10 breakthroughs in Medicine-2025 ( chapter-1)

 

Breakthroughs in metabolic medicine

To start, 2025 brought new breakthroughs in metabolic medicine, which is good timing: almost 4 billion adults are expected to have overweight or obesity by 2050.

1.Fatty liver disease

Semaglutide became the second drug approved to treat severe fatty liver disease (MASH) — probably the most interesting medical condition hardly anyone’s heard of. It’s common (5% of people), progresses in a stepwise (but interruptible) manner, and has potentially serious complications (liver cirrhosis, liver failure, cancer).

The first approval for this condition was only in 2024, but the pipeline is now red hot, with four drugs in phase 3, eight in phase 2, and three combination therapies being trailed, too.

2.LDL cholesterol

It was a good year for prevention of cardiovascular disease — and particularly for PCSK9 inhibition as a mode-of-action, which stimulates the uptake of LDL cholesterol from the blood (where it can accumulate in plaques) and into the liver (where it can’t).

The PCSK9-inhibiting antibody, Evolocumab, became the first non-statin proven to reduce heart attacks/strokes in people who’ve never had one before, and was approved for primary prevention of cardiovascular disease.

3.Lipoprotein(a)

High levels of lipoprotein(a) (an LDL-like molecule with an added protein component) presents a serious unmet need: it’s a risk factor for heart attacks and strokes, but its levels are controlled by genetics — unaffected by diet, exercise, or statins.

It was a good year for progress towards dedicated therapies, with Eli Lilly releasing data for a new siRNA that can drive down levels of lipoprotein(a) by >90%.

4.Obesity

Phase 3 trials dropped for obesity drugs with new modes-of-action: the GLP1 + amylin receptor agonist, Cagrisema, the GLP1/glucagon receptor dual agonist, Mazdutide, the triple agonist, Retatrutide, and oral GLP1 receptor agonists — Orforglipron and Semaglutide. 

There were results for earlier-stage obesity drugs, too, like Eli Lilly’s single amylin receptor agonist, Eloralintide. This demonstrated, for the first time, a single mode-of-action that might rival GLP1s. GLP1s suppress hunger, but amylin agonists increase satiety.

In the next post we will discuss breakthroughs in infectious diseases