This year's Pipeline Report profiles 32 compounds that are the early fruit of pharma's investment in targeted drug design. In diabetes, HIV, hepatitis C—and especially oncology—vibrant R&D is set to revolutionize treatment with new classes of drugs over the coming decade. We spotlight today's geeky names—the DPP-IVs and MK-0518s, the Tykerbs and Telaprevirs—that are most likely to be tomorrow's glam blockbusters. Even the year's downers—we're still waiting on Acomplia, Exubera is failing to live up to the hype—are reminders of how improvements in drug development, such as Phase 0, are helping industry in its drive to become more effective. Although riskier than squeezing me-too drugs out of proven products, targeted R&D is lighting pathways not only to cures of killer diseases but to a fresh paradigm of progress and profits, and to renewed confidence in the pharmaceutical industry. From where we stand, the future looks bright.

OPEN MOUTH, INSERT... DPP-IVs, the Latest in Diabetes Innovation

Saxagliptin Bristol-Myers Squibb

Redona GlaxoSmithKline

TARGET INDICATION Type-2 diabetes
DEVELOPMENT Phase III
LAUNCH DATE 2010

SSR-162369 Sanofi-Aventis

TARGET INDICATION Type-2 diabetes
DEVELOPMENT Phase I
LAUNCH DATE 2014

Unnamed Ferring Pharmaceuticals/Johnson & Johnson

TARGET INDICATION Type-2 diabetes and obesity
DEVELOPMENT Preclinical
LAUNCH DATE TBA

FAILURE TO LAUNCH: Lung-Damage Data Has Pfizer Holding Its Breath on Exubera

The new drugs prevent the DPP-IV enzyme from doing its dirty work—blocking incretin, a hormone that turns on insulin and turns off glycogen. By opposing DPP-IV, the inhibitors indirectly prolong the incretin effect, allowing the body to reduce blood-glucose levels on its own. The new drugs, which are being developed alone and in combination with other meds, are best deployed in patients who have pre-diabetes, a condition of impaired glucose tolerance before it reaches the level of diabetes.