Biogen at Morgan Stanley Conference: Strategic Shift in Focus

On Monday, 08 September 2025, Biogen Inc. (NASDAQ:BIIB) participated in the Morgan Stanley 23rd Annual Global Healthcare Conference. CEO Chris Viehbacher outlined a strategic pivot focusing on immunology and rare diseases while addressing challenges such as the decline in the MS portfolio. The discussion highlighted both growth opportunities and potential obstacles, including policy impacts and competition.

Key Takeaways

• Biogen is shifting its focus towards immunology and rare diseases to offset the decline in its MS portfolio.
• The launch of LEQEMBI, an Alzheimer’s drug, faces challenges due to systemic changes in neurology practices.
• Biogen is preparing for patent expiries between 2035 and 2040 by investing in research and pipeline development.
• 54% of Biogen’s revenue comes from outside the U.S., providing some protection from tariffs.
• The company is actively pursuing business development and innovation, particularly around GLP talks.

Operational Updates

Biogen’s CEO emphasized the company’s strategic pivot towards immunology and rare diseases. This shift is aimed at countering the declining MS portfolio and ensuring long-term growth. The company is also focusing on research and pipeline development to prepare for patent expiries expected between 2035 and 2040.

The launch of LEQEMBI, an Alzheimer’s drug, was described as slow due to the increased diagnostic requirements and the need for infusion beds. Biogen is working on strategies to improve patient throughput, including a subcutaneous formulation and direct-to-consumer campaigns.

Future Outlook

Biogen is optimistic about its future, with a focus on strategic investments and pipeline development. The company expects to leverage its strengths and explore new opportunities in the evolving healthcare landscape. Biogen is also preparing for potential policy impacts, particularly regarding tariffs and Medicaid patient decline after 2027-2028.

The Alzheimer’s market is expected to grow, with Biogen and Lilly both contributing to an expanding prescriber base. Biogen anticipates a comparable market share of 50/50 in the long run despite new competitors entering the market.

Policy & Strategy

Biogen’s global revenue footprint provides some protection from tariffs, with 54% of revenue generated outside the U.S. The company is also considering the location of product manufacturing as part of its business development strategy.

China presents both a competitive threat and a business development opportunity. Biogen is disciplined in capital allocation and is exploring mergers and acquisitions as stock market valuations decline.

LEQEMBI and Alzheimer’s Market

The LEQEMBI launch faces challenges due to shifts in neurology practices. Blood-based diagnostics are expected to drive earlier referrals to neurologists, with meaningful uptake anticipated in 6 to 9 months.

The subcutaneous formulation of LEQEMBI, approved in August, aims to reduce the workload on neurologists. Biogen is conducting pre-symptomatic trials, with results from the HEAD 345 trial expected in 2028, to demonstrate the benefits of early intervention in Alzheimer’s.

Biogen believes that stabilizing 70% of patients with low tau levels after six months of treatment is achievable, with 60% of patients experiencing some benefit.

The company is confident in maintaining treatment adherence due to an FDA-approved maintenance indication and the availability of a subcutaneous form.

It can take several years for patients to be referred to a neurologist after initial memory loss complaints, highlighting the importance of improved diagnostic pathways.

To read the full transcript of the conference call, please refer to the document below.

Full transcript - Morgan Stanley 23rd Annual Global Healthcare Conference:

Terence Flynn, U.S. Biopharma Analyst, Morgan Stanley: Great. Good morning, everybody. Thanks for joining us. I’m Terence Flynn, Morgan Stanley’s U.S. Biopharma Analyst. Very pleased to be hosting Biogen this morning. We have Chris Viehbacher, the company’s CEO. Before we get started, for important disclosures, please see the Morgan Stanley research disclosure website at www.morganstanley.com/researchdisclosures. If you have any questions, please reach out to your Morgan Stanley sales representative. Chris, thanks so much for joining us this morning.

Chris Viehbacher, CEO, Biogen: It’s great to be with you, Terence.

Terence Flynn, U.S. Biopharma Analyst, Morgan Stanley: Absolutely. Maybe I’ll turn it over to you to kick off with some prepared remarks, and then we’ll go into questions.

Chris Viehbacher, CEO, Biogen: I’ll just say, you know, we’ve been on a journey the last two and a half years with Biogen. It’s pretty common in our industry, as you well know, that the more successful you are, the more likely it is you’re going to have a problem, right? Because we are in an unstable industry living by the life of our patents. You know, Biogen’s MS portfolio of really great drugs has been slowly declining. The relay of growth that we thought was going to be there with LEQEMBI has proven to be slower. That meant that we really had to reinvent the company to a great degree. We’ve done a number of things. One is we took a major risk in some ways of pulling all the promotion from our MS portfolio. That actually did not affect the actual sales trajectory.

That gave us a lot of ammunition to go invest in new product launches. We’ve been doing some business development. One of the issues the company had been we were so focused on neurology. Neurology is an exciting area, but it’s also a very difficult and risky area. You know, we couldn’t move too far because of where I think Biogen’s capabilities lie, but we have been pushing more into immunology and rare diseases, building out our pipeline, building out our commercial portfolio. I’m actually feeling very good about where the company is today. I think we’ve been through a lot of change, but the culture of the company is intact. We’ve been hitting our marks on our pipeline so far. We’ve got an awful lot of data catalysts coming starting next year.

As I look out, I’d say, unlike a lot of companies, we’ve kind of got our pipeline more than capable of offsetting the erosion of our existing business. Most of our patent expires are in the rearview mirror. I think Biogen is starting to be positioned for a period of long-term sustained growth.

Terence Flynn, U.S. Biopharma Analyst, Morgan Stanley: Great. I think we’re going to get into a lot of those points. Thanks for framing that. I guess the first one I wanted to do a check on is just the policy dynamic. Obviously, that’s been an overhang, not just for Biogen, but the whole sector right now with respect to both tariffs and MFN. Any update that you can share from your interactions with, you know, DC policymakers and where we stand in this whole dynamic right now?

Chris Viehbacher, CEO, Biogen: Yeah, I think every one of us in the industry is spending a whole lot more time on thinking about the dynamics in Washington. I would say, though, from a Biogen perspective, we’re a little bit sheltered from some of that, and that’s largely because of our product portfolio. In terms of tariffs, for example, 54% of our revenue is actually outside the U.S., and in the rare disease space where we are predominantly positioned, you can’t really take significant price reductions in other countries and make any business because there’s just not enough patients. That was one of the things I saw years ago when I was at Sanofi and we acquired Genzyme. You can actually get decent pricing in Latin America and Asia, and that’s how we also do 54% of our revenue, by the way, outside the U.S., is that we actually have that.

From an MFN point of view, we’re not as exposed either. I think where we are, we feel relatively protected from what’s going on in the environment. That said, it is a serious point in time for the industry. I remember we thought the sky was falling in when Medicare Part D came in, and we thought the sky was falling in again when the Affordable Care Act came in. Both of those ended up not being detrimental to our business because it was a volume offset. The Affordable Care Act expanded Medicaid coverage, for example, and while we paid an awful lot of excise taxes and there were some other things, the business actually flourished.

Here, we’re going to see actually a volume decrease, right, because the number of Medicaid patients is expected to decline after 2027, 2028, and we’re not necessarily seeing any expansion of coverage out of things like MFN or tariffs. This is probably a more challenging period, certainly, than what we’ve witnessed in the past.

Terence Flynn, U.S. Biopharma Analyst, Morgan Stanley: To the extent, I mean, this is always difficult. It’s one of those crystal ball questions in terms of timeline that you’re expecting or when we might know more from a visibility standpoint. Is this like by the next weeks? Is this by year end? Is it going to linger? You know.

Chris Viehbacher, CEO, Biogen: I think this month will certainly be one to watch. There’s the government needs to be funded, and we have to be careful in that. I think under the IRA, the next batch of products is going to be announced. The 60-day period of those companies that receive the letters will come this month. One of the things we do see is that MFN is not a simple task, though. Tariffs, yes, but the administration is also extremely concerned around the security of drug supply chains. As an industry, we have put hundreds of billions of dollars on the table of new investment in the U.S. I think there’s still enough moving parts here, and we certainly know that there are a lot of people, for instance, in Congress who are very concerned around the competitiveness of the innovative biotechnology industry, particularly seeing the rise in power of China.

I wouldn’t say it’s all negative. There’s a lot of maneuvering that has to happen, but I would say, generally, we’re engaged as an industry, and I’m still optimistic that we will be able to preserve our competitiveness.

Terence Flynn, U.S. Biopharma Analyst, Morgan Stanley: Okay, great. Maybe just sticking on the strategy front here, you mentioned business development. You guys have been, I’d say, kind of moderately active. Just as you think about the opportunity set, it was interesting how you talked about our rare disease in the context of MFN, but maybe through the evolving policy dynamic, does that change the opportunity set of the types of assets that you guys are looking at now, given some of those cross-currents we were just talking about?

Chris Viehbacher, CEO, Biogen: One of the things you certainly start to look at when you look at business development is where’s the product made? You know, there’s a lot of places that have gone to China, for example, and you have to start thinking about, okay, we need to repatriate the manufacturing. The likelihood is that we’re not going to completely escape tariffs. There will be some tariff environment somewhere. We don’t know what it is or what it looks like. One of the things you have to do is start to say, okay, what’s the cost and what’s the timeline for bringing something back? One of the things about business development that is also not clear is what happens when Company A owns the rights in the U.S. and Company B owns the rights in the rest of the world?

In those types of agreements, you typically have anti-class clauses that actually prevent Company A from influencing the price of Company B. I think that is something that the industry is thinking about. We have zero clarity on that today. That could also influence how business development deals get struck.

Terence Flynn, U.S. Biopharma Analyst, Morgan Stanley: The implication there would be that a company would want worldwide rights as opposed to doing some split because you need to control global pricing?

Chris Viehbacher, CEO, Biogen: The question is if you have a company that has the, you know, if you take, we did an ex-U.S. rights with Stoke. Stoke retained the rights in the U.S. Biogen has those rights ex-U.S. Biogen cannot, and Stoke cannot influence us as to what price we pick in Europe, for example. Then would Stoke have to pay attention to that from an MFN point of view because it would hardly be fair to hold Stoke accountable for Biogen’s pricing in Europe. You might actually see more of those split rights to avoid the MFN problem. That is very difficult to say today. I mean, those are things that we are thinking about. All it really illustrates is that for every rule that comes along, there is going to be an impact somewhere.

There may be options for us to try to ameliorate the situation, which again comes back to this is an industry that has constantly faced an awful lot of challenge. Somehow, I think we’ve demonstrated resilience in all that. The uncertainty right now is certainly extremely high.

Terence Flynn, U.S. Biopharma Analyst, Morgan Stanley: You mentioned competition from China, but there’s also the kind of opportunity set to do business development deals there. We’ve seen a number of companies in the sector do that. As you think about weighing the opportunity versus the competition lens, how do you think about those two aspects vis-à-vis your business?

Chris Viehbacher, CEO, Biogen: I think if we do this right, there’s clearly going to be caution around data sharing, for example, respect for intellectual property. If we do get all of that right and everybody plays by the rules, net-net, this could be a positive for the industry because there’s greater sources of innovation. At the moment, it seems most of the Chinese companies are not really ready to go global, so there are ex-China rights available. You have to do your diligence about the companies and where they did their data. We’ve seen it’s not so simple to translate. Summit this morning, suddenly, everybody thought, okay, this is a better cake true, but when you actually go to replicate the data, it doesn’t always work out. I think net-net, there could be a bigger source of business development substrate if you add China in there.

Terence Flynn, U.S. Biopharma Analyst, Morgan Stanley: How should we think about over the next kind of 12 months in terms of your level of activity? Is this something you still see as a priority, or do you feel like you have enough internally right now and you’re kind of executing on these opportunities, and then it’s more kind of medium-term when we should expect more activity from you guys?

Chris Viehbacher, CEO, Biogen: BD is still a priority. One of the things I’ve seen over my years is that really at Senior Management, we have not spent enough time personally and individually in research. Research is really where you’re building your company. We tend to leave that to a Head of R&D. What we do is we end up spending a lot of money on R&D, and then we have to go do a lot of expensive acquisitions because the R&D didn’t develop. I think from a capital efficiency point of view, but I would also argue from a capability point of view, bringing in innovations at around GLP talks would be the ideal thing. One of the things I’m focused on is really making sure we have enough of a research pipeline because I see a period of strong growth coming for Biogen.

The time to prepare for patent expiry in 2035 to 2040 is now. I take personal, I’m not a scientist. I know enough to be dangerous. I’m really focused on do we have enough in research that will carry this company through into the 2040s and 2050s and doing that today. That’s priority number one. Priority number two is, I mean, we are balancing the growth of the new products versus the decline of our existing portfolio in MS. If we could find a business development deal that’s pretty close to commercialization, we would do it. You look at the stock market valuations and you say this should be an M&A paradise. All the valuations are down. What you do find is actually good companies are actually getting funded. It’s the good companies you want to buy. It’s not so easy to buy at those levels.

The good news is that where we are today, I don’t feel any desperation to do a deal. It’s always incumbent upon management, I think, to use your capital and see if you can do something that creates shareholder value. We are very disciplined in how we look at that.

Terence Flynn, U.S. Biopharma Analyst, Morgan Stanley: Yeah. Okay, great. Maybe we’ll move on to one of the key launch products in LEQEMBI. As you said, it was a bit of a slow start, but there are some inflection points that you guys have talked about. One of those is the subcutaneous formulation, which you recently got approval at the end of August here. Maybe just as you look out through the back half of this year into 2026, how confident are you about the forward trajectory here in the product and it being one of the key growth drivers for the company?

Chris Viehbacher, CEO, Biogen: I think all-time is probably the single biggest opportunity for Biogen, still. This was a highly unusual launch, I have to say. I’ve been in this business for 35 years. I’ve seen product launches in just about every therapeutic category there is. This launch was a slow start, not because of the product and not because of demand. This was a dramatic shift in the practice of neurology. It entailed a huge amount of work for the neurologist. The neurologist was already a busy practice. Now you’re suddenly putting thousands of Alzheimer’s patients where they need a PET scan or a lumbar puncture to get the validation of the diagnosis. I need to go now find infusion beds.

In some cases, hospitals are requiring the neurology department to do a business case about why we should make those infusion beds available to an Alzheimer’s patient versus a cancer patient, for example. Most neurologists have not had to do business cases before. Suddenly thinking about adding staff. If you’re in an IDN, a lot of those IDNs are pretty stressed financially because of the rise in salaries post-COVID. Some of the hospitals tell us it took 90 days to get approval to hire a nurse who could take care of a lot of this work. This has been a massive shift in how neurology is practiced. We also have roughly 500,000 newly diagnosed patients every year, and there are 13,000 neurologists. It’s taken quite a long time for people to get an appointment. The other problem is that these drugs work best if you can catch people early enough.

It’s a neurodegenerative disease. Nobody knows how to bring neurons back to life. The best time is before too many neurons have died. Right now, that’s MCI. I think by the end of this decade, we’re going to see this whole market shift to pre-symptomatic patients. Today, it’s MCI. Unfortunately, about half of the patients that finally get in to see a neurologist are too advanced in their disease to be treated. A lot of the things that we have been doing are trying to improve the productivity of this neurologist. If you can get one of these precious neurology appointments, how do we get now as many patients through that neurologist as possible? That means, how do we make that easier for the neurologist? One is, can we get rid of the PET scan and the lumbar puncture?

Now we’ve seen the blood-based diagnostic has been approved by the FDA. It’s not that neurologists are going to abandon PET scans from one day to the next. Neurologists like these scans. It’s how they look in the brain, and they’ve been using them for generations. I think over time that they will shift more to blood-based diagnostics instead of PET scans. The next are the infusion beds. We now have had the approval for the subcutaneous formulation. Once the patient has finished the 18-month initiation period, they can actually take a pen once a week at home. That eliminates the need for those patients to have infusion beds. We got that approved on a Friday, and on the Monday, we initiated the rolling submission for the initiation period.

Over time, I think you’ll be able to see physicians switching from, again, infusion beds even during that 18-month period to at-home use of pens. We still have the MRIs. Probably in the early days, we may see some patients staying on infusions if they’re in an urban setting because neurologists like to have the MRI done when they’re coming in from infusions. I think this will greatly alleviate a lot of the workload at the neurology level. We’ve initiated a DTC campaign, and I think we’re seeing already a strong resonance from that. All of these confluence of things, we already saw a nice increase. We were above market expectations in Q2 on LEQEMBI. I think we’re now seeing that this market is opening up and we’re gaining momentum here.

Terence Flynn, U.S. Biopharma Analyst, Morgan Stanley: Maybe on the neurologist side, are there any programs that you guys are working on to help increase that number, or do you think 13,000 is ultimately where we’re going to stand and it’s more some of the other steps that you’ve taken, or is there a way to actually boost that number so then that also helps alleviate some of this bottleneck?

Chris Viehbacher, CEO, Biogen: You know, we’re facing shortages in a lot of specialties, particularly post-COVID. I mean, we see this actually in postpartum depression as well. We’re probably missing thousands of OBGYNs versus what we need. I’m not sure that we’re going to be able to increase the population anytime soon. What we can do, again, is how do we get more patient throughput? We are looking at doing a PCP pilot. Because of the blood-based diagnostic, perhaps we can actually get that referral to the neurologist earlier. Right now, a patient starts to have some memory loss and some signs of dementia. Is that just normal aging, or is that something else? It can take three or four years between the patient starting to complain about some memory loss and the actual referral to a neurologist. You can ask people at LabCorp and Quest.

They’re starting to be selling a lot more of these Alzheimer’s diagnostics. I think we bought some data that suggests in the last year alone, 300,000 of these tests have been sold. The idea would be if you could get that referral earlier, because now I have a diagnostic. I don’t know how much amyloid plaque I have, but I have some presence. The primary care might say, you know, now’s maybe the time to actually go see the neurologist and therefore increase the yield of patients who are eligible for treatment, who actually get one of these appointments.

Terence Flynn, U.S. Biopharma Analyst, Morgan Stanley: Yeah. Where are we in terms of commercial coverage of the blood-based diagnostics? I know that’s something that you guys have been working on, but in terms of actually getting insurance coverage for those?

Chris Viehbacher, CEO, Biogen: I think once you get, you know, you can sell the diagnostic if you have a clear lab, essentially. You don’t need an FDA approval, but you’re not really going to get uptake or reimbursement until you get that. We have been talking to a lot of the diagnostics companies, and clearly, we are talking to our physicians about the availability of that. Again, the neurologist is a cautious physician. I think it’ll take probably six to nine months to get meaningful uptake of a blood-based diagnostic. It’s starting to, I think they’re starting to get confidence that they could maybe dispense with the PET scan. I think the payers might drive that. It’s about $5,000 for a PET scan. Last I heard, I think the Alzheimer’s test is available for under $1,000. As I look at 2026, we see a confluence of favorable factors here.

You’ve got the subcutaneous for maintenance. You should have the subcutaneous sometime in the middle of next year for initiation. You’ve got an increased investment in direct-to-consumer advertising. I think a lot of the physicians are now starting to understand ARIA and believe that that is manageable. If you can get now these earlier stage patients, I think Lilly is potentially going to present a first study in pre-symptomatic. The odds are that you’re going to see much higher rates of CDR, some of the boxes benefits, although that’s not their endpoint. You’ll start to see better rates of efficacy. We have this landmark study, we and our partner Eisai, called the HEAD 345. That will be a truly pre-symptomatic patient, people with very low levels of amyloid plaque. We believe that Lilly’s study is actually really just pre-MCI patients. Important, though, because I think that’ll benefit the whole field.

It turns out that if you have plaque at less than 40 centiloids, and we have the HEAD 3 study looking at that, it seems that at 40 centiloids of plaque, that’s where you trigger tau, tau production. The tau overproduction is almost independent of your level of amyloid after that. There the promise is, and you know that we still have to wait several years for that, you could actually potentially prevent Alzheimer’s. Certainly, again, if you can catch people earlier, because people are building plaques and losing neurons years before they actually demonstrate symptoms. We’re very excited about Alzheimer’s just because there’s now so much data, there’s new modalities coming along, you’ve got the diagnostics, and there are a lot of patients who could really benefit from treatment.

Terence Flynn, U.S. Biopharma Analyst, Morgan Stanley: Yeah. I just want to circle back on one question, just on the market dynamics. It does look like on the prescription data that Lilly’s been making a bigger push on market share recently. It sounds like it’s more about growing the total market here, and that’s what we should be focused on as we go into 2026. Can you just talk through those dynamics in terms of share, and then also rate of growth for next year relative to this year for the market?

Chris Viehbacher, CEO, Biogen: You know, we always talk about molecules, but most of us in business are talking about people because it’s people who are operating our business, and it’s people who are prescribing, and it’s people who are patients. If you’re a sales rep from Lilly, where’s the first place you’re going to go? You’re going to go where Biogen and Eisai have actually already created the care pathways and opened up those. That was logical that they were going to go and look for share. The real prize is growing the prescriber base and growing the benefit of that drug. In the second quarter, I think we saw market growth occurring from the efforts of both companies, which is what we’ve always believed. We’ve always believed that it was beneficial to have Lilly out there in the marketplace.

Every single market that has been created always grows faster when you have multiple players.

Terence Flynn, U.S. Biopharma Analyst, Morgan Stanley: We should expect market growth above what we saw in 2025 if we think about 2026 high level.

Chris Viehbacher, CEO, Biogen: That’s what we’re hoping.

Terence Flynn, U.S. Biopharma Analyst, Morgan Stanley: Do you think you can deliver at least comparable market share? You think this shakes out roughly 50? I don’t know if I can give specific guidance, but is there any reason to think this would be different than a 50/50 split over time?

Chris Viehbacher, CEO, Biogen: I don’t think so. I don’t see why. I mean, on the one hand, Lilly offers the once-a-month dosing, and they tried to present this as kind of a one-treatment cycle and done. At the same time, Biogen and Eisai have demonstrated that, four years after starting treatment, you’re still doing better. We have a maintenance indication approved by the FDA, and we have a subcutaneous form. Why would you stop treating? Donanemab can’t have a maintenance indication. That is playing out there in that way. There are more patients out there than either company is dealing with today. We’re not so focused on LEQEMBI versus donanemab. It’s really around how do we establish this marketplace and get more patients benefiting from these treatments.

Terence Flynn, U.S. Biopharma Analyst, Morgan Stanley: Okay. I want to come to the pre-symptomatic setting. First, Novo is going to have some data from their oral Sema evoke trials. I think there’s some debate in terms of, is that an opportunity for the A-beta? Is it a competitive threat? Does it increase the total pool of people that are going to be coming onto therapy? We’d just love your kind of latest thoughts on when we do see this data, what it means for the market in the event, let’s say that’s positive data.

Chris Viehbacher, CEO, Biogen: Yeah, and it’s hard to know whether it’s going to be positive when talking to an awful lot of experts. You know, there’s some plausibility why it might work, whether it’s, we know that obesity is a risk factor for Alzheimer’s. If you’re reducing that, second is there seems to be potentially some impact on neuroinflammation. We’ll have to wait and see the data. I mean, the GLP-1s, other people have said, do you really want to give those to elderly people because of the risk of muscle loss? I think net-net, it will be a positive because in all likelihood, they will be, they’re not going to be used instead of disease-modifying treatments, but alongside them. You might actually see a lot more patients in primary care starting to get diagnosed because these would be available to primary care physicians.

Then you’re getting a bigger population of early-stage diagnosis and that they continue to progress and they end up in the neurologists and on A-beta. I think I could see a synergistic benefit out of that.

Terence Flynn, U.S. Biopharma Analyst, Morgan Stanley: Okay. You talked to this a little bit, but the preclinical setting, I think there’s a growing focus on that opportunity here. As you alluded to, you’re running the HEAD 345 trial. Lilly has a Trailblazer ALZ 3 study. As we start to think about doing cross-trial comparisons, maybe just talk to us about why you chose the design that you guys chose and why you’re confident that that’s the right approach here. When we see the Lilly study, how much read across is there from that trial to your program?

Chris Viehbacher, CEO, Biogen: One of the things about these neurodegenerative diseases is that they take so long, right? I mean, this HEAD 345 study, we started recruiting in 2020, and we expect to have results in 2028. That’s the scope of the investment that you need to do in this space. We do believe that will be a landmark study. We believe that Lilly’s study is more with patients of higher amyloid burden because that’s where their drug has benefited, and so they’re really kind of pre-MCI patients. Now, again, they’ll be earlier, and every bit of evidence that we have seen suggests that earlier is better. We demonstrated already with LEQEMBI that if you get people with very low levels of tau, so very early patients, now when you look at it, after six months of treatment, you have 70% of patients who have shown no further decline.

You have stabilized those patients, and that is huge, by the way. If you’re an Alzheimer’s patient, you’re a caregiver of an Alzheimer’s patient, not seeing further decline is amazing. This pulls the doors off the 27% CDR sum of boxes because that was in a different patient problem. Now you talk about, okay, we can see a lot, and 60%, 60% actually see some benefit. That sort of suggests that the neurons are not just alive or dead, but perhaps in a stress-type time frame status that they can actually recover if you reduce the pressure that’s being caused by the plaques. We do believe that Lilly should be able to demonstrate also very strong data in these earlier patients.

However, their endpoint is really a time-to-event, and what you’re really going to want to know is, is it worthwhile to treat a patient who is otherwise healthy, has no symptoms of Alzheimer’s? We don’t yet know what the risk of ARIA is in these patient populations, and that’s where I think the Eisai Biogen study is going to be so important because we are looking at those early-stage, low levels of plaque. What is the impact on CDR sum of boxes? What is the impact on cognition? You’re talking about someone who’s maybe 60, early 60s. They’ve had a blood test, it’s positive. PET scan says, I don’t know, 50 centiloids. Do I wait until I get to 70, 80 to treat them, or should I treat already at 50?

I think payers are going to want to see that because that’s not an inconsequential investment, and staying on the drug then for quite a long time and hopefully maybe never getting Alzheimer’s or certainly much later than they otherwise would have. That is where the real promise is, really getting patients as early as you can and preserving as many neurons as you can. When people talk about efficacy, these drugs are highly efficacious. We get rid of all the plaque, both donanemab and lecanemab. The issue is that you’re dealing with an upstream effect on the neurons, so your reservoir of neurons is really what’s going to depend on how healthy you are. We can stop the destruction of neurons, but we can’t bring them back.

The logic of doing these studies, and that has to be borne out obviously by the evidence of the trials, is that if you can intervene before you’ve lost too many neurons, you will do much better. That is the goal of the study.

Terence Flynn, U.S. Biopharma Analyst, Morgan Stanley: Is it possible that we see any data from you guys before 2028?

Chris Viehbacher, CEO, Biogen: We don’t think so, largely because you do want to follow all of these patients through and show the benefit of cognition. Remember, you’re dealing with asymptomatic patients, so you have to wait for them to progress. You don’t want to take a chance of looking at that too early and not see the benefit on cognition.

Terence Flynn, U.S. Biopharma Analyst, Morgan Stanley: All right, Chris, I think we’re up against time, but always a pleasure. Thank you so much.

Chris Viehbacher, CEO, Biogen: Thank you. It’s great to be with you.

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