Muscarinic Choline

$MDGL $NVO $LLY $RHHBY $VKTX $XBI MASH no longer looks like a standalone liver market. GLP-1s are absorbing the left side. FGF21s are moving into fibrosis-heavy disease. The middle is getting squeezed. “F2 Bridge Trap” “Hepatologists as residual-risk managers” Clinaptis.

@drsprs Thanks Dr. S for the feedback. I hear you; will publish more forward looking content soon. Check out Obesity 2026 piece.

@MAcetylcholine Very nice writeup that has described what has happened in 2026 but provides little to no forward thinking or actionable insight to make money for the rest of the year.

Biotech 2026: dispersion, not direction. 2-pager on what’s actually driving returns YTD — convexity vs. crowding, platform re-pricing, and where capital is flowing. (Clinaptis Advisors)

Obesity 2026: Leaders De-risked, Debate Shifting Toward Market Structure A few thoughts on how obesity ecosystem evolved over the last ~12 months: from efficacy wars → oral GLP-1 scalability → metabolic platform expansion → manufacturing and distribution becoming next moat.

$AXSM So an old antidepressant drug (AXS-12; reboxetine) shows ‘numerical benefit’ on ESS scale (most important for Excessive Daytime Sleepiness) and has 57% response rate on cataplexy on placebo arm?! But hey study hit.

$CRNX PATHFNDR-2 results are okay (largely because THE bar was forcefully lowered in past month or so) but commercial opportunity is something I can’t get behind with SSA injectables going generic in near term. No Path, No gain!

Think lower end of $2.5B-$4.0B MCap (3x P/S on $800M-$1.25B US revenue) without M&A premium. $150-$180/sh is fine. But will change my mind if the KOL feedback & early launch metrics are good & upper end of drug pricing/month is not overly too payer/access restricted $MDGL #NASH

@MAcetylcholine @Goderguy $MDGL fair value closer to $220?

@haodongvli Comparing market cap of $LLY commercial behemoth, worthy of Mag 7 spot, to an early clinical stage biotech company $XBI is not a worth a water cooler discussion, though.

$VKTX: $LLY $NVO market cap surged $400B on their weight loss drug. $VKTX could have the best in the class in a few years, how much market cap surge is fair?

Is 'Specialist' an underhanded roast of 'dedicated' healthcare Hedge Funds haha🤣Understand the aversion of large long-only (LO) funds to binary risk, and market cap investing limitations, but others..? Cozy with $XENE $SRPT $LLY $VRTX $ITCI. Got barbecued on $VKTX, $ALT & $AKRO [Longs] helped but barely. Would be helpful if someone shares a better way of tracking positioning on consensus longs, other than HC trading desk comments, 13F Filings and short interest (SI) % of float?

$AMLX Monster Truck 22%+ 1D move but what was more interesting was bears (not necessarily short) didn't have conviction either. Tbh neither did I, seemed 60%+ likely hitting primary endpoint

$BPMC reloading [Short] here in high 80s - least because of H&S chart pattern but ISM indication peak sales modeling is wishful thinking imo. Okay with takeout risk, [L] $AGIO should mitigate some pain: even after a strong move, better M&A target in heme space

Every single darn time (looks 7-8 to untrained eye) $ALKS tries to grow up into 30s (FY21-till date) on back of a new upside driver narrative, or the very same (like OX2 narcolepsy) with a new spin, gets knocked back down to its happy place - 20s. Till next time.

@brianhc @Sports_bios Yeah totally. What a spectacle. Perhaps $BIIB passed on $TGTX in Multiple Sclerosis (MS) as FTC would have been further triggered at #biopharma industry and M&A driven consolidation, with $SGEN deal getting scrutiny in the background

@MAcetylcholine @Sports_bios Fair point. I think pharma's reason for passing on $amlx is a mixture of hubris and politics. ALS gets an outsized portion of attention, that may be off-putting.

$AMLX - at least they didn't miss - and the big chg in the Phoenix data timeline now including BEFORE 2Q - .. guess people will be chasing everything about Phoenix and not so much on everything else - .. pretty impressive they are still doing 400MM +/- run rate on rev. - other than that not much to add - been great to do travels - though a bit rainy for the last couple of days - but I am used to heavy rain etc - wont bother me one bit - the Onsen bath[s] are xcllnt - even better w/ the my own private one in a balcony next a traditional Japanese garden or overlooking the sea of Japan.. have to book these places early though - they are filled months before.. so back to the cave till mid next wk after I wrap this R&R in Kyushu... jmho.

@brianhc @Sports_bios Agree on MOA but not that Skyclarys' antioxidant MOA is something to write home about too.

@MAcetylcholine @Sports_bios They know exactly what they're doing. Maybe it's hubris given the composition of the medicine, who knows

$NBIX Fan-fav '568 M4 agonist readout guidance seems way too aggressive 2H24: 1) clinictrial.gov Dec '24 completion); 2) Initiated P2 slightly after $CERE's P3 with significant US trials sites still enrolling patients & even accounting for trial design differences, # acute schizophrenia patients (some nuances re: ex-US site Bulgaria) is not that different & overlapping sites; emraclidine P3 completion Nov '24; 3) Psych docs casually stated SCZ US trials getting harder to enroll 4) $ACAD mgmt. took [-] SCZ study to EU and comments not US-favorable. Would be hilarious if emcraclidine reads out with ~8 pt PANSS score before '568, penetration rates will be butchered for both assets. Endo CAH clinical meaningfulness [=/+] debate will keep Longs hopeful for now?