A French biotech has raised €12m to test whether GLP-1 drugs can modify osteoarthritis progression.

The funding will advance 4Moving Biotech’s lead programme, 4P004, toward a phase 2a proof-of-concept readout in knee osteoarthritis, a joint disease that causes pain and stiffness.

Despite affecting more than 600 million people worldwide, no therapy approved in Europe or the US has yet been shown to slow or modify disease progression in osteoarthritis.

4Moving Biotech is testing whether GLP-1 receptor agonists, drugs best known for diabetes and obesity, can succeed where others have fallen short.

“With this closing in place, we are well equipped to reach the next value-creation milestone by delivering robust phase 2a data and reaching a proof-of-concept inflection point,” said Luc Boblet, chief executive of 4Moving Biotech.

Rather than systemic administration, the company is testing whether GLP-1 biology can be made relevant to osteoarthritis by acting directly in the joint, targeting local inflammation and tissue responses that systemic approaches have repeatedly failed to address.

“By acting directly in the joint, 4P004 tackles pain, inflammation and tissue damage through GLP-1-mediated pathways,” said professor Francis Berenbaum, the company’s chief medical officer.

The study is designed to assess “dual efficacy: symptom relief and synovial health improvement via contrast-enhanced MRI,” which images the joint lining, with topline results expected in the second half of 2026.

The round was secured from private investors and family offices investing directly into 4Moving Biotech, a subsidiary of 4P-Pharma, and combines equity with loans, a structure the company says is aligned with long-term value creation.

It follows a €7.6m France 2030 i-Démo grant awarded last year and coincides with the transatlantic expansion of the INFLAM-MOTION phase 2a study to the US.

Founded in 2020 as a spin-off from 4P-Pharma, 4Moving Biotech has now raised around €30m in total, combining private capital with non-dilutive public funding.

The broader landscape for disease-modifying osteoarthritis drugs offers little room for overconfidence.

A 2025 review of phase two and three osteoarthritis trials found that while “many DMOADs have progressed to clinical trials, very few have made a significant impact and none have been approved for clinical use.

Reviewing eleven candidates tested between 2010 and 2024, including small molecules, biologics and cell or gene-based therapies, authors conclude that failure has been driven less by any single mechanism than by the difficulty of demonstrating truly disease-modifying benefit.

Several programmes reported statistically significant effects on either pain or joint structure, but rarely both.

The review notes that “the clinical relevance of a marginal increase in one without the other remains unclear,” warning that structural effects without symptom relief may be clinically meaningless, while pain relief without structural protection could even accelerate disease progression.

Over the past decade, major programmes at Pfizer, Eli Lilly, AbbVie, GlaxoSmithKline and Sanofi have been discontinued or deprioritised after failing to deliver regulator-acceptable evidence of disease modification.

In 2020, Unity Biotechnology reported phase two data showing that its senolytic candidate UBX0101, developed as a disease-modifying therapy for knee osteoarthritis, failed to deliver clinically meaningful improvements in pain or joint structure.

Unity subsequently discontinued its osteoarthritis programme, exited the field entirely and ceased operations in 2025.

The phase 2a readout will be the point at which the GLP-1 approach in osteoarthritis either earns its next chapter or joins a long list of programmes that fell short.

The Scottish Medicines Consortium has declined to recommend the Alzheimer’s therapy donanemab (Kisunla, Eli Lilly) for early-stage disease in NHS Scotland.

The decision affects patients with mild cognitive impairment and mild dementia caused by Alzheimer’s disease who are apolipoprotein E epsilon 4 heterozygotes or non-carriers, a genetic marker.

The consortium cited uncertainty over clinical relevance and economic viability despite clinical trial data showing statistically significant cognitive benefits over placebo for donanemab.

As a result, no disease-modifying treatment is currently available for Alzheimer’s disease within NHS Scotland, despite growing interest in amyloid-targeting treatments.

Clinical management will therefore continue to focus on symptomatic therapies, non-pharmacological interventions and supportive care.

Henry Simmons, chief executive of Alzheimer Scotland, described the ruling as “devastating for people living with dementia, their families and carers.”

He said it exposed fundamental flaws in how dementia drugs are assessed.

He called for dedicated pilot sites to test promising treatments in real-world settings before final NHS funding decisions are made, and urged the creation of a dementia drug innovation fund.

“We owe it to people who have waited decades for effective treatments to give these drugs a genuine chance to show their life-changing potential,” Simmons added.

Alzheimer’s disease affects more than 90,000 people in Scotland and is the most common form of dementia, accounting for around 66 per cent of cases.

The condition progresses from preclinical disease to severe dementia, with existing treatments limited to symptom management rather than disease modification.

Donanemab is a recombinant humanised immunoglobulin G1 monoclonal antibody, a type of targeted drug, that selectively binds to a modified form of amyloid-beta found in brain amyloid plaques, protein build-ups that are a pathological hallmark of the disease.

By targeting these plaques, the drug promotes their clearance through phagocytosis, a process where immune cells remove debris.

The recommended regimen consists of intravenous infusions every four weeks, starting with 700 milligrams for the first three doses, followed by 1,400 milligrams thereafter. Therapy should be discontinued if patients progress to moderate Alzheimer’s disease before completing treatment.

Treatment continues until amyloid plaque clearance is confirmed, or for a maximum of 18 months.

The phase three TRAILBLAZER-ALZ 2 study showed that donanemab slowed cognitive and functional deterioration at 76 weeks compared with placebo.

The trial enrolled 1,736 patients with gradual and progressive memory changes, amyloid pathology confirmed by PET imaging and specific tau pathology markers.

The primary endpoint measured changes in integrated Alzheimer’s Disease Rating Scale scores, which measure both cognition and daily function.

However, consortium clinical experts noted that this scale and the Clinical Dementia Rating Scale-Sum of Boxes are not routinely used in UK clinical practice, and views differed on whether changes exceeding 20 per cent on these scales represent clinically meaningful improvement for patients and families.

Amyloid-related imaging abnormalities were identified as the main safety concern.

ARIA-E, which refers to oedema or effusions, occurred in 24 per cent of patients receiving donanemab compared with 1.9 per cent of those receiving placebo, whilst ARIA-H, microhaemorrhages, occurred in 20 per cent versus 7.4 per cent respectively.

Most radiographic events developed within 24 weeks of treatment initiation, although they can occur at any time.

This necessitates brain MRI scans before treatment and during use, in line with the summary of product characteristics.

The committee expressed significant uncertainty about the “modest” clinical benefits observed in trials and how these would translate into real-world practice.

Implementation would also require substantial changes to services, including PET scans or cerebrospinal fluid analysis to verify beta-amyloid pathology, genetic testing for apolipoprotein E epsilon 4 status and regular MRI monitoring.

Clinical experts consulted by the consortium emphasised that these requirements would have major service implications and require considerable additional clinical capacity.

The rejection was driven largely by insufficient cost-effectiveness data.

Although the manufacturer estimated 422 eligible patients in the first year, rising to more than 2,100 by year five, the committee concluded that the long-term economic impact was disproportionate to the benefits offered.

This decision aligns with similar recent rulings by the National Institute for Health and Care Excellence in England and Wales.

Donanemab has, however, received regulatory approval for private use from the Medicines and Healthcare products Regulatory Agency.