2025 Pharma M&A: 20 Deals, $95.3B

Patent cliffs forced pharma's hand. The result was the most active dealmaking year in a decade - 20 acquisitions worth $95.3B in total potential value. Here are the themes that defined the year.

Updated April 2026 - TheraRadar Intelligence

Every deal at a glance

Theme 1: Patent cliff defense drove the biggest checks

Merck wrote two of the year's largest checks - $10B for Verona Pharma's COPD drug Ohtuvayre and $9.2B for Cidara's flu antiviral CD388 - totaling $19.2B, all to insulate itself from Keytruda's looming patent cliff. Keytruda generated $31.7 billion in 2025 sales (48% of Merck's revenue), and its biologics exclusivity expires in 2028. Rather than defend a single franchise, Merck diversified into respiratory and infectious disease. It would add a third deal in early 2026 - Terns Pharmaceuticals ($6.7B) for a CML drug - bringing total cliff defense spending to over $26B.

Sanofi showed a similar pattern. Facing Dupixent's potential 2030 patent cliff, it spent $14B across four acquisitions - Blueprint Medicines ($9.5B, rare disease), Dynavax ($2.2B, vaccines), ViceBio ($1.6B, vaccine platform), and Vigil ($590M, Alzheimer's). Four different therapeutic areas in seven months.

Theme 2: The MASH gold rush - two FGF21 deals in three weeks

In September and October 2025, two of the world's largest pharma companies made competing bets on the same biology. Roche paid $3.5B for 89bio's pegozafermin on September 18. Three weeks later, Novo Nordisk paid $5.2B for Akero's efruxifermin on October 9. Both are FGF21 analogs. Both target MASH with advanced fibrosis and cirrhosis. Both are in Phase 3.

MASH affects 5-7% of the global adult population, and over 75% of patients have comorbidities like obesity and type 2 diabetes. There are no approved therapies that halt or reverse fibrosis progression. Both FGF21 analogs have shown anti-fibrotic and anti-inflammatory effects - efruxifermin is the only treatment to show significant fibrosis regression in Phase 2 in compensated cirrhosis (F4).

Roche's CVR structure tells the story of its ambition: the final milestone triggers at $4 billion in annual global sales. That would make pegozafermin one of the best-selling drugs in history. Novo Nordisk, which already dominates metabolic disease through its GLP-1 franchise, sees efruxifermin as complementary - addressing liver damage that GLP-1s alone cannot reverse.

Theme 3: The CNS renaissance

For years, pharma retreated from neuroscience - the biology was too complex, the trial failures too expensive. 2025 marked the reversal. Johnson & Johnson opened the year with the largest deal of 2025: $14.6B for Intra-Cellular Therapies and its approved antipsychotic Caplyta, announced at JPM 2025. It was a bet on Caplyta's expansion into major depressive disorder.

AbbVie followed with a $1.2B acquisition of Gilgamesh's bretisilocin, a next-generation psychedelic compound for MDD. The drug is designed to deliver the therapeutic benefits of psychedelics - rapid, durable antidepressant effects - without the hours-long psychoactive experience that limits current agents.

Sanofi's $590M acquisition of Vigil added an oral TREM2 agonist for Alzheimer's - a novel approach that targets microglial dysfunction rather than amyloid plaques. These three deals signal that pharma sees a path through the historical difficulty of CNS drug development.

Theme 4: Platform bets - buying the engine, not just the drug

Several 2025 deals weren't about a single drug - they were about acquiring entire technology platforms. Novartis paid $12B for Avidity Biosciences and its Antibody Oligonucleotide Conjugate (AOC) platform, gaining three late-stage programs for muscular dystrophy plus a delivery system that could extend to other diseases. Genmab paid $8B for Merus and its Multiclonics bispecific antibody platform, not just the lead asset petosemtamab.

Pfizer's $9.8B Metsera acquisition was explicitly a platform play - gaining both a monthly GLP-1 (MET-097i) and a monthly amylin analog (MET-233i), plus the sustained-release delivery technology that enables long-acting injectables. Sanofi's ViceBio deal ($1.6B) brought the Molecular Clamp vaccine technology that could enable rapid development of combination respiratory vaccines.

The common thread: paying a premium today for optionality tomorrow. These platforms can generate multiple products across indications, making the initial price tag look small if even one follow-on program succeeds.

Theme 5: Invest first, acquire later

A pattern emerged in 2025 that accelerated into 2026: pharma companies making strategic equity investments, securing rights of first negotiation, then converting those positions into full acquisitions once data matured.

Sanofi made a $40M investment in Vigil in June 2024, including exclusive right of first negotiation. Eleven months later, it acquired Vigil for $590M. Lilly invested in Ajax's Series C in 2024, then acquired the company for $2.3B in April 2026. Gilead partnered with Arcellx in 2022, expanded the deal in 2023, then bought the remaining 88% for $7.8B in 2026.

This approach reduces risk for the acquirer (they see the data before committing) and provides non-dilutive capital to the biotech (funding operations while the partnership develops). Expect this playbook to become standard.

What targets did pharma buy?

The targets pharma chose to acquire reveal where the industry sees the next generation of blockbusters. Two FGF21 analogs for MASH ($8.7B combined). Two mRNA platforms for oncology and infectious disease ($2.5B). PCSK9 gene editing for cardiovascular disease ($1.3B). A pan-mutation KIT inhibitor for a cancer that hasn't had a new standard of care in 20 years ($1.15B).

The pattern is clear: pharma is buying into validated biology where first-generation drugs have proven the mechanism but left room for improvement. FGF21 for MASH, mutant-selective PI3Ka for breast cancer, pan-KIT for GIST, next-gen anti-IgE for allergy - each is a bet on doing what exists, but better.

Active trials for acquired programs

Acquisitions don't stop trials - they accelerate them. Across the 20 deals, 18 acquired programs have matching clinical trials in ClinicalTrials.gov, with 34 actively recruiting or running.

Top acquirers of 2025

Merck was the biggest spender of 2025, deploying $19.2B across two deals - Verona Pharma ($10B) for the first-in-class COPD drug Ohtuvayre and Cidara Therapeutics ($9.2B) for the long-acting flu antiviral CD388. Both acquisitions diversify Merck beyond Keytruda before its 2028 patent cliff.

Johnson & Johnson made the single largest deal of the year - $14.6B for Intra-Cellular Therapies and its approved antipsychotic Caplyta, announced at JPM 2025. Sanofi was the most active by deal count, closing four acquisitions totaling $13.9B across rare disease (Blueprint, $9.5B), Alzheimer's (Vigil, $590M), vaccines (ViceBio, $1.6B and Dynavax, $2.2B).

Novartis made one bet but a big one - $12B for Avidity Biosciences and its RNA therapeutics platform for muscular dystrophy. Pfizer re-entered the obesity race with its $9.8B Metsera acquisition after abandoning its in-house oral GLP-1. Genmab made its largest-ever acquisition, paying $8B for Merus and the bispecific antibody petosemtamab in head and neck cancer.

Eli Lilly seeded what became a 2026 buying spree with three 2025 deals: Scorpion ($2.5B, PI3Ka inhibitor), Verve ($1.3B, PCSK9 gene editing), and Adverum ($322M, ocular gene therapy). Smaller but strategic bets that signaled Lilly's intent to build a genetic medicine platform.

Where the money went

What it means for 2026

The 2025 M&A wave wasn't a one-off. It was driven by structural forces - patent cliffs, pipeline gaps, and the maturation of new modalities like gene editing, in vivo cell therapy, and RNA therapeutics - that will persist for years.

Early 2026 confirmed this. In the first four months alone, pharma announced 27 more acquisitions worth over $80B. Lilly has been the most aggressive, spending $24B across 8 deals to build a genetic medicine platform from scratch. The targets pharma is buying - FGF21, NLRP3, OX2R, TREM2, PI3Ka - point to where the industry believes the next generation of blockbusters will come from.

For biotech, the signal is clear: differentiated science in validated targets attracts premium valuations. The median deal premium in 2025 was above 50%. Companies with Phase 2+ data in underserved indications are the most attractive acquisition targets, especially those where the acquirer can leverage existing commercial infrastructure.

Sources

All deals verified against primary press releases. Links to original announcements: