A new "King of Drugs" is born! K drug struggles, Abbvie and Sanofi start the battle for dominance

As 2024 approaches its end, the global best-selling drug list is highly anticipated by the industry.

Recently, a report published on the official website of Nature revealed the answer. From the perspective of single-drug sales, the K drug is expected to continue reigning with an annual sales figure of $31 billion. However, if we consider the overall sales of semaglutide, the report predicts that the diabetes version Ozempic and the weight loss version Wegovy combined have already reached $35.6 billion. The K drug, having only held the title of "king of drugs" for one year, is reluctantly giving it up.

With the K drug's top position in jeopardy, Merck is determined to seek the next blockbuster. According to the revenue TOP 10 multinational pharmaceutical companies' third-quarter reports compiled by E drug managers, compared to 2023, Merck still leads with the highest R&D expense ratio (R&D expenses/revenue) among MNCs due to its substantial investments. Additionally, Johnson & Johnson has made a comeback this year, becoming one of the MNCs with the highest R&D expense ratio, alongside Merck and Roche.

Currently, the R&D return on investment for global pharmaceutical companies has dropped from 15% twenty years ago to just 6% today. In response, MNCs are compensating for this by "spending heavily" to boost their presence on the best-selling drug list.

A War Without Gunpowder

In the predicted list of the top 10 best-selling drugs globally for 2025, three intense battles are worth noting: the K drug's "king of drugs" defense battle, the market share battle between Eli Lilly and Novo Nordisk for GLP-1, and the autoimmune "dominance" struggle between AbbVie and Sanofi. Behind these three battles lies the anxiety and ambition of MNCs transitioning from the oncology dominance battle to the non-oncology arena.

The K drug, which has dominated cancer treatment, has a fleeting position in the global prescription drug sales ranking.

As the new king of drugs, the K drug's reign may only last about two years. According to Nature's predictions, by 2025, the K drug will be rapidly surpassed by Novo Nordisk's semaglutide, which will become the new king of drugs globally.

In 2023, the K drug finally became the world's best-selling drug, sitting on this "iron throne" after nine years of fierce competition. However, with the emergence of semaglutide, it seems the K drug must "abdicate" ahead of schedule.

But how long can semaglutide maintain its position after taking over?

Eli Lilly's tirzepatide is rising at an astonishing speed, not only as the fastest-growing blockbuster but also closely chasing semaglutide.

The emergence of tirzepatide has stirred the GLP-1 market landscape, which was originally dominated by semaglutide. Leveraging its first-mover advantage, semaglutide occupies a significant market share in weight loss and diabetes treatment indications, but Eli Lilly's tirzepatide is also making impressive strides, showing explosive sales growth and posing a strong threat to semaglutide's dominant position in a short time.

Currently, production capacity has become a new battleground for these two giants. Whoever can better meet the growing global market demand is likely to emerge victorious in the competition for GLP-1 market share In addition, according to the forecast for the best-selling drugs list in 2025, Abbvie's Risankizumab is expected to enter the global TOP 5. Abbvie, which recently lost its status as the king of drugs, is still in the painful period of digesting the patent cliff of Humira, but several of its autoimmune products are already experiencing sustained high growth, notably its two core products, Risankizumab and Upadacitinib.

It is worth noting that if we look solely at the autoimmune sector, Sanofi's Dupilumab is currently the king of the field. In its first year on the market (2017), Dupilumab's sales were only €200 million, but by 2019, it had increased more than tenfold to €2.1 billion, and by the first half of 2024, it surpassed Abbvie's Humira and Johnson & Johnson's Ustekinumab, becoming the new generation of autoimmune "king of drugs."

The explosive growth of Dupilumab is attributed to its comprehensive offensive in clinical applications and market promotion, fundamentally driven by the continuous expansion of its indications. Since receiving approval for atopic dermatitis in 2017, Dupilumab has been approved for seven indications globally, including asthma, nodular prurigo, and chronic obstructive pulmonary disease (COPD).

According to Nature's predictions, Dupilumab is expected to rank 4th in 2025. Both Dupilumab and Risankizumab are engaged in fierce competition in terms of investment in innovative drug development, progress in clinical trials, and market channel expansion, all aiming to secure a more advantageous position in the best-selling drug list of 2030. This battle for dominance in the autoimmune sector is full of suspense, and the outcome remains to be seen.

Where Will the New Dominator Come From?

An undeniable fact is that GLP-1 products will dominate the top position in the global best-selling drugs for at least the next 10 years. However, the battlefield seems to be shifting, with the main competitors still being the confrontation between Novo Nordisk and Eli Lilly, as well as "self-transcendence."

If the GLP-1 competition in 2025 is still primarily focused on Semaglutide and Tirzepatide, by 2030, the main forces in the war will be multi-target formulations, combination agents, and oral GLP-1 products.

This is indeed the case. Evaluate Pharma previously pointed out in another report that by 2030, Novo Nordisk's new GLP-1 product CagriSema will enter the battlefield. This product is an "upgraded version" of Semaglutide, composed of Semaglutide and another intestinal hormone. Evaluate Pharma predicts that its sales in 2030 may exceed $20 billion.

However, just today, Novo Nordisk updated the latest clinical data for CagriSema. Although the weight loss effect is significant, it does not meet the previously predicted 25%, which led to a 21% drop in Novo Nordisk's stock price in pre-market trading.

Eli Lilly's "vanguard" may also shift to the small molecule oral GLP-1 product Orforglipron and the GLP-1R/GIPR/GCGR tri-target product Retatrutide, with analysts predicting that both products are expected to hit the market in 2027 In addition to Eli Lilly and Novo Nordisk, which have already bet on GLP-1 products, leading global multinational pharmaceutical companies seem to be anxious about their future growth trajectories.

The most "anxious" may be BMS. With several blood products acquired from the purchase of Celgene and the patent cliff of the anticoagulant Eliquis, BMS has fallen to the lower end of the TOP 10 in overall revenue rankings. Moreover, overseas analytical institutions have reported that according to revenue forecasts for 2025-2029, BMS could potentially lose up to 76% of its revenue due to drug patent expirations, while GSK, ranked second, could lose 56%. Currently, GSK has already dropped out of the revenue TOP 10.

Of course, BMS's way of "self-rescue" is also very direct—by increasing investment. According to statistics from E Drug Manager on the R&D expense ratio (R&D expenses/revenue) of the TOP 10 pharmaceutical companies for the first three quarters of 2024, BMS's R&D expense ratio is about 22.16%. Compared to its revenue ranking at the bottom of the list, BMS has achieved a mid-range level in the R&D expense ratio ranking.

Additionally, Merck has once again topped the list with an R&D expense ratio of over 30%. Facing 2025, as Keytruda is about to lose its "king of drugs" status, Merck still aims to continue consolidating its dominant position in the oncology field. Just after being head-to-head defeated by Kangfang Biotech's PD-1/VEGF dual antibody in the non-small cell lung cancer field, it has spent billions of dollars to acquire a dual antibody targeting the same site from Eli Lilly.

Of course, there are gains and losses. Following the failure of various TIGIT antibody development projects, and after combination therapies failed to outperform the single-agent efficacy of Keytruda, Merck ultimately abandoned the development of its TIGIT antibody Vibostolimab this week. Also abandoned by Merck is an anti-LAG-3 antibody Favezelimab.

In fact, as the cost of developing a new drug continues to rise while the return on investment in R&D hits new lows, accumulating ammunition through cash flow and debt leverage has almost become the main means for MNCs to resist patent cliffs.

According to overseas institution Jefferies Financial Group, Merck's cash reserves and debt leverage capabilities rank second among MNCs, with Johnson & Johnson holding the top position.

It can be seen that Johnson & Johnson, with an R&D expense ratio of nearly 26%, ranks just behind Merck and Roche among the TOP 10 pharmaceutical companies by revenue. However, this also reflects its anxiety over the current pipeline being "out of balance." According to the aforementioned reports from Nature and Evaluate Pharma, Johnson & Johnson's anti-tumor product Daratumumab is still maintaining high growth rates and is expected to be among the top ten best-selling drugs by 2030.

In addition, in the oncology field, new products such as Johnson & Johnson's BCMA CAR-T therapy Cilta-cel, ERLEADA, and Abiraterone are continuously contributing to its performance However, this seems unable to keep pace with the decline in some of Johnson & Johnson's products. After all, in the first three quarters of this year, the revenue growth rate of Johnson & Johnson's Innovative Medicines was only 3.9% (CER), and the growth rate of its proud self-immunity business was merely 1%. When Johnson & Johnson's Innovative Medicines can rely on new products to regain rapid performance growth will be a test for them.

Overall, as MNCs seek new growth points through "spending money," high value has become a common characteristic of their business development (BD) and mergers and acquisitions (M&A). Taking the 2024 China innovative drug license-out transactions as an example, projects favored by large multinational pharmaceutical companies are either unique molecular design anti-tumor pipelines, have broad future market potential, or have already achieved excellent clinical data and possess First-in-Class (FIC) / Best-in-Class (BIC) potential.

In addition, whether it is the BD/M&A direction of MNCs or the blockbuster drug forecasts for 2030, it seems to suggest that, besides oncology and immunology, neuroscience and cardiovascular fields are new directions that MNCs are collectively betting on. Public data shows that from 2010 to 2024, among various indications, only immunology, cardiovascular, and CNS assets have an average acquisition price exceeding $2.5 billion.

Author of this article: Erin Kathy, Source: E 药经理人, Original title: "The Birth of the New 'King of Drugs'! K Drug Struggles, Abbvie and Sanofi's Self-Immunity Dominance Battle Begins"