I've spoken about fragment-based drug design and ligand efficiency here a few times. There's a new paper in J. Med. Chem. that puts some numbers on that latter concept. (Full disclosure - I've worked with its author, although I had nothing to do with this particular paper).
For the non-chemists in the crowd who want to know what I'm talking about, fragment-based methods are an attempt to start with smaller, weaker-binding chemical structures than we usually work with. But if you look at how much affinity you're getting for the size of the molecules, you find that some of these seemingly weaker compounds are actually doing a great job for their size. Starting from these and building out, with an eye along the way toward keeping that efficiency up, could be a way of making better final compounds than you'd get by starting from something larger.
Looking over a number of examples where the starting compounds can be compared to the final drugs (not a trivial data set to assemble, by the way), this work finds that drugs, compared to their corresponding leads, tend to have similar to slightly higher binding efficiencies, although there's a lot of variability. They also tend to have similar logP values, which is a finding that doesn't square with some previous analyses (which showed things getting worse during development). But drugs are almost invariably larger than their starting points, so no matter what, one of the keys is not to make the compounds greasier as you add molecular weight. (My "no naphthyls" rule comes from this, actually).
There are a few examples of notably poor ligand-efficient starting structures that have nonetheless been developed into drugs. Interestingly, several of these are the HIV protease inhibitors, with Reyataz (atazanavir) coming in as the least ligand-efficient drug in the whole data set. A look at its structure will suffice. The wildest one on the list appears to be no-longer-marketed amprenavir, whose original lead was 53 micromolar and weighed over 600, nasty numbers indeed. I would not recommend emulating that one. In case you're wondering, the most ligand efficient drug in the set is Chantix (varenicline).
In the cases where ligand efficiency actually went down along the optimization route, inspection of the final structures shows that in many cases, the discovery team was trading efficiency for some other property (PK, solubility, etc.) To me, that's another good argument to make things as efficient as you can, because that gives you something to trade. A big, chunky, lashed-together structure doesn't give you much room to maneuver.