Cardiovascular disease can be managed with drugs that take various approaches, but few of them work by reducing inflammation. Novartis is getting an anti-inflammatory drug candidate through its $1.4 billion acquisition of Tourmaline Bio, a company whose Phase 3-ready antibody goes after a promising pathway for cardiovascular conditions. The Tourmaline drug gives Novartis the opportunity to catch up to Novo Nordisk and CSL Behring programs pursuing the same target, but with a potential dosing advantage.
The deal terms announced Tuesday call for Novartis to pay $48 in cash for each Tourmaline share. That price is a 57% premium to Tourmaline’s closing price on Monday. Shares of the New York-based biotech opened Tuesday at $47.62.
Tourmaline’s lead indication is atherosclerotic cardiovascular disease (ASCVD), in which plaque builds up in arterial walls. Cholesterol-lowering drugs can manage the condition, but many of these products, such as widely prescribed statins, are daily pills. Tourmaline’s pacibekitug is a monoclonal antibody designed to block interleukin-6 (IL-6), a signaling protein involved in inflammation. It’s a validated target, with IL-6-blocking antibodies already commercially available for certain inflammatory disorders. None of those indications are cardiovascular.
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Pacibekitug is a long-acting antibody designed to offer a high binding affinity to its target, a long half-life, and lower risk of sparking an immune response against the therapy. Tourmaline is developing the drug for subcutaneous dosing once every three months, which would be less burdensome for patients and could improve medication adherence that can wane with daily pills.
For ASCVD, Tourmaline aims to leverage the anti-inflammatory activity of pacibekitug as a way to prevent major cardiovascular events, such as death, nonfatal myocardial infarction, and stroke. This past May, Tourmaline reported preliminary Phase 2 results in patients with elevated cardiovascular risk. Results showed quarterly and monthly dosing of the drug led to significant reductions in C-reactive protein, a validated biomarker for inflammation. The drug’s safety and tolerability were comparable to a placebo. At the time of the data readout, Tourmaline said these results support advancing the drug to a Phase 3 cardiovascular outcomes trial enrolling patients with ASCVD and a planned Phase 2 test in abdominal aortic aneurysm.
“With no widely adopted anti-inflammatory therapies currently available for cardiovascular risk reduction, pacibekitug represents a potential breakthrough in addressing residual inflammatory risk in ASCVD with a differentiated mechanism of action targeting IL-6,” Shreeram Aradhye, president, development and chief medical officer of Novartis, said in a prepared statement.
Meanwhile, Novo Nordisk is developing an IL-6-blocking antibody named ziltivekimab. Phase 3 tests are underway in ASCVD, heart failure with preserved ejection fraction, and acute myocardial infarction. CSL Behring’s contender is clazakizumab, an IL-6 inhibitor in late-stage clinical development for end-stage kidney disease patients with diabetes or ASCVD. Both ziltivekimab and clazakizumab are dosed as a once-monthly injections, so the less burdensome quarterly dosing of pacibekitug would be an advantage compared to its rivals in the IL-6 antibody drug class.
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Cardiovascular, renal, and metabolic disorders comprise one of Novartis’s four core therapeutic areas alongside immunology, neuroscience, and oncology. The company’s top cardio drug by revenue is Entresto, a chronic heart failure and hypertension drug that accounted for more than $7.8 billion in sales in 2024. But Entresto’s patents start expiring this year and this drug is among those selected for price negotiation by the Centers for Medicare and Medicaid Services.
With Entresto revenue set to fall amid generic competition and CMS price negotiation, Novartis has turned to dealmaking to find additional assets for its cardiometabolic drug lineup. In February, Novartis reached a $925 million deal to acquire Anthos Therapeutics and its lead drug, abelacimab, a potential blood clot-prevention medicine that originated in Novartis’s labs. In April, Novartis agreed to pay $800 million for Regulus Therapeutics and its Phase 3-ready program for a rare kidney disease. The pharma giant’s second-largest cardio product is Leqvio, a cholesterol-lowering medication RNA interference drug that accounted for $754 million in revenue in 2024, a 112% increase compared to the prior year. Leqvio, approved by the FDA in 2021, came from Novartis’s $9.7 billion acquisition of The Medicines Company in 2019.
Tourmaline was founded in 2021. The following year, it licensed from Pfizer global rights to the anti-IL-6 antibody that is now pacibekitug. Pfizer had advanced the drug as far as Phase 2 testing. Tourmaline paid $5 million in cash and gave the pharma giant a 15% equity stake in the company, according to regulatory filings. The agreement put Pfizer in line for up to $128 million tied to the achievement of development and regulatory milestones. If the antibody is approved and reaches the market, Tourmaline could pay Pfizer up to $525 million in sales milestone payments as well as royalties from product sales.
Tourmaline became a public company through a 2023 reverse merger with beleaguered cell therapy developer Talaris Therapeutics. Up to that point, Tourmaline had raised $125 million in financing.
The boards of directors of both Novartis and Tourmaline have approved the acquisition, which still requires the customary approvals and the tender of the majority of outstanding Tourmaline shares. The companies expect to close the deal in the fourth quarter of this year. Upon closing, Tourmaline will operate as a Novartis subsidiary.
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