Pharma industry watchers will be familiar with the huge impact of the latest hepatitis C drugs, both medically and commercially. What might not be as clear is their dominance of the industry's biggest launches, taking up four of the top five slots (Table 1). Gilead's Sovaldi generated headlines over its price when it launched in 2013, but it is the follow-on product, Harvoni, that holds the record for the biggest launch, with over US$10 billion in sales in its first four full quarters on the US market.

Table 1 Top US drug launches

Outside the antiviral field, the biggest recent launch success was Biogen's multiple sclerosis (MS) therapy Tecfidera. Its success was largely down to its — at the time — revolutionary oral delivery and relatively benign safety profile. MS drug Ocrevus also had a major non-infective drug debut, with Roche hailing it as the biggest launch in its history.

When it comes to big launches, Pfizer's Lipitor was always going to be on the list. Not only does the statin have one of the biggest opening performances, it is one of the most commercially successful products ever, reaching cumulative sales of $162 billion in 2017, despite losing patent protection in 2011. Another older product on the list is the COX2 inhibitor Celebrex from Pharmacia, which was acquired by Pfizer. Fellow COX2 inhibitor, Vioxx, which was subsequently withdrawn owing to safety issues, is also in the top ten.

Although many of the products in Table 1 had first-in-class status when they launched, such as Pfizer's CDK4/6 inhibitor Ibrance, being second to market is not always a handicap, as shown by Harvoni. The commercial success of the VEGF inhibitor Eylea for macular degeneration is also notable, considering that similar drugs were already available, including Lucentis, another of the biggest launches. And while Opdivo might have recently lost ground to Keytruda, being the second PD1 inhibitor on the market was not a barrier to beating its rival at launch. It seems likely though that it will take another curative product — something that health-care systems still seem willing to pay for — to knock Harvoni from its top spot.