Mid-sized molecules: The new frontier for biopharma and CDMOs

The rise of mid-sized molecules is visible in both approvals and the pipeline. We define "mid-sized" molecules as synthetic therapeutics that are larger and more complex than conventional small molecules: macrocyclic peptides, protein degraders and other complex molecules. After decades of R&D, the science is getting clinical validation. Vepdegestrant became the first FDA-approved PROTAC in 2026, while icotrokinra became the first targeted oral IL-23R peptide. The pipeline is growing with close to 2000 programs globally with over $200 Bn TAM. Mid-sized molecules could expand what is druggable: large enough to disrupt protein-protein interactions, yet in some cases small and permeable enough to reach intracellular targets or be taken orally. J&J's icotrokinra delivered ~70% IGA 0/1 and ~55% PASI 90 at Week 16 in Phase III studies;