Bayer AG / Recursion Pharmaceuticals, Inc.

Fibrotic Diseases of Lung, Kidney, and Heart

50K US cases/yr · $4.5B Global IPF therapeutics market 2020

Disease Overview

The Bayer-Recursion collaboration targets fibrotic diseases across three high-burden organ systems. Idiopathic pulmonary fibrosis (IPF) affects an estimated 100,000-150,000 U.S. patients with ~50,000 new diagnoses annually and a median survival of 3-5 years post-diagnosis without treatment. Chronic kidney disease (CKD) affects ~37 million U.S. adults with diabetic kidney disease and focal segmental glomerulosclerosis (FSGS) representing fibrosis-anchored subsets. Heart failure with preserved ejection fraction (HFpEF, with cardiac fibrosis component) affects ~3 million U.S. patients. Fibrosis represents the common pathophysiologic endpoint across organ systems — pathologic activation of myofibroblasts, deposition of extracellular matrix, and tissue scarring driven by TGF-β, integrins, lysyl oxidase, and Wnt signaling. Standard of care in IPF is dominated by two anti-fibrotic small molecules — Esbriet (pirfenidone, Roche) and Ofev (nintedanib, Boehringer Ingelheim) — which slow forced vital capacity (FVC) decline by ~50% but neither halts nor reverses disease progression. The strategic premise of the Bayer-Recursion alliance is to leverage Recursion's AI/ML phenomics platform to identify novel anti-fibrotic targets and lead molecules across organ systems where standard approaches have repeatedly failed in late-stage trials. WAC pricing for IPF anti-fibrotics is approximately $115K per year for Ofev and $120K for Esbriet, supporting multi-billion dollar peak sales for novel disease-modifying entrants.

Competitive Landscape

The fibrosis competitive landscape is anchored in IPF by two approved anti-fibrotics that slow but do not reverse disease, with broad pipeline activity across organ systems and novel mechanisms. Approved standard of care includes Ofev (nintedanib, Boehringer Ingelheim — multi-tyrosine kinase inhibitor; ~$3.5B 2022 sales across IPF/SSc-ILD/PPF) and Esbriet (pirfenidone, Roche — TGF-β/PDGF inhibitor; declining post-2022 generic erosion). Late-stage IPF entrants include Roche/Pliant's bexotegrast (PLN-74809, αvβ6/αvβ1 integrin inhibitor, Phase 2/3), FibroGen's pamrevlumab (anti-CTGF, Phase 3 ZEPHYRUS missed 2023), United Therapeutics' Tyvaso DPI (treprostinil dry-powder, IPF-PH approval), and Galapagos' ziritaxestat (autotaxin inhibitor, Phase 3 ISABELA failed 2021). Cardiac and renal fibrosis pipeline entrants include eplerenone/spironolactone (mineralocorticoid receptor antagonists), finerenone (Bayer's Kerendia, ~$300M 2023 sales), and Boehringer's Jardiance (empagliflozin, anti-fibrotic adjacent in HFpEF). AI-driven competitor platforms include Insitro/Gilead's NASH/IPF programs, Exscientia/Sanofi multi-target deal, Atomwise, and Schrödinger. The Bayer-Recursion alliance positions Bayer alongside finerenone as a multi-organ anti-fibrotic franchise builder, with the AI/phenomics platform as the discovery differentiator versus traditional target-led approaches.