At Nordic Life Science Days (NLSDays), leading pharmaceutical executives from Novo Nordisk, AstraZeneca, and Roche convened to discuss the evolving landscape of cardiovascular, renal, and metabolic (CVRM) drug development. The “Transforming CVRM Health” panel revealed that despite clinical successes with GLP-1 medications, access challenges and high discontinuation rates are reshaping both drug discovery methodologies and manufacturing priorities across the CVRM space.
Discontinuation Crisis Signals Manufacturing Imperative
High discontinuation rates for GLP-1 medications have emerged as an industry challenge, with cost and access ranking as the primary barriers according to physician surveys. Key findings presented at the session:
- Physicians consistently cite cost and lack of access as the top reasons patients discontinue GLP-1 therapy
- Access issues affect both initial patient onboarding and continuation
Lotte Newson, Chief Scientific Advisor at Novo Nordisk, emphasized that despite two decades of investment in obesity treatments and a century-long history in diabetes, “the number of people who actually are treated adequately is relatively low.”
Oral Formulations Emerge as Access Solution
Regina Fritsche Danielson, Senior Vice President and Global Head of CVRM R&D at AstraZeneca, outlined a strategic pivot toward oral formulations as a pathway to democratizing access. This manufacturing shift addresses multiple barriers simultaneously:
- Cost reduction: Oral formulations typically offer lower manufacturing costs than injectables
- Distribution efficiency: Easier storage and distribution requirements reduce supply chain complexity
- Patient compliance: Simplified administration may improve adherence rates
- Market access: Lower price points facilitate broader insurance coverage and market penetration
“We’re putting a lot of effort into developing oral alternatives to injectable drugs,” Regina explained. “If we can create more affordable options that are easier to store and distribute—and then combine them with other small molecules that address related complications—that, I believe, is the real strength of AstraZeneca’s strategy.”
Data-Driven Discovery Reshapes Early Development
A recurring theme emphasized the importance of human data over traditional animal models in target selection and pathway validation. Lotte highlighted key lessons from GLP-1 development experience:
Target selection requires pathway understanding first.
Lotte warned against committing to specific molecular targets before validating the broader biological pathway: “Do not fall in love with your target too early,” without understanding the full pathway. She explained that choosing the wrong target leads to negative clinical data, and “it’s really difficult to start over again” after such failures, making upfront pathway validation essential.
Animal models often misrepresent disease timing.
Preclinical studies typically use young animals, which don’t reflect the older populations affected by cardiometabolic conditions. “Most scientists use baby animals—or teenagers,” Lotte said. “To model adult disease, they need to be at least one year old.”
Human genetic data de-risks drug development.
Lotte’s team now mines clinical trial datasets using deep omics, biobanks, and real-world evidence to generate new hypotheses. “It’s never been a better time to use human data for idea generation,” she said. This human-first strategy validates targets in real pathophysiology before major investment—reducing the risk of preclinical findings failing to translate.
Precision Medicine and Patient Segmentation
The panel concluded that despite innovations in GLP-1s and emerging therapies, significant patient sub-segments with high unmet needs remain underserved. Future development and manufacturing strategies must account for:
- Precision approaches: Targeting specific patient populations with tailored therapies
- Fibrosis interventions: Addressing common pathological endpoints across CVRM conditions
- Insulin sensitization: Safe approaches complementary to existing treatments
- Anti-inflammatory mechanisms: Leveraging the 50% CRP reduction seen with GLP-1s
