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As anticipated, there was a shakeup at the top of the pharma industry rankings in 2023. Having sat at the top of the pile for several years as a result of huge sales of its COVID-19 vaccine Comirnaty (tozinameran), Pfizer dropped precipitously from the top spot to be replaced by Johnson & Johnson (Fig. 1a). The new market leader grew prescription pharmaceutical sales by almost US$3 billion year on year, the largest absolute growth in the cohort and second largest in percentage terms. Johnson & Johnson’s growth is driven by a diversified mix of products, led by Darzelex (daratumumab) and Stelara (ustekinumab). Both of these products also feature in the top ten selling products in 2023 (Fig. 1b). Darzalex, indicated for multiple myeloma, climbs five positions from 14th in 2022 to 9th in 2023, and is the third biggest year-on-year growth driver among the top ten in percentage terms. This trajectory is expected to continue as Darzalex cements its position as the leader in an increasingly crowded multiple myeloma market. Stelara, on the other hand, could well be enjoying its last year in the top ten, with patent expiry opening up the door to biosimilar competition and forecasts projecting a rapid decline in sales for the product.