Every day, one story that matters, broken down into three numbered scenarios, each with its own probability. Never fixed — it shifts as the situation changes.
Scénario
Friday, science
Neuropathy: Research Moves Forward, Treatments Stall
Publié le 18 septembre 2026
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The question at hand
Dozens of clinical trials are underway: could a treatment that stops the disease, rather than just numbing it, arrive before 2030?
The facts
The term "neuropathy" refers to damage to the peripheral nerves, the ones that connect the spinal cord to the hands, feet or organs. Behind this single word lie dozens of distinct diseases: some stem from diabetes, others from chemotherapy, from the immune system attacking its own nerves, or from a genetic mutation passed down through families. This diversity of causes is not a minor detail: it explains why, despite very active research, there is almost never a single treatment that works for everyone. A drug designed for an autoimmune neuropathy, for instance, has no reason to work on a genetic neuropathy, even if the symptoms look similar on the surface.
Understanding it
"Neuropathy" covers dozens of diseases with completely different causes, not just one.
Poorly controlled diabetes, chemotherapy, an immune system attack, or an inherited genetic mutation can each damage nerves in very different ways. It's as if "fever" referred at once to the flu, appendicitis, and an allergic reaction: the symptom looks similar, but treating the cause requires a completely different approach each time. This is why a single clinical trial can almost never apply to all forms of neuropathy at once.
By far the most common cause remains diabetes. The International Diabetes Federation counts 589 million adults living with diabetes worldwide in 2024, or 11.1% of the adult population aged 20 to 79, a figure that could climb to 853 million by 2050 according to official projections. Diabetic neuropathy is the most common complication of this disease: it is estimated that around 50% of diabetic patients develop neuropathy after 25 years of living with diabetes, although studies show highly variable figures, ranging from 8% to nearly 60% depending on the diagnostic criteria used. This huge range is not a measurement error: it reveals that there is still no single, widely shared medical definition of exactly what an early-stage diabetic neuropathy is.
In terms of treatment, most of what is currently prescribed to patients remains symptomatic: this means the pain or tingling is eased, without addressing the underlying cause or preventing the nerves from continuing to deteriorate. A true curative treatment would either treat the disease causing the damage, stop the progression of the nerve damage, or allow the damaged nerve to regenerate. These four goals — relieving symptoms, treating the cause, stopping progression, and regenerating nerves — are often conflated by the general public, even though they correspond to completely different scientific strategies, with very uneven levels of difficulty and risk depending on the disease targeted.
Recent news illustrates this difficulty well. In June 2026, the pharmaceutical company Sanofi announced the discontinuation of its phase 3 trial called MOBILIZE, which was testing riliprubart against chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)*, a rare autoimmune neuropathy. An independent monitoring committee judged that the trial, which involved around 140 patients, would not deliver sufficient efficacy to continue, despite encouraging results from the earlier phase 2 trial. No safety signal was detected: the drug was not dangerous, it simply was not effective enough to justify continuing. Another trial of the same drug, VITALIZE, conducted in patients already treated with immunoglobulins, remained under evaluation after this setback, with no automatic halt or announced timeline.
Understanding it
Easing the pain, treating the cause, stopping the worsening, or regenerating the nerve: four very different goals.
Most current treatments simply ease the pain, somewhat like a painkiller for an untreated fracture. Sanofi's trial aimed for a far more ambitious goal: stopping the progression of the disease itself, not just its symptoms. Its failure shows just how much more difficult this second goal remains, even today, compared with the first.
This episode is not isolated: it is a textbook case of what makes this field so slow to produce concrete results for patients. Moving from a promising phase 2 trial to a confirmed phase 3 is a classic hurdle in medicine, but it is particularly pronounced for rare neuropathies like CIDP, where the number of patients available for a trial remains limited and where the disease progresses very unevenly from one individual to another. Other avenues are advancing in parallel, such as the experimental gene therapy ST-503, being tested in a clinical trial and aiming to directly suppress the Nav1.7 gene, responsible for transmitting pain signals, in patients suffering from small fiber neuropathy resistant to conventional treatments. In France, an Inserm research unit is developing AAV* viral vectors for Charcot-Marie-Tooth disease type 2, a genetic neuropathy, as well as RNA interference nanomedicines for other hereditary forms.
It is precisely this accumulation of contradictory signals — real and documented scientific leads on one side, phase 3 trials that regularly fail on the other — that makes the field's medium-term future uncertain. A favorable scenario would see at least one of these leads gain regulatory approval before 2030 for a specific form of neuropathy. A more cautious scenario, considered the most likely by industry experts, would see research continue to progress without any breakthrough changing the lives of the majority of patients. A worse-case scenario would see failures pile up instead, while the number of people affected keeps growing alongside the global rise of diabetes.
Adults living with diabetes worldwide (2024)589 million projected to reach 853 million by 2050 (IDF, Diabetes Atlas)
Prevalence of neuropathy after 25 years of diabetesaround 50% range of 8-60% depending on the study, rising with age and duration of diabetes
Favorable, stable, or degraded
Neuropathies : vers un vrai traitement d'ici 2030 ?
What we're assessing
FavorableUn traitement ciblé obtient une approbation réglementaire pour une neuropathie précise avant 2030.
StableLa recherche progresse scientifiquement mais les soins restent très majoritairement symptomatiques.
DégradéLes essais cliniques échouent en série tandis que le nombre de patients touchés continue d'augmenter.
Favorable
25%
Unlikely
A targeted treatment is approved before 2030
In this scenario, at least one lead currently in clinical trials clears all regulatory hurdles before 2030 for a specific form of neuropathy, whether genetic or autoimmune. This could be a gene therapy like those being developed by Inserm for Charcot-Marie-Tooth disease, or an approach like ST-503, which directly targets the Nav1.7 pain gene. The common thread among these leads is that they never target all neuropathies at once, but rather a specific, well-characterized form, which increases their chances of success in clinical trials.
This scenario remains a minority outcome compared with the stable scenario, since Sanofi's riliprubart failure in June 2026 shows that a successful move from phase 2 to phase 3 is far from automatic, even for a company with considerable resources. It also differs from the worse-case scenario on a specific point: gene therapies targeting a single mutation, like those aimed at Charcot-Marie-Tooth, are scientifically simpler to validate than a drug targeting an autoimmune disease with more diffuse mechanisms, such as CIDP.
Indicators affected
Adultes diabétiques dans le monde589 millions, en hausse vers 853 millions en 2050→589 millions (2024)
Prévalence de la neuropathie après 25 ans de diabèteenviron 50%, mais un sous-groupe de patients bénéficie enfin d'un traitement curatif ciblé↓environ 50% (2026, sans traitement curatif disponible)
The France angleInserm, already positioned in gene therapy for genetic neuropathies, could be among the first to validate an approach of this kind. ↑ Fairly favorable for France.
Stable
55%
Fairly likely
Research advances, care remains symptomatic
This scenario is a continuation of the current situation: phase 2 trials keep yielding encouraging results, new gene therapy and neuroprotection leads are published regularly, but none crosses the threshold of a treatment widely available to the majority of patients. A person with diabetic neuropathy or CIDP continues, in this case, to receive mainly pain treatments, without the progression of their disease being truly halted by an approved drug.
This scenario differs from the favorable one in that no full regulatory pathway is completed by 2030: the scientific evidence exists, but turning a promising trial into an approved drug has historically taken more than ten years. It differs from the worse-case scenario because it assumes research keeps moving forward regardless, without a collapse in the number of ongoing trials or a string of failures comparable to what Sanofi experienced in 2026.
Indicators affected
Adultes diabétiques dans le monde589 millions, en progression continue vers 853 millions en 2050↑589 millions (2024)
Prévalence de la neuropathie après 25 ans de diabèteenviron 50%, essentiellement traitée par des symptomatiques, sans recul du chiffre→environ 50% (2026)
The France angleFrench patients continue to be treated with symptomatic treatments, without access to a widely available curative therapy. ↓ Fairly unfavorable for France.
Degraded
20%
Unlikely
Trials fail, patient numbers rise
In this scenario, several major clinical trials fail in the coming years along the lines of Sanofi's riliprubart discontinuation in June 2026, with no breakthrough reaching the market. At the same time, the continued rise in the number of people with diabetes worldwide, projected to reach 853 million by 2050, keeps mechanically increasing the number of people affected by neuropathy, since diabetes remains its leading cause. The gap between the number of patients and the availability of curative treatments would then widen rather than narrow.
This scenario differs from the stable one in its cumulative nature: it is not just the absence of progress that defines it, but a series of failures that would discourage certain research investments, particularly in rare diseases like CIDP, where the number of patients available for new trials is already limited. It differs from the favorable scenario in that no breakthrough occurs at all, whereas the favorable scenario assumes that at least one targeted lead succeeds despite the sector's difficulties.
Indicators affected
Adultes diabétiques dans le mondeprogression accélérée, se rapprochant des 853 millions projetés dès avant 2050↑589 millions (2024)
Prévalence de la neuropathie après 25 ans de diabètesupérieure à 50%, sans nouveau traitement pour freiner la progression↑environ 50% (2026)
The France angleFrench patients with rare forms such as CIDP would see their prospects for a curative treatment set back even further. ↓ Fairly unfavorable for France.
Ordres de grandeur indicatifs pour les 3 scénarios ci-dessus, estimés avec l'information disponible à la publication et réévalués si la situation change — jamais des prévisions garanties. Learn more about our method →
Key takeaways
Could a treatment that truly stops neuropathy, rather than just numbing it, arrive before 2030?
Diabetes, the leading cause of neuropathy, already affects 589 million adults worldwide, and around half of them develop neuropathy after 25 years of living with the disease; in June 2026, the phase 3 failure of Sanofi's riliprubart against CIDP was a reminder of how difficult this field is.
No, probably not on a widespread scale: the scenario considered most likely (55%) foresees research continuing to advance without any therapeutic breakthrough replacing current symptomatic treatments by 2030.
Worth watching: the fate of the VITALIZE trial of riliprubart in patients on immunoglobulins, for which Sanofi has not yet announced a final decision since June 2026.
Fairly negative
Our assessment of the impact for France: fairly negative.with a 55% probability of a scenario where care remains symptomatic and 20% of a worse-case scenario where failures pile up, only 25% of the odds favor a curative breakthrough before 2030, which weighs on patients with rare or diabetes-related neuropathies in France.
A rare disease in which the immune system mistakenly attacks the protective sheath of the peripheral nerves, causing progressive weakness and sensory problems in the arms and legs.
AAV vector
A virus that has been modified and rendered harmless, used as a vehicle to carry a therapeutic gene into a patient's cells, a common technique in gene therapy.
