Issue #191·

Merck just dropped $10B on a lung drug. The Keytruda clock is ticking.

Merck's $10 billion acquisition of Verona Pharma is the kind of deal that screams urgency: Keytruda's patent cliff is two years away, and the company just bet its respiratory future on a single COPD drug. Meanwhile, Novartis watched its own $12 billion acquisition stumble, a gene editor that doesn't cut DNA cured sickle cell, and Novo Nordisk gave Wegovy to first-graders. It's been a week.

Top Story Today

Merck Drops $10 Billion on a COPD Drug as Keytruda's Expiration Date Looms

Merck is paying $10 billion in cash for Verona Pharma and its COPD drug Ohtuvayre, a dual-mechanism inhaler that relaxes airways and fights inflammation simultaneously. The reason is simple math: Keytruda, which generated roughly $31.7 billion last year, starts losing patent protection in late 2028, with analysts projecting a 19% revenue drop in 2029 alone. Ohtuvayre is already FDA-approved and on the market, giving Merck something most of its recent acquisitions haven't: near-term revenue. Analysts project $3 to $4 billion in peak annual sales, though payer pushback on pricing could slow uptake.

Why it matters: This is Merck's clearest signal yet that it's preparing for life after Keytruda. Acquiring a commercial-stage respiratory asset (rather than another early-stage oncology bet) shows the company is prioritizing revenue diversification with real urgency as its biggest patent cliff approaches.

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Deals and M&A

Lilly Pays Up to $2.9 Billion for a Phase 1 Autoimmune Startup

Eli Lilly acquired Merida Biosciences for up to $2.875 billion, buying a platform that selectively destroys disease-causing antibodies instead of suppressing the whole immune system. The lead drug, MER511, targets Graves' disease and thyroid eye disease but hasn't finished Phase 1 testing yet. It's Lilly's tenth-plus deal of 2026, continuing an acquisition spree funded by GLP-1 profits.

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Novartis's $12 Billion RNA Bet Just Hit a Wall

The crown jewel of Novartis's $12 billion Avidity Biosciences acquisition missed its primary endpoint in Phase 3. Del-desiran failed to show benefit over placebo in myotonic dystrophy type 1, sending Novartis shares down roughly 12%. Analysts yanked $3 billion peak-sales estimates from their models.

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Moderna Raises $2.6 Billion to Go All In on Cancer Vaccines

Moderna closed a $2.6 billion convertible note offering at 0% interest, earmarking the cash for its oncology pipeline. The former COVID darling already has the first personalized cancer vaccine to clear a Phase 3 trial (in melanoma, with Merck), plus eight total oncology studies running across tumor types. Revenue has fallen from $6.8 billion in 2023 to $1.9 billion, making this pivot existential.

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Clinical Breakthroughs

The Deadliest Lung Cancer Just Met a Combo It Couldn't Shake

A bispecific T-cell engager paired with immunotherapy showed a survival benefit in extensive-stage small cell lung cancer for the first time ever. The Phase 3 DeLLphi-305 trial combined AstraZeneca's durvalumab with Amgen's tarlatamab as maintenance therapy, hitting both overall survival and progression-free survival endpoints. Earlier phase 1b data hinted at median survival of 25 months, roughly double the historical standard of 9-10 months.

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Novo Nordisk Gave Wegovy to Six-Year-Olds. 40% Were No Longer Obese.

In the STEP Young trial, 40.4% of children ages 6 to 11 on semaglutide were reclassified out of obesity after 68 weeks. The placebo rate: zero percent. It's the first strong efficacy data for any GLP-1 drug in elementary-age kids, a group with essentially no approved pharmacotherapy options today. Regulatory and insurance battles lie ahead, but the conversation about pediatric obesity treatment just changed.

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Science and Discovery

A Gene Editor That Doesn't Cut DNA Just Cured Sickle Cell Across Four Continents

Published in Cell Stem Cell, new results show CorrectSequence Therapeutics' base-editing therapy achieved 100% remission across sickle cell and beta-thalassemia patients from Nigeria, Laos, Malaysia, Pakistan, and China. Unlike first-generation CRISPR, base editing chemically converts a single DNA letter without cutting the double strand, potentially reducing the risk of genomic rearrangements. No off-target edits were detected.

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