Alongside oncology and metabolic disease, one of the most striking clusters in recent big pharma transactions over the last few months is respiratory and infectious disease. Chronic obstructive pulmonary disease (COPD), asthma, rare lung disorders and seasonal viral infections such as influenza are all seeing renewed strategic attention, backed by multi-billion-dollar deals.
This article is Part 4 of the “Big Pharma Mega Deals in the Last Few Months” series and focuses on this respiratory/infectious cluster. We will use the following transactions as anchors:
- Merck – Verona Pharma: a roughly $10 billion acquisition built around the COPD inhaled drug Ohtuvayre.
- GSK – Aiolos Bio: an up to $1.4 billion deal for the long-acting TSLP antibody AIO-001 targeting asthma and other inflammatory conditions.
- Sanofi – Inhibrx: a deal valued at up to about $2.2 billion to acquire INBRX-101 (SAR447537) for alpha-1 antitrypsin deficiency (AATD), a rare lung disease.
- Merck – Cidara Therapeutics: a recently announced acquisition centered on CD388, a long-acting antiviral for influenza prophylaxis.
Together, these deals illustrate how big pharma is building multi-layered strategies that span chronic lung disease, rare pulmonary disorders and seasonal viral threats.
1. Why focus on respiratory and infectious disease now?
1-1. Aging populations and the burden of chronic lung disease
As populations age and exposure to smoking and environmental pollutants accumulates, chronic lung diseases such as COPD and severe asthma are becoming more prevalent and more costly. COPD in particular is associated with:
- Progressive loss of lung function and quality of life
- Frequent exacerbations leading to hospitalizations
- Close links with cardiovascular and metabolic comorbidities
Merck’s acquisition of Verona can be seen as a move to position COPD as one of the pillars of a broader long-term cardiopulmonary franchise, especially as the company prepares for a future beyond its key oncology blockbuster.
1-2. A “quiet upgrade” in priority after the pandemic
The COVID-19 pandemic fundamentally reshaped how companies think about infectious diseases and respiratory threats. Even as the acute phase has receded, several themes remain:
- Seasonal viruses such as influenza and RSV continue to pose serious risks
- Immunocompromised populations are growing, increasing vulnerability
- Pandemic preparedness and antimicrobial resistance (AMR) remain on the policy agenda
In this context, Merck’s move to acquire Cidara for its late-stage influenza prophylaxis program CD388 is emblematic of a broader post-pandemic strategy: treating seasonal viral threats as a long-term strategic frontier rather than a short-term emergency.:contentReference[oaicite:15]{index=15}
2. Merck – Verona Pharma: rebuilding a cardiopulmonary platform around COPD
2-1. What Ohtuvayre brings to the table
Merck’s ~$10 billion acquisition of Verona is centered on Ohtuvayre, an inhaled therapy for COPD that has already been approved in the U.S.
- A novel mechanism aimed at improving airflow and symptoms in COPD
- Potential expansion into other lung diseases such as non-cystic fibrosis bronchiectasis
- A commercially ready asset with significant peak sales potential
Strategically, this gives Merck a foothold in a chronic, high-burden respiratory disease that can serve as a foundation for a broader cardiopulmonary portfolio.
2-2. The cardiometabolic connection
COPD rarely exists in isolation. Many patients have overlapping cardiovascular and metabolic risk, including:
- Reduced physical activity leading to worsening cardiometabolic fitness
- Systemic inflammation contributing to atherosclerosis and heart failure
By strengthening its COPD position while maintaining strong cardiovascular and oncology franchises, Merck is effectively building a more integrated picture of risk across heart, lung and systemic inflammation—a theme we also saw in earlier parts of this series.
3. GSK – Aiolos Bio: redefining asthma care with long-acting biologics
3-1. AIO-001 and the TSLP pathway
GSK’s acquisition of Aiolos adds AIO-001, a long-acting antibody targeting TSLP, to its respiratory and inflammatory disease pipeline. AIO-001 is designed with the potential for dosing as infrequently as once every six months, particularly in severe asthma.
TSLP is a key cytokine in airway inflammation, and blocking it can reduce exacerbations and improve control in certain asthma populations. Long-acting inhibition of this pathway could offer a new level of convenience and disease stability.
3-2. Why dosing frequency matters
In respiratory medicine, especially with biologics, dosing frequency is not a cosmetic detail; it directly shapes adherence, clinic workload and long-term outcomes.
- Monthly injections vs. once every few months vs. twice a year
These differences can translate into:
- Less disruption to patients’ work, school and family life
- Reduced pressure on infusion or injection capacity
- Higher persistence on therapy over many years
The Aiolos deal therefore reflects a strategic shift in which dosing interval itself becomes a core dimension of differentiation, alongside efficacy and safety.
4. Sanofi – Inhibrx: targeting rare lung disease in alpha-1 antitrypsin deficiency
4-1. INBRX-101 (SAR447537) and AATD
Sanofi’s acquisition of Inhibrx, valued at up to about $2.2 billion, is primarily about securing INBRX-101 (now SAR447537), a next-generation therapy for alpha-1 antitrypsin deficiency (AATD), a rare genetic condition that can cause early-onset emphysema and liver disease.
INBRX-101 aims to improve on existing AAT replacement therapies by offering higher and more sustained serum levels, potentially with less frequent dosing.
4-2. Rare disease as a strategic niche within respiratory
Although rare diseases like AATD involve smaller patient populations than COPD or asthma, they can be strategically valuable components of a respiratory portfolio:
- High unmet need and relatively limited competition
- Specialized care networks and identifiable patient cohorts
- Potentially attractive pricing and long-term treatment
Seen this way, the Sanofi–Inhibrx deal is not an isolated rare disease bet, but part of a broader effort to span both common and rare lung conditions with differentiated offerings.
5. Merck – Cidara: building a new layer of protection for seasonal influenza
5-1. CD388 as a long-acting antiviral prophylaxis
The Merck–Cidara acquisition brings CD388, a long-acting antiviral designed for the prevention of influenza infection, into Merck’s infectious disease portfolio. A Phase 3 study is already underway, aligned with Northern Hemisphere flu seasons, and the program is positioned as a potential first-in-class approach for flu prophylaxis.
5-2. Complementing vaccines rather than replacing them
Influenza control has historically relied on vaccines, but vaccines alone have limitations:
- Reduced effectiveness in older or immunocompromised individuals
- Year-to-year variability in strain match
- Gaps in uptake among certain populations
Long-acting prophylactic antivirals like CD388 could complement vaccines by:
- Providing additional protection for high-risk patients
- Supporting infection control in settings such as long-term care facilities and hospitals
Merck’s move can thus be read as a bet on a multi-layer defense strategy for seasonal influenza, pairing vaccines with durable antiviral protection.
6. Shared themes across respiratory and infectious disease deals
6-1. Balancing seasonal and chronic risk
One unique feature of this therapeutic area is the coexistence of:
- Seasonal, acute threats (e.g., influenza, RSV)
- Chronic, progressive diseases (e.g., COPD, severe asthma, AATD)
Merck’s acquisitions of Verona and Cidara illustrate a deliberate attempt to cover both fronts: chronic COPD management on one side, seasonal influenza prevention on the other. The portfolio logic is to secure a presence across the full temporal spectrum of respiratory risk.
6-2. A clear shift toward long-acting modalities
Long-acting modalities are a recurring motif in these deals:
- AIO-001 with potential twice-yearly dosing for asthma
- INBRX-101 aiming for less frequent dosing in AATD
- CD388 as a seasonal, pre-emptive antiviral prophylaxis
These approaches are designed not only to improve convenience, but also to:
- Boost adherence over years of treatment
- Optimize use of healthcare resources
- Enable population-level risk management strategies
6-3. Intersections with cardiovascular, metabolic and immune systems
Respiratory and infectious diseases intersect with other systems in multiple ways:
- COPD and AATD are linked to cardiovascular risk and systemic inflammation
- Infections exploit vulnerabilities created by cancer therapy or immunosuppression
When we look at these deals through a cross-system lens, they align with a broader trend across this series: large pharma companies are increasingly designing portfolios around integrated risk across organs and time, rather than isolated organ-based lines of therapy.
7. How investors and BD teams can read respiratory/infectious deals
7-1. Seasonal vs. year-round revenue dynamics
One practical lens is to ask whether an asset is primarily:
- A seasonal product with revenue concentrated around specific months, like an influenza prophylaxis
- A year-round chronic therapy, such as a COPD maintenance inhaler or an AATD replacement therapy
This distinction has implications for forecasting, manufacturing, and payer negotiations. Portfolios that intelligently mix both types may be better positioned to smooth volatility and optimize resource use.
7-2. Lung-centric vs. whole-body risk reduction
Another key question is whether the value proposition is framed purely in terms of lung function and symptom control, or whether it extends to:
- Hospitalization and exacerbation reduction
- Cardiovascular and all-cause mortality
- Systemic inflammation and long-term organ protection
Deals that plausibly touch these broader endpoints can carry strategic weight beyond their apparent niche, especially when plugged into wider CVRM or oncology portfolios.
8. Implications for researchers, clinicians and startups
- For researchers: It becomes increasingly important to explore respiratory and infectious diseases as part of connected networks, not isolated organs. Understanding how lung pathology interacts with the immune system, the heart and metabolic pathways will likely shape the next wave of targets and modalities.
- For clinicians: Clinical decision-making will continue to evolve from “Which inhaler or biologic should I use?” toward “How do I manage this patient’s integrated cardiopulmonary and infection risk over time?” That includes seasonal planning, vaccination, prophylaxis and chronic maintenance, all tailored to individual risk profiles.
- For startups: The most compelling stories may be less about single products and more about where a technology fits in the broader respiratory/infectious stack. Long-acting agents, rare pulmonary indications and tools that help stratify risk and timing (e.g., who needs what, and when) all have potential to be attractive to big pharma partners.
9. My thoughts and future outlook
Looking across the recent respiratory and infectious disease deals, it feels as though the field is moving from a fragmented landscape—separate inhalers, vaccines and antivirals—to a more consciously designed architecture of risk management. COPD inhalers, long-acting asthma biologics, rare lung disease therapies and seasonal influenza prophylaxis may look like unrelated pieces at first glance, but the pattern suggests that companies are trying to build layered defenses that stretch across seasons, disease stages and comorbidities.
For people living with chronic lung disease or recurrent infections, however, the experience is naturally much more personal. The real question is not only whether a new therapy improves FEV1 or reduces flu infections, but whether it makes it easier to climb stairs, show up for work, spend time with family or travel without constant anxiety. As the respiratory and infectious toolbox becomes richer, the challenge for developers and investors will be to design treatment strategies that are not only scientifically elegant but also sustainable and humane over the long haul. If this installment helps readers think about recent deals in that more integrated, life-centered way, then it has accomplished its purpose.
This article was prepared by the Morningglorysciences editorial team.
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