Muscle-preserving drugs could generate over $30 billion in sales by 2035, TD Cowen says

TD Cowen projects that muscle-preserving drugs, used in conjunction with GLP-1 obesity treatments like Eli Lilly's Zepbound and Novo Nordisk's Wegovy, could generate over $30 billion in sales by 2035. This forecast follows promising mid-stage results from Regeneron and Scholar Rock, with investors closely monitoring Lilly's bimagrumab data; the first treatment could launch by 2028, contingent on demonstrating additional health benefits to secure regulatory approval. Concerns about muscle loss associated with GLP-1 drugs are driving the development of these therapies, with analysts estimating obesity drug sales could reach $150 billion annually by the early 2030s.

Analysis

A significant ancillary market is emerging from the rapid growth of GLP-1 obesity treatments, with TD Cowen forecasting that muscle-preserving therapies could generate over $30 billion in sales by 2035. This opportunity is driven by the need to counteract muscle loss, a noted side effect of highly successful drugs like Eli Lilly's Zepbound and Novo Nordisk's Wegovy, which themselves are projected to create a $150 billion market by the early 2030s. The field is gaining momentum, evidenced by promising mid-stage data from companies like Regeneron (REGN) and Scholar Rock (SRRK). A key near-term catalyst is the upcoming presentation of mid-stage data for Eli Lilly's (LLY) own muscle-preserving candidate, bimagrumab. Despite the optimism, a notable hurdle remains: regulatory approval, which will require companies to demonstrate tangible health benefits beyond lean mass preservation, with the first potential product launch not anticipated until 2028. The market is also expected to segment, with myostatin-targeting drugs forecasted to capture the majority share due to superior safety, while activin-based drugs may be reserved for higher-risk patients, representing a smaller $5 billion sales opportunity.

Key Decisions for Investors

• Investors should monitor the upcoming mid-stage data for Eli Lilly's bimagrumab, as positive results could serve as a major validation for the entire muscle-preservation sub-sector and further solidify LLY's dominant position in the broader weight-loss market.
• Consider exposure to pure-play biotechs like Regeneron and Scholar Rock, which have already delivered promising data and could offer higher beta opportunities as this new therapeutic class develops.
• Acknowledge the long-term timeline and regulatory risk; the first product is not expected until 2028 and will face a high bar for approval, requiring demonstrated health outcomes beyond just muscle preservation.
• Differentiate between the primary GLP-1 players, as Eli Lilly is positioned to benefit from both the core obesity drug market and this ancillary muscle-preservation market, while Novo Nordisk is currently framed primarily as creating the market need.