Top 200 Medicines Report 2024: Clash of the titans
Top 200 Medicines Report 2024: Clash of the titans
By Andrew Humphreys | [email protected]
Keytruda is breaking new barriers as the top-selling pharmaceutical medicine. Marketed by Merck, the checkpoint inhibitor Keytruda in 2023 became the first-ever prescription product to exceed $25 billion in annual sales, generating an impressive $4.07 billion increase compared to the drug’s 2022 tally of nearly $20.94 billion.
The anti-programmed death receptor-1 (PD-1) therapy works by increasing the ability of the body’s immune system to help detect and fight tumor cells. The humanized monoclonal antibody blocks the interaction between PD-1 and its ligands, PD- L1 and PD-L2, thereby activating T lymphocytes which may impact tumor cells and healthy cells. Merck has the industry’s largest immuno-oncology clinical research program, with more than 1,600 studies assessing Keytruda across a wide range of cancers and treatment settings. The Food and Drug Administration’s marketing clearance in June 2024 for Keytruda (pembrolizumab) as the first anti-PD-1 therapy approved in combination with chemotherapy for adults with primary advanced or recurrent endometrial carcinoma regardless of mismatch repair status marked the product’s 40th approved indication in the United States. The medicine’s key patent is protected from expiration until 2028.
As the blockbuster medication continues to accumulate new indications, the massive sales momentum produced by Keytruda continues on in 2024. Merck reported first-half sales totaling about $14.22 billion, representing an 18 percent improvement versus same-time 2023. Analysts at Evaluate Ltd told Med Ad News that Keytruda is on track to generate worldwide sales of $28.65 billion for full-year 2024, which would represent over $11 billion more than the total for the next closest projected brand, the weight-loss phenomenon Ozempic. The Novo Nordisk medicine is projected to produce sales of roughly $17.48 billion for 2024, according to Evaluate’s forecast model. Ozempic sales have skyrocketed in recent years, coming in at $4.89 billion during 2021, $8.67 billion in 2022, and $13.89 billion for last year.
Ozempic (semaglutide) leads Novo Nordisk’s portfolio of GLP-1 based therapies for type 2 diabetes and chronic weight management, which represent the trendiest drug class in the United States. Another hot seller for the Danish pharmaceutical company is the obesity medicine Wegovy, which additionally is composed of the active chemical semaglutide. Introduced in the United States during June 2021, Wegovy produced global sales of about $4.55 billion throughout the course of 2023. “Sales of front-runner Wegovy, a household name barely three years post-launch, are expected to triple over the next five years,” according to analysis from Evaluate’s 2024 World Preview Report that was released during July.
Projecting the top 10 sellers around the globe in 2030, Evaluate has Ozempic slated to be No. 1 worldwide and Wegovy landing in seventh place. Lilly’s tirzepatide-based products Mounjaro for type 2 diabetes and Zepbound for chronic weight management are forecast to come in third and fifth place at the start of the next decade. Mounjaro was one of the most impressive performers in Med Ad News’ Top 200 Medicines Annual Report, with sales increasing from $483 million in 2022 to $5.16 billion during 2023. Mounjaro’s momentum has grown during 2024, with Q1 sales coming in at nearly $1.81 billion. After being launched in the United States during November 2023, Lilly reported Q1 2024 Zepbound sales of $517 million.
According to Evaluate, ranking in between Lilly’s two tirzepatide drugs in fourth place for 2030 with projected sales of $20.2 billion would be CagriSema, which is being developed by Novo Nordisk. With a net present value of about $80 billion, the follow-on combination CagriSema (semaglutide and the amylin analog cagrilintide) is rated as the most valuable pipeline candidate in the pharma industry per Evaluate’s 2024 World Preview Report. Not surprisingly, the No. 2 and 3 most valuable pipeline candidates per Evaluate are also anti-obesity prospects: Lilly’s oral GLP-1 product orforglipron and “triple-G” drug retatrutide, which hits GLP-1, GIP, and the glucagon receptor (GCGR).
Metabolic disease products are anticipated by Evaluate analysts to likely dominate the top medicine ranks beyond 2030. “Five metabolic diseases drugs will by 2030 scoop in over $100 billion combined, dominating the top 10 drug ranking. Those are Ozempic and Mounjaro in diabetes, analogs Wegovy and Zepbound for obesity, plus the follow-on combination CagriSema. More than 1 billion people worldwide – including 50 percent of all U.S. adults – are classified as obese. These treatments not only help reduce weight but are also shown to cut the risk of related conditions including heart, liver, and kidney disease. So $100 billion may not be the ceiling,” stated Evaluate’s 2024 World Preview Report.
Outside of the oncology and the GLP-1 settings, a variety of other medicines continue to help pace the leading sales generators around the globe. The top-selling medicine of all-time, AbbVie’s autoimmune diseases drug Humira ranked No. 2 globally during 2023 despite the loss of roughly $7.06 billion in worldwide sales (including sales in Japan reported by Eisai) compared to the product’s 2022 performance after losing U.S. patent exclusivity. Evaluate forecast models show the tumor necrosis factor blocker will drop out of the top five product rankings in 2024. For Humira (adalimumab), AbbVie reported first-half 2024 net revenue of $5.08 billion worldwide, representing a 32.7 percent year-0ver-year decrease.
The No. 1 prescribed oral blood thinner Eliquis (apixaban) produced sales of about $12.21 billion for Bristol Myers Squibb during 2023, coming in fourth place on Med Ad News’ listing in this report. Eliquis sales in first-half 2024 were reported at nearly $7.14 billion. Evaluate projects that Eliquis will rank fourth among the best sellers in 2024.
Expected to come in third place on Evaluate’s top products list for calendar-year 2024 is the monoclonal antibody Dupixent (dupilumab). The Sanofi and Regeneron medicine is used for allergic diseases including atopic dermatitis, asthma, and nasal polyps that lead to chronic sinusitis. Dupixent is additionally used as a treatment for eosinophilic esophagitis and prurigo nodularis. Global sales rose from about $5.68 billion in 2021 to $8.97 billion during 2022 to $11.59 billion for 2023 per the Med Ad News data vault. Dupixent sales for the first six months of 2024 totaled about $6.63 billion, according to Regeneron.
Evaluate projects that Dupixent will be the world’s No. 2 seller in 2030. “… the pipeline-in-product will sell over $22 billion in 2030 as it collects approvals beyond asthma, eczema, and most recently, eosinophilic esophagitis. The drug’s average annual growth of almost 10 percent banks an anticipated approval in chronic obstructive pulmonary disease: recent Phase III data showed the IL-4/IL-13 inhibitor significantly reduces exacerbations and improves lung function in some COPD patients.”
Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) finished in fifth place on Med Ad News’ ranking compilation for calendar-year 2023 with sales of $11.85 billion. Evaluate trackers estimate that Biktarvy will be the No. 5 seller globally during 2024. The fixed-dose combination antiretroviral medication is marketed by Gilead Sciences for the treatment of HIV/AIDS. Gilead reported Q1 2024 sales of nearly $2.95 billion.
A pair of medicines for RSV made a big splash during their 2023 market debut. Arexvy from GSK generated nearly $1.06 billion in sales after the drug’s U.S. launch during the third quarter. The Pfizer vaccine Abrysvo had a strong launch with abbreviated 2023 sales of $890 million after winning FDA marketing clearance on Aug. 21.
And not to be forgotten, 2023 was a down sales year for COVID-19 products. Three of them that appeared on Med Ad News’ Top 200 Medicines list for the 2022 sales year fell off the chart for the 2023 calendar term: Xevudy from GSK, Vaxzevria/Covishield from AstraZeneca, and Lilly’s bamlanivimab/etesevimab/bebtelovimab grouping. The 2022 global sales leader at $37.81 billion, Pfizer’s Comirnaty produced $11.22 billion in 2023. Pfizer’s Paxlovid (nirmatrelvir and ritonavir) dropped from $18.93 billion to $1.28 billion. Sales for Moderna’s messenger RNA molecule Spikevax fell from $18.44 billion in 2022 to $6.67 billion. Merck’s Lagevrio (molnupiravir) plummeted from $5.68 billion to $1.43 billion. Gilead’s Veklury (remdesivir) sales dropped from $3.91 billion to $2.18 billion during 2023. REGEN-COV/Ronapreve sales from Regeneron and Roche decreased from $3.64 billion in 2022 to $1.2 billion. AstraZeneca’s Evusheld sales amounted to $1.07 billion in 2023 versus the previous year’s total of $2.19 billion. Sales for J&J’s Janssen COVID-19 Vaccine went down from $2.18 billion in 2022 to nearly $1.12 billion.
The listing of the Top 200 Medicines based on global sales during 2023 is available in the Med Ad News August 2024 digital edition.
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MedAdNews: What are projected to be the top five prescription drugs in global sales for the entirety of calendar-year 2024?
 Figure 1 MedAdNews: What are some of the anti-obesity pipeline candidates and potentially new R&D technologies behind them that consumers can look forward to beyond the current marketplace leaders?
See from the World Preview report (right), which shows a mix of therapeutic categories, but no single one will have a comparable impact to the obesity drugs. MedAdNews: What is propelling a rejuvenated CNS drug segment? Clinical data. Breakthroughs in schizophrenia and Alzheimer’s disease following years of failures that led to large pharma companies reprioritizing resources away. In part these are due to an improved understanding of certain diseases, although there is a large slice of persistence and smart decision making, learning from failures. It is too soon to say that we are in a new era of precision neurology, but successes encourage reinvestment, and we will begin to better segment patients according to biomarker-based definitions of disease. MedAdNews: What factors are driving the fast-growing ADC and radiopharmaceutical segments? Clinical data. Breakthroughs in NSCLC (Enhertu) and prostate cancer (Pluvicto), alongside their commercial prospects, are leading others to reevaluate these modalities and conduct a healthy amount of deal-making to catch up. This drives investment into new start-ups seeking to improve upon current platforms, and the next wave of deal-making. |
Andrew Humphreys is contributing editor of PharmaLive and Med Ad News.
