I'm SHORT $MNOV. They changed the test mid-trial to make life...
Biotech Autist@BiotechAutist
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Sep 26, 2026
~5 min read
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I'm SHORT $MNOV.
They changed the test mid-trial to make life easier.
They can't change the drug.
It fails🧵
They changed the test mid-trial to make life easier.
They can't change the drug.
It fails🧵
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2/ Quick context if you're new here.
Medicinova has a pill called MN-001. Any day now it reports a 40-person trial in diabetics with fatty livers and high blood fats.
The stock went from about $1.40 to nearly $4 this month on hype.
Here's what the dumbasses buying the top didn't read.
Medicinova has a pill called MN-001. Any day now it reports a 40-person trial in diabetics with fatty livers and high blood fats.
The stock went from about $1.40 to nearly $4 this month on hype.
Here's what the dumbasses buying the top didn't read.
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3/ The trial started in August 2022 measuring liver fat with an MRI, the accurate scan.
Seven months in, they swapped it for FibroScan, a quick ultrasound-style scan.
It's like changing referees mid-game to one with worse eyesight.
Seven months in, they swapped it for FibroScan, a quick ultrasound-style scan.
It's like changing referees mid-game to one with worse eyesight.
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4/ What the swap did:
To get in, patients used to need at least 8% liver fat on MRI. Now any fatty liver at all on FibroScan will do.
Head to head against liver biopsies, the MRI was far more accurate than FibroScan.
A blurrier ruler hides small changes. And patients with less fat have less fat to lose.
Easier to sign people up. Harder to win.
To get in, patients used to need at least 8% liver fat on MRI. Now any fatty liver at all on FibroScan will do.
Head to head against liver biopsies, the MRI was far more accurate than FibroScan.
A blurrier ruler hides small changes. And patients with less fat have less fat to lose.
Easier to sign people up. Harder to win.
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5/ Eleven days after the switch, MNOV filed a report with the SEC describing a trial that no longer existed. It still said MRI.
A year later the MRI words quietly vanished, with nothing in their place.
FibroScan's first appearance in an SEC filing: one slide, two years after the switch.
Investors paid for this trial. They found out last.
A year later the MRI words quietly vanished, with nothing in their place.
FibroScan's first appearance in an SEC filing: one slide, two years after the switch.
Investors paid for this trial. They found out last.
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6/ Now the drug they can't change.
The only human data for this drug in this disease is a tiny pilot. No placebo group. Everyone got the drug. 19 patients, when their own 2016 slides planned 40.
They stopped it early for "significant positive results." Then the actual results took nearly five years to show up publicly.
When they finally did, the main goal was flat and liver fat hadn't moved.
The only human data for this drug in this disease is a tiny pilot. No placebo group. Everyone got the drug. 19 patients, when their own 2016 slides planned 40.
They stopped it early for "significant positive results." Then the actual results took nearly five years to show up publicly.
When they finally did, the main goal was flat and liver fat hadn't moved.
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7/ And they already knew about the liver fat.
In 2022 mnov announced that "in the next study" they'd check liver fat by MRI. Like it was a fresh idea.
Then, seven months into that study, they switched to the blurrier scan anyway.
In 2022 mnov announced that "in the next study" they'd check liver fat by MRI. Like it was a fresh idea.
Then, seven months into that study, they switched to the blurrier scan anyway.
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8/ The pilot's number one goal, per its own protocol, was a cholesterol test called "cholesterol efflux."
Result: basically zero.
Search every MNOV SEC filing for "cholesterol efflux." One hit: the 2016 slide promising it. The result never made it into a single filing.
Last November they bragged about cholesterol efflux in immune cells. In cells, a miracle. In humans, a zero.
Result: basically zero.
Search every MNOV SEC filing for "cholesterol efflux." One hit: the 2016 slide promising it. The result never made it into a single filing.
Last November they bragged about cholesterol efflux in immune cells. In cells, a miracle. In humans, a zero.
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9/ The pilot's other primary: triglycerides, measured "after 12 weeks of treatment."
July 2020, more than two years after primary completion, CMO Kazuko Matsuda signed SAP v2.0. It moved the triglyceride primary to week 8.
The protocol promised the SAP "prior to database lock." The registry said 12 weeks right up until results posted.
Changing the rules one day early got $CAPR torched. Medicinova went two years late.
July 2020, more than two years after primary completion, CMO Kazuko Matsuda signed SAP v2.0. It moved the triglyceride primary to week 8.
The protocol promised the SAP "prior to database lock." The registry said 12 weeks right up until results posted.
Changing the rules one day early got $CAPR torched. Medicinova went two years late.
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10/ Same rulebook: each patient's starting triglyceride number is "the highest value" of two blood tests.
Start from someone's worst reading and the number tends to fall on its own, drug or no drug. It's like taking your "before" photo right after Thanksgiving dinner.
The new trial has a placebo group. That free drop goes to both groups now.
Start from someone's worst reading and the number tends to fall on its own, drug or no drug. It's like taking your "before" photo right after Thanksgiving dinner.
The new trial has a placebo group. That free drop goes to both groups now.
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11/ So how much did triglycerides really fall? Their own protocol measures each patient's percent change.
What they posted publicly: about 22%.
What they put on the investor slide: 40.2%.
The slide math lets the patients who started highest count the most. Same data. Nearly double the number. Magic.
What they posted publicly: about 22%.
What they put on the investor slide: 40.2%.
The slide math lets the patients who started highest count the most. Same data. Nearly double the number. Magic.
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12/ Why only diabetics in the new trial?
A post-hoc split of those same 19 open-label patients. Diabetics looked better. p-value: 0.098.
Their deck and their 10-K can't even agree on what that 0.098 is testing.
They built a whole new trial on it.
A post-hoc split of those same 19 open-label patients. Diabetics looked better. p-value: 0.098.
Their deck and their 10-K can't even agree on what that 0.098 is testing.
They built a whole new trial on it.
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13/ Say the drug works anyway.
Medicinova says it blocks one of the same enzymes as cilostazol, an old generic pill. Cilostazol's FDA label: triglycerides down 15% versus placebo.
It also carries the FDA's scariest warning: don't give it to heart failure patients.
Best case, they spent ten years reinventing a generic with a black box.
Medicinova says it blocks one of the same enzymes as cilostazol, an old generic pill. Cilostazol's FDA label: triglycerides down 15% versus placebo.
It also carries the FDA's scariest warning: don't give it to heart failure patients.
Best case, they spent ten years reinventing a generic with a black box.
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14/ And even a win is a dead end.
In 2016 the FDA said lowering triglycerides in people on statins doesn't prove a drug prevents heart attacks or strokes. It stripped two drugs of part of their approval over it.
The first study the FDA cited was in type 2 diabetics. The same kind of patients as this trial.
In 2016 the FDA said lowering triglycerides in people on statins doesn't prove a drug prevents heart attacks or strokes. It stripped two drugs of part of their approval over it.
The first study the FDA cited was in type 2 diabetics. The same kind of patients as this trial.
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15/ Now the ALS story they will hide behind when MN-001 misses. Readout in December.
MNOV's own CMO co-authored an earlier open-label study of this drug in ALS at up to 100 mg a day.
31% of patients quit over drug-related side effects. No significant reduction in PET signal or neurofilament.
COMBAT-ALS runs the same top dose.
MNOV's own CMO co-authored an earlier open-label study of this drug in ALS at up to 100 mg a day.
31% of patients quit over drug-related side effects. No significant reduction in PET signal or neurofilament.
COMBAT-ALS runs the same top dose.
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16/ Hear it from their own business chief.
David Crean, this month, on the small ALS study that launched the big trial: "It was small. The treatment groups were imbalanced." The results were "not truly definitive evidence of efficacy."
Then he brought up Relyvrio, the ALS drug pulled after its big trial flopped. Bold move for a sales pitch.
David Crean, this month, on the small ALS study that launched the big trial: "It was small. The treatment groups were imbalanced." The results were "not truly definitive evidence of efficacy."
Then he brought up Relyvrio, the ALS drug pulled after its big trial flopped. Bold move for a sales pitch.
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17/ Follow the money.
Dec 29, 2025: MNOV hires Lucid Capital Markets to sell up to $50 million of new stock, for a 3% cut.
Jan 5, 2026: Lucid starts publishing research on the stock.
Aug 19, 2026, six weeks before results: new contracts for CEO Yuichi Iwaki and Matsuda. If Iwaki is pushed out around a sale, he walks with two years of pay plus two years of bonus.
Everybody gets paid. Except you.
Dec 29, 2025: MNOV hires Lucid Capital Markets to sell up to $50 million of new stock, for a 3% cut.
Jan 5, 2026: Lucid starts publishing research on the stock.
Aug 19, 2026, six weeks before results: new contracts for CEO Yuichi Iwaki and Matsuda. If Iwaki is pushed out around a sale, he walks with two years of pay plus two years of bonus.
Everybody gets paid. Except you.
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18/ And they're already bracing you. Same talk, two weeks before the data: a negative MN-001 result "would not determine the outcome" of the ALS trial.
When a company tells you a result doesn't matter right before it lands, it's not because they're optimistic.
When a company tells you a result doesn't matter right before it lands, it's not because they're optimistic.
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19/ They've done this before. March 2007, same CEO.
Headline: "MediciNova Announces Positive Clinical Results."
Third paragraph: the drug missed the main goal the trial was designed to hit.
Their 2007 deck promised the next big MS trial "as early as 08Q2." Kids born that quarter can vote now. Still no big MS trial.
Headline: "MediciNova Announces Positive Clinical Results."
Third paragraph: the drug missed the main goal the trial was designed to hit.
Their 2007 deck promised the next big MS trial "as early as 08Q2." Kids born that quarter can vote now. Still no big MS trial.
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20/ Scoreboard: $443.6 million lost since they started. Approved drugs: zero.
This trial misses. Short it.
And if the headline says "positive" anyway, short more. Yuichi Iwaki has done it before.
$MNOV goes to $1-1.5.
This trial misses. Short it.
And if the headline says "positive" anyway, short more. Yuichi Iwaki has done it before.
$MNOV goes to $1-1.5.
