Altimmune's recent earnings call (Q1 2024 Transcript) was filled with the usual optimistic pronouncements about pemvidutide, the company's dual GLP-1/glucagon agonist in development for obesity and NASH. They highlighted the impressive weight loss and body composition data from the MOMENTUM Phase 2 obesity trial, and expressed confidence in the upcoming IMPACT trial readout for NASH in early 2025. Yet, hidden within the usual biopharma optimism lies a subtle clue that could point to a blockbuster opportunity being overlooked by analysts.

While much of the discussion focused on pemvidutide's potential in the crowded obesity market, Altimmune made a fascinating remark about the rapid enrollment rate in the IMPACT NASH trial. They attributed this to the eagerness of NASH patients to participate in a trial that offers them the chance to lose weight – a feature absent in other NASH trials. This seemingly innocuous statement, however, reveals a powerful dynamic at play: the desperate desire for weight loss among NASH patients.

NASH, unlike many other chronic diseases, is largely asymptomatic. Patients don't feel the slow, insidious damage being inflicted on their liver. What they do experience is the weight gain that often accompanies the condition and drives its progression. This weight gain, combined with the societal stigma associated with obesity, creates a significant psychological burden for NASH patients.

Altimmune's IMPACT trial, by offering patients a chance to visibly and tangibly address their weight concerns, taps into a powerful motivator. This enrollment advantage becomes even more significant when considering the competitive landscape.

Resmetirom, the recently approved thyroid hormone receptor beta agonist, while showing efficacy in treating NASH, doesn't offer weight loss. The FGF21 analogs, another promising class of NASH therapies, also lack this crucial attribute. Even tirzepatide, the much-hyped GLP-1/GIP agonist from Eli Lilly, despite showing promise in resolving NASH, delivers less liver fat reduction than pemvidutide.

Herein lies the potential for a blockbuster. Pemvidutide, by combining potent liver-directed activity with clinically meaningful weight loss, could become the preferred choice for both physicians and patients. This preference, driven by the enrollment advantage observed in the IMPACT trial, could translate into significant market share in a NASH market projected to reach $21.5 billion by 2028.

To quantify this potential, let's look at some hypothetical scenarios. Let's assume the IMPACT trial is successful and pemvidutide receives FDA approval for NASH. If pemvidutide, thanks to its enrollment advantage and dual-action mechanism, captures even 20% of the projected NASH market, that would translate to $4.3 billion in annual revenue – a significant leap for a company currently valued at roughly $520 million.

Furthermore, this market share estimate could be conservative. If pemvidutide's oral formulation proves successful, offering patients a convenient alternative to weekly injections, its market penetration could be even higher.

Of course, this is all contingent on the IMPACT trial's success. Yet, the "silent" enrollment advantage Altimmune has uncovered offers a glimpse into a potential blockbuster opportunity that goes beyond the hype surrounding the obesity market. By addressing the deep-seated desire for weight loss among NASH patients, pemvidutide could be poised to become a dominant player in a massive and underserved market.

Projected Annual Revenue of Pemvidutide in NASH Market

This chart illustrates the potential annual revenue of pemvidutide if it captures 20% of the projected NASH market.

"Fun Fact: The Gaithersburg, Maryland headquarters of Altimmune is just a stone's throw from the National Institute of Allergy and Infectious Diseases (NIAID), highlighting the company's deep roots in cutting-edge biomedical research."