As AbbVie’s Humira (adalimumab) tops the biggest-selling drug list again in 2018, it is hard to see where any challenger might come from to snatch the autoimmune disorder therapy’s crown ahead of its patent expiry in 2023. With the exception of Boehringer Ingelheim, AbbVie’s legal team has successfully settled with companies wanting to launch biosimilar versions of this monoclonal antibody (mAb) targeting tumour necrosis factor (TNF) in the US, while price increases in the region have helped pushed Humira sales up to just under US$20 billion in 2018 (Fig. 1a). AbbVie has reportedly also found a way to compete with the biosimilars that have launched in Europe, winning its first national tender by offering Humira at an 80% discount to its list price.
In second position in the list, as in 2017 (Nat. Rev. Drug Discov. 17, 232; 2018), is Celgene’s Revlimid (lenalidomide), with sales of $9.6 billion. The revenue stream for this small-molecule blood cancer drug, while less than half that for Humira, was probably one of the attractions for the $74 billion move by Bristol Myer-Squibb (BMS) to acquire Celgene earlier this year — even if that deal is now facing questions.
The continued achievements of Merck & Co.’s PD-1 checkpoint inhibitor Keytruda (pembrolizumab) in first-line lung cancer indications and other tumour types have seen it rocket from outside the top ten last year to number three this year. BMS’s rival checkpoint inhibitor Opdivo (nivolumab) has also made it onto the list this year, but the company’s limited success in expanding into new indications has seen it continue to lag behind Keytruda, despite reaching the market first.
For Roche the big question will be how long Herceptin (trastuzumab), Avastin (bevacizumab) and Rituxan (rituximab) remain on this list. All three mAb products now have approved US biosimilars, but for now the contribution from the three, alongside breast cancer product Perjeta (pertuzumab) and multiple sclerosis therapy Ocrevus (ocrelizumab), have helped to move Roche up from third place in 2017 to second in 2018’s list of biggest companies by sales (Fig. 1b).
Pfizer retained its number one spot thanks to strong sales of breast cancer drug Ibrance (palbociclib), pneumococcal vaccine Prevnar 13 and surprisingly Lipitor (atorvastatin). Despite losing patent protection over 7 years ago, the industry’s most successful drug still managed to contribute $2 billion worth of sales to Pfizer in 2018. But the pharma giant has run to stand still over the last year. Year-on-year growth was flat, which will do little to quieten the voices calling for Pfizer to pull the trigger on a large-scale acquisition.
Johnson & Johnson edged a little higher in the ranks in 2018 owing to continued growth from psoriasis treatment Stelara (ustekinumab), but this progress is not expected to help to plug the predicted hole in sales from the looming patent expiry of prostate cancer drug Zytiga (abiraterone), which last year contributed $3.5 billion to sales. The group’s continued price cutting to maintain the market share of its TNF inhibitor Remicade (infliximab) will also hit turnover.
Notwithstanding Keytruda’s success, Merck & Co. remained in sixth place in the rankings, with GlaxoSmithKline and AbbVie also holding the positions they occupied last year (Nat. Rev. Drug Discov. 17, 232; 2018).
Amgen was a new entrant to the top ten. Strong sales growth for products like Repatha (evolocumab) and Prolia (denosumab) and a better-than-expected performance from its newly launched migraine drug, Aimovig (erenumab), are likely to be offset by heavy sales declines for its best-selling TNF inhibitor Enbrel (etanercept) due to increased competition and biosimilar erosion in Europe. Biosimilar competition is also expected to hit the company’s other big-seller Neulasta (pegfilgrastim) this year, so Amgen’s inclusion in the top ten might be short-lived.
Competing Financial Interests
The author declares no competing financial interests.