周末医疗脉搏：减肥的沉重面——肽制造、浪费及未来方向

Rebecca Liang, Ph.D.+852 2123 2656rebecca.liang@bernsteinsg.comMiki Sogi, Ph.D.+81 3 6777 6991miki.sogi@bernsteinsg.comCourtney Breen+1 917 344 8407courtney.breen@bernsteinsg.comJustin Smith+44 20 7762 5899justin.smith@bernsteinsg.comEve Burstein+1 917 344 8313eve.burstein@bernsteinsg.comLee Hambright+1 917 344 8429lee.hambright@bernsteinsg.comSusannah Ludwig+41 582 723 127susannah.ludwig@bernsteinsg.comWilliam Pickering, MD+1 917 344 8340william.pickering@bernsteinsg.comLance Wilkes+1 917 344 8501lance.wilkes@bernsteinsg.comDelphine Le Louet+33 1 42 13 92 93delphine.le-louet@bernsteinsg.com Related reading - Weekend Healthcare Pulse: GLP-1 peptides, frombench to bedside - a manufacturing view spending is projected to compound in the mid-20s, adding morethan USD 50 Bn of incremental spend between 2025 and 2029and pushing the categorytoward the USD 100 Bn thresholdbythe end of the decade. PEPTIDES - LARGEST MARKET AMONG NEW DRUGMODALITIES Growth in the obesity market pushes peptide forward as thetop new drug modality in size and growth, beating ADCs, next-generation antibodies and oligonucleotides. While recombinantproteins and conventional antibodies still dominate in absolutevalue, the growth bubble for peptides is now comparable to thoseestablished biologic classes. By 2030, IQVIA projects medicine use roughly 4 trillion defineddaily doses globally. Across the top 20 therapy areas, most see mid-single to low-teens growth, butobesity is in its own quadrantand forecast to grow fastest over the next five years, wellahead of diabetes, oncology and immunology. Global obesity drug EXHIBIT 1:Oncology and obesity are the fastest growing therapeutic areas - and should remain so in the near term EXHIBIT 2:Depending on pricing and reimbursementdevelopments, obesity spending could break into the$100Bn level in the coming years EXHIBIT 3:Among the newer molecular modalities, peptidesstand out as both the largest market by 2030 and one of thefastest-growing Top peptide drugs drive a global manufacturing capacitycrunch.Flagship GLP-1 products like semaglutide, tirzepatide,and liraglutide each rely on long, chemically synthesized peptidesor hybrid recombinant-chemical routes. And GLP-1s are notthe only driver: blockbusters such as octreotide, leuprolide,goserelin, teriparatide and lanreotide span endocrinology,oncology, osteoporosis and neuroendocrine tumors, each withits own manufacturing route (pure SPPS, hybrid, or recombinantDNA). The combined demand boom catapults the supply side -peptide synthesis - from a niche segment reserved for academicresearch and cosmetics a decade ago into a major industry ofpharmaceutical manufacturing. flexible (e.g. can incorporate non-natural amino acids, lipidation)and compatible with automation, which is why it has become theindustry standard for modern peptide APIs despite its heavy solventusage. SPPS and batch chromatography (for purification) are extremelysolvent- and reagent-consuming: industry analyses suggest thatup to16,000 kg of chemicals are needed per kg of GLP-classpeptide API, with purification and lyophilization major contributorsto process mass intensity (PMI). At larger scales, any inefficiency incoupling, deprotection, or chromatography multiplies into higherCOGS and more hazardous waste. If the API is of long sequencesand hydrophobic segments, this would increase aggregation andside-product formation, making high-purity specs harder to hit.ESG is, consequentially, a problem: organizations like theACS Green Chemistry Institute explicitly flag peptide APIs asamong the least sustainable modalities. There three major challenges peptide manufacturing scales: •High PMI and solvent consumptionthreatenmarginsustainability: if CDMOs cannot meaningfully cut solvent andraw-material use per kg, rising volume magnifies costs andenvironmental liabilities. •Batch purification and complex multi-step workflows limiteffective capacity and raise theprobability of batch failures,constraining revenue growth and creating supply risk overhangs. FROM KG TO MULTI-METRIC TON MANUFACTURING Historically, peptide APIs were produced in kilograms per year, andnow they’re entering multi-kilogram and even metric-ton annualvolumes. Most marketed peptide APIs are manufactured either bybioreactors (recombinant expression followed by purification) or bychemical synthesis, with solid-phase peptide synthesis (SPPS) thedominant route for short- to medium-length and heavily modifiedpeptides. SPPS builds the peptide stepwise on a resin with iterativedeprotection, coupling, and washing cycles, then cleaves andpurifies the crude sequence by chromatography. The process is •ESG and regulatory expectationsaround waste minimizationand impurity control are tightening; players that remain onlegacy solvent-heavy platforms risk losing share, facing highercapex, or less sticky contracts with customers that prefergreener synthesis routes. EXHIBIT 7:Peptide synthesis is a dirty process thatconsumes high