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

Analysts at TD Cowen project that therapies designed to preserve muscle mass in patients using GLP-1 obesity drugs 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 presentation next week amid concerns that GLP-1 drugs can lead to muscle loss and decreased strength; the first of these muscle-preserving treatments could launch by 2028, pending regulatory approval based on demonstrated health benefits.

Analysis

A significant new therapeutic sub-market is emerging within the obesity treatment space, with TD Cowen analysts forecasting that muscle-preserving therapies could generate over $30 billion in sales by 2035. This market directly addresses a key clinical concern associated with leading GLP-1 drugs like Eli Lilly's Zepbound and Novo Nordisk's Wegovy—the loss of muscle mass and strength during weight loss. The development is driven by promising mid-stage data from companies like Regeneron and Scholar Rock, with about a dozen firms now competing in this area. A critical near-term catalyst is Eli Lilly's upcoming data presentation for its own asset, bimagrumab. While the first treatments could launch by 2028, a key hurdle remains the regulatory requirement to demonstrate tangible health benefits beyond muscle preservation. Analysts differentiate between drug classes, projecting that therapies targeting the myostatin protein will capture the majority of the market due to a superior safety profile, while activin-based drugs will serve a smaller, higher-risk patient segment, estimated at a $5 billion opportunity.

Key Decisions for Investors

• Investors should view muscle-preservation therapies as a complementary growth driver for the entire obesity market, potentially enhancing the long-term value proposition and patient adherence for GLP-1 leaders like Eli Lilly and Novo Nordisk.
• Pay close attention to the forthcoming mid-stage data for Eli Lilly's bimagrumab, as positive results could solidify its competitive moat by integrating muscle preservation directly within its own treatment ecosystem.
• Consider speculative positions in smaller biotech firms like Regeneron and Scholar Rock, which have shown early promise and offer more direct exposure to the upside of this new therapeutic class, contingent on clinical and regulatory success.
• Factor in regulatory risk as a key variable, as the projected 2028 launch timeline and $30 billion market size depend on companies successfully demonstrating additional health benefits to secure approval.