Episode 195 - September 11, 2026

What It Covers

Biotech Hangout Episode 195 covers a turbulent week for biotech markets driven by oil-price inflation and rising Treasury yields, alongside major FDA leadership confirmations, Novartis's dual Phase 3 failures in LP(a) reduction and DM1, positive Phase 2 data from Roivant in pulmonary hypertension, and emerging oral amylin weight-loss data from Structured Therapeutics.

Key Questions Answered

• •FDA Stabilization Signal: The permanent appointments of Michael Davis at CDER and Kareem Mikhail at CBER mark a shift toward regulatory predictability after five CDER director turnovers since 2025. Mikhail has explicitly framed his role as a "conductor" rather than a unilateral decision-maker, signaling a return to scientific consensus-driven approvals. Biotech investors should monitor Davis's stance on compounded GLP-1s and psychedelics as near-term policy indicators.
• •LP(a) Cardiovascular Thesis Weakens: Novartis's Horizon trial, enrolling ~8,000 patients with average LDL of 60–65, produced a fully negative outcome for pelicarcen despite 80% LP(a) reduction. The failure pattern—slower-than-modeled event rates—mirrors early signals in Amgen's ongoing LP(a) trial. Investors tracking Amgen and Lilly's LP(a) programs should treat mismodeled event pacing as a leading indicator of likely trial failure, not a neutral operational footnote.
• •DM1 Modality Risk—ASO vs. siRNA: Novartis's Avidity-derived siRNA drug failed its Phase 3 VHOT endpoint in DM1, raising questions about whether cytoplasmic siRNA mechanisms can effectively silence nuclear-retained DMPK RNA. Dyne Therapeutics' ASO approach shows ~25% placebo-adjusted CASI-22 splice correction, a mechanistically more appropriate modality for nuclear targets. Expansion cohort data from Dyne arrives early next year and now carries higher strategic significance.
• •Large-Cap M&A Pricing Risk: Novartis's $12B Avidity acquisition, which modeled ~$6B peak sales, is now facing activist pressure from Artisan Partners demanding board restructuring and compensation reform. Analysis shows large-cap pharma deals routinely inflate revenue projections in SEC filings to justify multiples. A portfolio strategy of six smaller, earlier-stage acquisitions targeting ~35–40% probability of success outperforms single high-conviction late-stage bets priced at near-certainty multiples.
• •Roivant's PHILD Phase 2 Outperformance: Roivant's inhaled soluble guanylate cyclase agonist (in-licensed from Bayer) achieved a 56% pulmonary vascular resistance reduction and 36-meter six-minute walk improvement at 16 weeks, reaching ~50 meters by 48 weeks in PHILD patients. Phase 3 was already enrolling at data release. With low cough burden versus competitor Tyvaso and a ~$2.5B addressable market at modest penetration, the program represents a concrete execution benchmark for rare pulmonary disease development timelines.
• •Biotech Rate Sensitivity—Threshold Matters: XBI declined ~3% during a week where Brent crude exceeded $108/barrel and 10-year Treasuries approached 5%, driven by US-Iran conflict. Rate sensitivity in biotech is not linear—25-basis-point moves have minimal sector impact, but multi-hundred-basis-point escalation cycles (as seen in 2022–2023) compress valuations structurally. Investors should track Fed funds trajectory over 12-month windows, not individual meeting decisions, as the relevant macro signal for biotech allocation.