'Seismic shift' as obesity overtakes cancer for R&D returns

In 2022, obesity contributed just 1% of the projected value of pharma industry pipeline, as calculated by Deloitte. Now, its share has rocketed to 25%, grouped around just a few drugs with the potential to be mega-blockbusters.

In the latest edition of Deloitte's annual report looking at the return on pharma innovation, the accounting giant says that the late-stage obesity pipeline in 2025 pushed cancer – which is estimated to account for around 20% of value – into second-place for the first time in 16 years.

Overall, the average internal rate of return (IRR) has improved for the third consecutive year, reaching 7% from 5.9% in 2024, but the report notes this is largely driven by a few programmes – mostly GLP-1 and GIP candidates and combinations for obesity, diabetes, and related conditions like heart and liver disease – and underlying productivity is "strained".

The concentration in mega-blockbusters is at an all-time high, with just 54 blockbuster assets, or around 9% of the late-stage pipeline, projected to generate approximately 70% of total risk-adjusted peak sales.

As might be expected, those assets have driven the predicted average forecast peak sales per asset to $598 million last year, compared to $510 million in 2024.

Deloitte says this is creating "a precarious balance of high potential returns and the risk of significant value destruction from a single programme failure."

For the companies developing those mega-blockbuster assets, that also introduces the risk of future shocks from tightening of pricing or market access – which is already evident in recent developments involving GLP-1 and GIP drugs in the US market under the Trump administration's Most-Favoured Nation (MFN) pricing drive – or other factors like increased competition, unexpected safety signals, or manufacturing supply constraints.

GLP-1-based assets are now forecast to account for an estimated 38% of projected commercial inflows from the 2025 late-stage pipeline, says the report.

"Organisations who succeed at bringing obesity assets to market will need to be highly sophisticated in terms of patient segmentation and targeting across reimbursed and direct-to-consumer markets," according to the report.

Meanwhile, costs keep rising, with the average cost to develop a drug from discovery to launch increased to $2.67 billion in 2025 from $2.23 billion in 2024, which Deloitte notes raises the bar for commercial success.

There is also evidence that developers are widening the net to find new therapies, as assets with a 'novel' mechanism of action rose sharply to 53% of total programmes in 2025 from 35% in 2024. And the well-established trend toward developing large-molecule, rather than small-molecule, medicines continues to accelerate.

The authors of the report recommend that developers evolve how they allocate capital, choose where to compete, and operationalise AI to build a resilient innovation engine and sustain value beyond the current GLP-1 wave.

Photo by Igor Omilaev on Unsplash