This report maps the immunology and inflammation competitive landscape across ~15.4K active programs as of Q3 2026, with ~2.3K approved and a pipeline crowded on every axis. Small molecules lead at ~6K programs, followed by mAbs at ~1.3K, with bispecifics (~450) and CAR-T (~320) arriving as newer entrants. CD19, JAK, and TNF are the most targeted pathways, each above 300 programs.

Every top pharma builds across many mechanisms rather than defending a single target. The field has moved from single-pathway biologics through orals to degraders, bispecifics, and cell therapies. 2026 is on track to set the record for annual I&I M&A deal value, with ~$325B disclosed across 172 deals since 2021.

The report breaks the landscape into five indication-level views. Type-2 and allergic is the busiest battleground, anchored by Dupixent's ~$14B franchise with durability and off-treatment remission emerging as the next axes. Psoriatic and axial is mature, with differentiation shifting to route of administration and long-interval dosing. IBD is concentrated in UC and CD, with TL1A entering as a new mechanism. Rheum/connective tissue covers a fragmented set of indications from RA (~$13.3B) through lupus, Sjogren's, and IgA nephropathy. Neuro-inflammatory is a frontier where novel MOAs are migrating in fast, with anti-CD20 and FcRn anchoring MS and myasthenia while cell therapy and BTK arrive from adjacent lanes.

Sleuth perspectives cover Humira's biosimilar pricing delay and what it means for Dupixent LOE, why efficacy headroom and biosimilar risk (not market size) decide which indications have real white space, how durability and one-time immune reset are becoming the next value axis, why orals win only after matching biologic efficacy with clean safety, tulisokibart's response biomarker as I&I's first patient-selection tool, and how cascade depth determines whether a molecule can migrate indications. Looking ahead, we expect value to migrate to patient selection over molecule, durability to compress into one-time resets, and the next I&I franchise to emerge from a mid-sized indication rather than a large established market.