As J&J outlines bullish pipeline goals, neuroscience pipeline takes a starring role

Johnson & Johnson expects neuroscience to play a pivotal role in its newly-announced revenue goals, including two rising stars in adjunctive depression that are slated to rake in at least $1 billion each by 2030. 

The healthcare giant touted fresh revenue goals for its pharmaceuticals unit at a Tuesday Enterprise Business Review event. Executives showcase the rise of neuroscience R&D as a top priority. Two of those, seltorexant and aticaprant, are currently in phase 3 trials slated to read out next year. 

“We think within the context of aticaprant and seltorexant are two different mechanisms that target biology that is dysregulated in specific subtypes of patients,” said Bill Martin, Ph.D., J&J’s global therapeutic head of neuroscience in an interview with Fierce Biotech. “We think that’s the big breakthrough here.”

Seltorexant is slated for patients with major depressive disorder (MDD) and who suffer from insomnia, while aticaprant is focusing on patients with both MDD and anhedonia—the inability to feel pleasure. Seltorexant is also being tested as a treatment for patients with probable Alzheimer’s disease who have clinically-significant agitation or aggression.

Martin's comments are buoyed by the success of intranasal esketamine drug, Spravato, which is approved as an adjunctive depression treatment and is J&J's fastest-growing product by a country mile. Through the first nine months of the year, global Spravato revenue was $483 million, an 88.8% increase over the same period in 2022, according to third-quarter results from October. Second to that was prostate cancer drug Erleada, which grew 29.8% through the first nine months, bringing in $1.74 billion in sales. J&J expects aticaprant and seltorexant to each bring in $1-5 billion in revenue by 2030. 

J&J also plans to stake its claim in what is now a viable Alzheimer’s treatment market, with Eli Lilly expected to join Eisai and Biogen with an anti-amyloid antibody by the end of the year. J&J's hopes are pinned on an anti-tau monoclonal antibody, currently in phase 2 development, that Martin says will readout in the next two years. Tau, like amyloid, can be misfolded and stick to other misfolded tau proteins, contributing to Alzheimer’s disease.

Martin ultimately believes that the best treatment regimen would be a combination of anti-tau and anti-amyloid antibodies, but J&J will first prove that its anti-tau candidate has clinical benefit as a monotherapy. 

“Because there's not going to be a single pathogenic driver, the efficacy [of amyloid therapies] will likely only be enhanced by the presence of an anti-tau-based therapy,” he said. J&J is also working on a blood-based biomarker test that can index levels of amyloid and tau, a critical measurement that may open up patients to treatment before they exhibit cognitive decline.

The jury is out on how much business development will bolster the neuroscience pipeline in the near term. Martin doesn't think J&J needs deals “as an overall growth driver” but that it remains close to the community of neuroscience drug developers. One condition that Martin was explicitly wary of veering into was post-traumatic stress disorder, a condition that’s had a stagnant treatment paradigm for years but that’s now being targeted by psychedelic biotechs. 

“I'm not sure we understand PTSD that well,” he said. “When you think about what you're measuring when you're measuring improvement in PTSD, I think there's still progress to be made there.” Martin was also clear that J&J is not interested in partnership opportunities involving psychedelics. 

The neuroscience team’s preclinical work is focused on precision therapies, Martin says, relying in part on data from the U.K. Biobank, which last week announced it had sequencing data on 500,000 people. He said that research focuses on “new target identification and validation” manifesting from some of those data consortiums. 

“We're starting to see the fruits of that labor kind of be playing out,” Martin said.