in recent decades. Now, “the science is breaking open,” he said, “and maybe that will be a big area in the future.”
With the company’s stock up more than 50% this year, are there any Lilly innovations that investors don’t fully appreciate? Skovronsky has a long list, including the company’s work in ulcerative colitis and Crohn’s disease, atopic dermatitis, and cancer. Lilly earlier this year launched Jaypirca for treatment of mantle cell lymphoma, and “I think that’s just the beginning,” Skovronsky said. “We’re growing this into other types of blood cancer, and this could be a really profound medicine for many patients.”
“Even if Lilly didn’t have our obesity drugs or our Alzheimer’s drugs,” he adds, “we’d still have one of the most exciting and fastest growing pipelines in the industry.”
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