The RNA space is at a crossroads.
We analyzed >3.1K therapeutic oligonucleotide programs for Sleuth's RNA report. The headline is that within the liver, RNA is moving towards a product execution story, but beyond it, it's still a delivery one.
Here's the story in a nutshell:
1. Industry pioneers like Alnylam and Ionis had to first prove synthetic oligos could reliably silence a target. Alnylam's first approved RNAi drug Onpattro used lipid nanoparticles to deliver siRNA.
GalNAc made liver delivery repeatable, turning RNA into a legitimate platform that could hit a variety of liver-expressed targets, which we saw Alnylam and Ionis take advantage of for a combined 8 approvals between 2019 - 2025.
2. But with liver delivery solved via widespread GalNAc adoption (+ standardized sequence design & chemical modification), many drug developers ended up converging on the same targets. And GalNAc conjugate patents are starting to expire in 2028, so the competitive pressure will only accelerate.
With some programs already showing 90+% knockdown and 6mo durability, incremental knockdown is just less interesting, pushing genuine differentiation towards traditional clinical metrics.
3. In response, developers have generally arrived at two potential paths:
(a) 𝗶𝗻𝗱𝗶𝗰𝗮𝘁𝗶𝗼𝗻 𝗱𝗿𝗶𝘃𝗲𝗻 𝘀𝘁𝗿𝗮𝘁𝗲𝗴𝗶𝗲𝘀: use proven liver delivery to pursue larger chronic indications and compete with the broader market / established SoC on clinical outcomes, safety, dosing, patient burden, cost and overall value.
(b) 𝘂𝗻𝗹𝗼𝗰𝗸 𝘁𝗵𝗲 𝗻𝗲𝘅𝘁 𝘁𝗶𝘀𝘀𝘂𝗲: make the bio-engineering leaps needed to allow systemic delivery into muscle, kidney, CNS or other tissues as repeatable as GalNAc into the liver.
There's certainly a lot of upside with path two, but there's a long list of challenges to address:
• cell-specific uptake
• productive intracellular delivery
• endosomal escape
• adequate activity, durability and safety
• scalable manufacturing
As shown in the report, only ~12% of clinical programs are clearly attempting to do this, although that figure is much higher for early preclinical programs.
There's clearly demand from Pharma to pay "platform prices" when a capability works across assets - Novartis' $12B acquisition of Avidity is one example, but you need to separate the clinical outcome of a single asset (del-desiran Ph3 HARBOR study missed its primary functional endpoint) from whether muscle-directed AOCs work. A big part of the payment is to buy a way into this new tissue.
The key for the field is to reproduce the success the last generation of programs showed: a genuine platform where the 2nd and 3rd drugs use the same route into a tissue and deliver clinical benefit.
The full report touches on deep dives into CNS / muscle delivery, 2026-2027 catalyst calendar and RNA dealmaking since 2021, among other things.
If you'd like it, just comment "RNA" below and we'll send it over!