Ep. 353 - Prasad Departure and Future of Fibrosis Therapies

What It Covers

BioCentury This Week examines Vinay Prasad's second FDA departure and its structural implications for CBER leadership, the expanding phase two fibrosis pipeline targeting IPF with over 20 programs across novel mechanisms, plus clinical setbacks for psychedelic GAD therapy and Novo Nordisk's Cagrisema head-to-head obesity trial against Lilly's tirzepatide.

Key Questions Answered

• •FDA Leadership Risk: When one or two individuals centralize drug approval decisions outside established review team structures, the entire regulatory system becomes vulnerable to political interference. Biotech investors and companies should monitor not just who replaces Prasad at CBER, but whether the successor restores multi-reviewer consensus processes or continues single-decision-maker precedent set under McCarrie.
• •IPF Pipeline Timing: With over 20 programs in phase two targeting IPF across mostly first-in-class mechanisms, a wave of proof-of-concept data is approaching. Companies are shifting strategy downstream in the fibrotic cascade to improve therapeutic index, avoiding broad pathway suppression that disrupts normal wound healing — a key lesson from prior phase three failures in this indication.
• •Fibrosis Reversal Signal: Evidence from MASH liver fibrosis trials showing partial reversal has re-energized the broader antifibrotic field. Boehringer's December approval of nerandomilast marks the first new IPF drug in a decade. Investors should track whether downstream pathway targeting or novel modalities beyond small molecules can replicate liver fibrosis reversal results in pulmonary settings.
• •Psychedelic Trial Design Flaw: Siebert Hellas reported 67% remission at six months for DMT compound in treatment-resistant generalized anxiety disorder, yet shares fell 34%. The collapse stemmed from pooling two dose groups that performed identically, eliminating dose-response evidence and raising expectation-bias concerns. Future psychedelic trials require placebo arms or validated active comparators to produce credible efficacy signals.
• •Amylin Tolerability Differentiation: Zealand Pharma's petrelintide showed placebo-adjusted 9% weight loss at 42 weeks — roughly half of Lilly's oleoylethanolamide benchmark — but reported near-zero vomiting, diarrhea, and constipation, with treatment discontinuation rates lower than placebo. Given that roughly 80% of GLP-1 patients discontinue within one year due to GI side effects, tolerability-optimized amylins may capture a durable second-line market position.