Johnston Pain Management

The XBI has plunged 27% since Donald Trump won the election, leaving the public markets an ugly mess for a biotech industry yearning for better times. Talk to CEOs these days and the mood for many is bleak — with worries about what the impact of tariffs and trade wars will have on the economy, adding some bitter seasoning to a stew of anxiety over a reorganization of the FDA and the abrupt mass exit of staffers under a controversial HHS chief whose skeptical views on vaccines skew to quackery. Trump’s recent attacks on Fed chief Jerome Powell have only further destabilized a market unsettled by daily social media posts from the White House. But it may amaze you to find out that it’s not all bad news for the first few months of the year. If you narrow the focus, a close look at the charts Chris Dokomajilar at DealForma posted for Q1 shows that several of the most-watched biotech numbers nevertheless continued to hang steady. That’s the silver lining to some troubling trends — though these numbers don’t include the turbulence we’ve witnessed in April. The bottom line: IPOs remain in the doldrums, with PIPEs and follow-ons continuing to struggle after a much more bullish Q1 in 2024 inspired short-lived hopes. But dealmaking activity remains consistent, Phase 2 assets are drawing some sizable payouts, and a fluctuating M&A scene held up in a period of reduced expectations — compared to the fondly remembered Covid boom. One big new trend you cannot ignore: Despite all the combative remarks between Chinese and US officials, Big Pharma is increasingly turning to Chinese biotechs for clinical-stage drugs. The big question now is how things will hold up in Q2, at a time uncertainty is killing hopes for a near-term recovery of biotech. Dealmaking activity slid somewhat compared to the big spike we saw in the last three months of 2024, but the number of deals was up significantly over Q1 2024 and registered as the second-highest quarterly performance compared to the past four years. AI SaaS and other service deals surged last year and remained strong in Q1, which is the primary reason why dealmaking has continued on a strong pace at the start of 2025. And it bodes well for continued work in AI, as industry players hustle to avoid being left behind of that big trend. Just looking at the number of deals, M&A and licensing/R&D partnerships also held steady in the first quarter, with some fluctuations. VC activity was steady for Q1 2025, compared to the same quarter a year ago, with the venture class focusing much of their money and attention on Phase 1. The venture numbers fall very much in line with what we tracked through last year, with $6.7 billion in total for Q1 compared to $27.6 billion in all of last year. The Q1 total also matched the performance of Q1 2024, though it all pales in comparison to the quarterly numbers driving a much more enthusiastic 2021. Breaking out the pie chart on where the full $34.3 billion through last year went, and you’ll see the biggest piece going to small molecules (25%) with non-ADC antibodies at 15% and AI/ML coming in at a close third with 12%. IPOs remain in the doldrums, which will be a surprise to no one with the slightest interest in biotech. The whole IPO field went cold after a torrid 2020 and the first half of 2021, and has been stuttering along ever since, periodically jumping enough to kindle hopes for a return of generalist investors, only to see the numbers dwindle again as deals go under water. It doesn’t help that a slew of biotechs are now trading for less than cash . And the experience of the new IPOs leaves a lot to be desired. Aardvark Therapeutics went public at $16 a share in February and has since lost close to half of that value. With examples like that scattered around like wrecked cars on the speedway, it’s no surprise to see biotechs hanging on to their S-1s. As the public markets skittered in and out of bear territory, with tariffs inspiring fears of slow growth and higher prices and a mood of general uncertainty that has generalists looking for a financially secure port in the storm, Q2 is not looking like the time for a rebound. Back at the start of 2024, one of the bright spots for biotech could be seen in the surge of new PIPEs and follow-ons that raised serious money for public companies. But the encouraging trend barely survived the first half of last year. In the first three months of 2025, the number of PIPEs dropped significantly, though the total raised edged up somewhat compared to Q4 2024. A meager 23 follow-ons raised only $2.9 billion in Q1 of this year, less than a third of what was gathered in the same quarter a year ago. M&A, which tends to fluctuate quarter to quarter, outperformed some meager numbers posted a year ago. Back in January, J&J got the M&A ball rolling with its $14.6 billion deal to acquire Intra-Cellular Therapies. That one deal accounted for a big chunk of the $33.7 billion in M&A DealForma tracked in Q1. That is much better than the $19.3 billion charted for the same period a year ago, as 2024 got off to a slow start on a field that has proven quite a disappointment in biopharma. Back at JPM, I made the bold prediction that we’d see a couple more deals over $10 billion by the end of the year. Right now, that’s looking like a long shot, at best. But it’s early yet. Biopharma licensing pacts also slid down from a surge at the end of 2024, though the numbers looked better than a year ago for the same period. The $4.4 billion shelled out in upfront cash for therapeutics and platforms in Q1 this year registered a sharp drop from the $7.1 billion on the table in Q4 of last year, but it was still significantly higher than a weak $1.7 billion start to 2024. Add in the biobucks and the Q1 tally comes in at $56.1 billion, compared to $35.6 billion for the same period a year ago. Look out over a few years and you’ll see that Q4 often ends on a high note, so perhaps a solid start indicates better performance for the months ahead. This year, though, will likely be notoriously difficult to predict. After claiming only a small, marginal number of deals with $50 million-plus upfront in 2022, the number of these deals originating from China — Chinese biotechs licensing to global partners — has rapidly swelled to 42% of the global share for these large pacts in Q1 2025, according to DealForma. The sudden emergence of Chinese biotechs as a source of major new drug programs has clearly shaken the biotech industry, presenting a rival to US biotechs which had grown accustomed to dominating this arena. Now China’s reputation for speed in clinical trials, along with an increasingly innovative approach to drug development, has the potential to blindside companies that had thought they had a clear shot at holding on to best-in-class, first-in-class boasting rights. And it’s all happening as trade tensions between the US and China reach extremes few could have predicted. The surge in China deals comes as large-cap companies have proven willing to pay out more for the drugs roped in from the smaller biotechs, with Phase 2 assets performing particularly well. YTD the median of upfront cash and equity from Big Pharmas for Phase 2 drugs has hit $200 million, compared to $150 million for all of 2024. Phase 1 has dipped — from $168 million to $90 million — though Q1 2025 has no Phase 3 deals to compare with last year’s track record. Right now, the bright and shining allure of discovery-stage drugs can’t compare to hard human data on drugs poised to go into pivotal trials. ADC deals have been doing a fast fade, perhaps underscoring that the best partnerships have been identified and struck, Dokomajilar notes. Back in 2023, ADCs were all the rage. But while 2025 got off to a promising start — compared to all of 2024 — it’s unlikely to come close to that earlier, torrid pace.

The buzz and excitement at JPM might well have been from another era. On Tuesday, the second and final day of of the Investival Showcase USA in Miami, the mood was decidedly glum when it came to raising capital. From early stage investors to private equity experts and operators, the only question was how to survive the current funding environment. Investors have an appetite for risk but generally prefer market certainty. They can pay for disruption as long as markets are not disruptive. And that has precisely what has shifted markedly in the past two months. U.S. stocks suffered their worst day in 2025 on Monday with the Dow dropping 900 points. Add to that the news about broad research cuts at the NIH, including it cutting $250 million in funding to just one U.S. university, two deaths from the West Texas, measles outbreak in individuals that were not vaccinated, a tariff war of words, job cuts at the VA and Health and Human Services. All of this has created an environment of unprecedented chaos. And yet, ideas will still need to find capital and innovation must continue. So what do you do in such a world? Sponsored Post Webinar: Tips To Have Your Practice Succeed This Year This on-demand webinar will offer insights and share tips on helping practices run more efficiently. By Elation Health and MedCity News Get Creative Mary Schaheen, president at Prevail Partners, said that companies have to look for alternative ways to find capital given that later stage startups are going to find the IPO markets fairly closed though she hopes the IPO market rebound at the end of the year or early next year. “We do a lot of matching funds ourselves. We have the states stepping up. We just talked to a company who has got a million dollars committed by the state of Delaware and they want us to match it, which we will gladly do,” Schaheen said. “It’s all kinds of interesting ways to keep it going….” So, how has the IPO market fared in the last few years? Andrew Lam, managing director and Head of Biotech Private Equity at Ally Bridge Group, said that we are in a kind of “IPO nuclear winter” The 10-year median for biotech IPOs is 35. In 2020 and 2021 it was 75 each; 2021 had 10, 2022 had another 10 IPOs as did 2023. Then in 2024 there were 17 IPOs and 2025 is projected to be only slightly better than 2024. Sponsored Post Tackling Messy Provider Data with an NPI-Forward Approach Mike Wirth of ProviderTrust shares insights about the company in this interview at the ViVE 2025 conference in Nashville last month. By ProviderTrust and MedCity News “The bankers tell me they expect to close the year at 25 given the macro weakness,”Lam said. “I’m skeptical that we’ll get to that number, but we are still very much in the cleansing periods after the heydays of 2020, 2021.”Crowdfunding Another creative path — other than looking to states to get funds — is to seek help from the average consumer. “If I were a small company now, a private company looking for $4 to $10 million, I’d be looking very seriously at crowdfunding,” said Jeff Luber, CEO of Clarity. As soon as someone laughed in the audiene, Luber shot back, “It;s no joke. Good luck trying to raise $5 million from an investor as a pre-revenue startup right now. I’d rather do it $500 at a time and then you can go raise up to $75 million through Reg A plus.” He explained that that through Reg CF (crowdfunding) from the SEC, companies can raise up to $5 million without any filings. However, SEC does require an annual report from companies engaging in crowdfunding. Reg A+ is an alternative to an IPO and is an exemption that allows small companies to sell their shares making it possible for almost anyone to invest in a business through crowdfunding. In other words, companies can use the Reg A + to raise money from both accredited and non-accredited investors. Reach Out to Incubators An investor with AbbVie pointed to incubators as a great starting point noting for entrepreneurs. Doug Faunce, executive director, head of search and evaluation for eye care named incubators Mission Bio Capital, BioLabs, and SoCal Bio as incubators worth for entrepreneurs to reach out to. He added that incubators are a way for entrepreneurs to begin to “get that early network” that will ultimately help in getting funding. As a large strategic investor, Faunce also had some advice on how to engage with AbbVie Ventures. “Don’t be afraid to connect with us early. A lot of folks think, “Well, I’m too early, maybe I don’t want to share yet.” Share. Openly. Early. Often. We take your information and your data as seriously as we take our own. The earlier that we can build that relationship on your journey to search and establish that first funding is all the better.” Have a commercial and clinical development planIt’s not just enough to have a regulatory plan for success. Startups need to have a commercial as well as clinical development plan. according to Peter Bojo, principal at TPG Lifesciences “It’s not just all about getting through regulatory milestones, but you can start to think about commercially how is this going to be positioned,” Bojo said.

Tris Pharma has been touting cebranopadol as offering a potential solution to the opioid crisis.\n Tris Pharma’s opioid alternative has scored a third win in a trio of clinical trials, providing the biotech with the data needed to take the pain relief drug to the FDA this year.The latest readout saw cebranopadol, a dual nociceptin/orphanin FQ peptide (NOP) receptor and µ-opioid peptide (MOP) receptor agonist, tested in a phase 3 trial of patients who have undergone toe surgery.The study achieved its primary endpoint of showing a statistically significant reduction in pain intensity measured each hour over 48 hours compared to placebo. Specifically, a once-daily 400-µg dose of cebranopadol resulted in a mean 56.1-point reduction in this pain measurement compared to placebo, giving a p-value of less than 0.001.A total of 57.5% of patients receiving cebranopadol didn’t require an additional “rescue medication” of a common analgesic, such as ibuprofen, over seven days compared to 28.4% of those on placebo, the biotech noted.A separate arm of the study involved patients receiving the common opioid oxycodone four times a day. The mean pain relief experienced by these patients was also less than the cebranopadol cohort, the company said.Tris’ drug also showed a favorable safety profile, with nausea being the most common adverse event and no serious adverse events reported in the trial. Today’s readout rounds off a trio of clinical proof points for cebranopadol this year, which Tris has been touting as offering a potential solution to the opioid crisis. January saw the biotech demonstrate a statistically significant reduction in pain intensity in patients who had undergone cosmetic surgery on their abdomen. Days later, the company pointed to data from a phase 1 trial of a crushed, nasal insufflation dose of cebranopadol to show that it was less likely to be abused than oxycodone.“With our phase 3 program for cebranopadol in the treatment of moderate-to-severe acute pain complete, we now have a comprehensive data package that will be submitted to the FDA as the basis for potential approval,” Tris’ CEO Ketan Mehta said in the March 6 release. “If approved, cebranopadol has the potential to redefine the standard of care for acute pain management, offering a first-in-kind treatment option for patients in need.”At the J.P. Morgan Healthcare Conference in San Francisco in January, Tris Chief Business Officer James Hackworth, Ph.D., told Fierce that the biotech believes cebranopadol’s mechanism is “unique.”While cebranopadol stimulates the MOP receptor in the same way that opioids do, its ability to also stimulate the NOP receptor avoids the other effects that have contributed to opioids’ addictiveness, he explained.Tris isn\'t the only company looking for a new way to treat pain after the the FDA recently approved Vertex Pharmaceuticals’ NaV1.8 pain signal inhibitor Journavx. But Hackworth told Fierce at JPM that he sees Vertex’s offering as “more complementary” than competitive to cebranopadol.