Market analyst firm Evaluate released their annual report, “EvaluatePharma World Preview 2018: Outlook to 2024,” last month. The report predicts that worldwide prescription drug sales will grow to over $1.2 trillion over the next six years. Novartis is projected to be 2024’s leading prescription drug company with $53.2 billion in overall sales, followed by Pfizer and Roche in competition for the second spot. The reason: Although only three Novartis products are predicted to be in the 2024 top 50 best sellers, EvaluatePharma forecasts that as many as 22 Novartis products will each have sales of at least $0.5 billion by that year. It is also a testament to Novartis’s continued efforts to invest in leading edge technologies to remain at the forefront of the industry, with EvaluatePharma giving the examples of Kymriah as the first CAR-T therapy to gain approval and Novartis’s acquisition of AveXis, a leading gene therapy company.
Humira (AbbVie), used in the treatment of a variety of autoimmune and inflammatory conditions, has been one of the best-selling drugs in the United States for the past four years, and so it is probably no surprise that Evaluate projects that it will continue to top the list in 2024. Part of the reason for Humira’s expected success is that AbbVie has reached settlements with two biosimilar developers, Amgen and Samsung Bioepis, which will keep their versions of Humira off the market until 2023. However, Humira revenues are eventually bound to decrease faster than they are today, as biosimilar versions enter the market and physicians become more accustomed overall to prescribing biosimilars, something we discussed in a previous blog post.
It is also not surprising that cancer immuno-oncology (IO) drugs Keytruda (Merck) and Opdivo (Bristol-Myers Squibb) are among the predicted top five drugs in the new report, with a combined revenue projection 2.5 times what it is today. This supports the trends that we have seen in the market: Not only is IO here to stay, but the use of these drugs is likely to expand considerably in the coming years to include new indications and therapeutics (e.g., combination therapy). Newcomers into the IO field (AstraZeneca, Pfizer, Roche, etc.) and increasing availability of IO drugs in international markets where there are no sales today will also contribute to the growth of IO.
Revlimid (Celgene) and Imbruvica (Johnson & Johnson/AbbVie) hold the number 3 and 6 positions on Evaluate’s top 10 list. Both drugs have been big winners against blood cancers — a market that is still not highly penetrated by IO drugs. Revlimid alone today accounts for more than half of Celgene’s revenue, so it’s not unexpected that this drug will continue to be a top seller. Revlimid is protected from biosimilar competition until at least 2022 — and potentially could avoid such competition much longer, given the issues that have challenged market entrance for biosimilars. Both Revlimid and Imbruvica are also being studied in various types of lymphoma and other indications, and Revlimid is being investigated in combination therapies. If these studies are successful, the results are likely to drive higher sales.
Eliquis (BMS/Pfizer) ranks at number 5 on the Evaluate list. It is a flagship drug and success story for BMS, especially considering that Eliquis has been able to enter and succeed in the crowded and competitive cardiovascular arena. A main reason for this success: A better safety profile in terms of reduced bleeding than competing products to prevent or treat deep vein thrombosis and pulmonary embolism.
Pfizer’s Ibrance, number 7 on the list and already a top-selling drug, is a powerful treatment for HR+ HER2- metastatic breast cancer. Strong sales are destined to continue, given the very large breast cancer market. Moreover, Pfizer is looking to move Ibrance into other lines of therapy and potentially other indications. That said, Ibrance — which was the first to market in the family of CDK4/6 inhibitors — will face competition from newer entrants Kisquali (Novartis) and Verzenio (Eli Lilly).
Dupixent (Sanofi/Regeneron), at number 8, is the drug with the largest projected revenue increase — the Evaluate analysts expect more than 30x growth, in part because it’s one of the most recently approved drugs on the list. Sanofi and Regeneron have big plans for Dupixent, as they are seeking to expand its use beyond eczema to other inflammatory diseases including asthma, nasal polyps, chronic obstructive pulmonary diseases, and food allergies.
Finally, rounding out the list at numbers 9 and 10 are Eylea (Regeneron/Bayer) and Stelara (Johnson & Johnson). Eylea, a treatment for wet macular degeneration, targets the aging baby-boomer population, and Stelara, which treats moderate-to-severe plaque psoriasis and Crohn’s disease, is one of the most expensive drugs on the U.S. market, priced at $30- $70,000 for one year of treatment.
Just missing inclusion on the top ten list — but also a strong contender — is Gilead’s recently launched one-pill, once-a-day treatment for HIV, Biktarvy. Evaluate analysts suggest Biktarvy sales will reach $6 billion in sales by 2024, the highest predicted revenue for any of 17 new launches or products now in late stages of R&D.