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Roche is back on top. Over the past few years, the tussle for biopharma’s biggest company by sales has largely been contested by Novartis and Pfizer; but a winning streak of blockbuster launches, including the multiple sclerosis drug Ocrevus (ocrelizumab) and PD-L1 inhibitor Tecentriq (atezolizumab) have helped the Swiss group leapfrog both of its rivals to claim the number one spot in 2019 (Fig. 1a). The company was also assisted by the limited impact of biosimilar competition in the key US market for some of its previous biggest cash cows, including the cancer therapies Avastin (bevacizumab) and Herceptin (trastuzumab).