Global top 20 Best-Selling Race of Medicine by 2023

Top 20 medications by global sales list of 2023 was not without its surprises, given the year's significant patent expirations, the emergence of weight-loss medications, and other novel developments. 

• Last year, Merck's cancer king, Keytruda, had even greater success, putting yet another feather to its cap. The PD-L1 inhibitor has over 30 indications that span different cancer types and stages, and there are no indicators that these indications will end. [1]

• Humira, which is currently ranked No. 2 on the list, has maintained its top position despite a wave of biosimilar competition when its exclusivity in the United States was lifted. 

• Adalimumab, popularly known as Humira, was formerly the most popular prescription medication in the world. 

• AbbVie used their infamous "patent thicket" to safeguard the drug's sales for a considerable amount of time. Humira's dominance, however, was never meant to last. In January 2022, Amgen's Amjevita, the first Humira biosimilar approved by the FDA, made its debut. Subsequently, a wave of summer launches progressively reduced Humira sales in the second half of the year, ultimately placing the medicine in the number two spot in 2023. [2] 

• With its GLP-1 diabetes medication Ozempic (and its obesity sibling Wegovy), Novo Nordisk has continued to do phenomenal business with being at the thrid spot. However, in 2023, this success came with a dilemma as the Danish pharmaceutical company had to contend with a shortage of semaglutide and an influx of fake products intended for aesthetic weight loss. 

• Eliquis, a blood thinner manufactured by Bristol Myers Squibb and Pfizer, came in fourth place and was chosen as one of the first ten medications under the Inflation Reduction Act (IRA) to have its price adjusted by Medicare starting in 2026. 

• No product comes close to Gilead Sciences' Biktarvy when it comes to HIV medicine sales; the triple drug cocktail dominated the market in 2023. At the close of the year, Gilead's most valuable HIV product held 49% of the US market share, placing it among the top 5 best-selling medications. [3]

• Sanofi Dupixent, which came in sixth place, and Regeneron seem to be getting closer to receiving FDA approval to treat chronic obstructive pulmonary disease (COPD). It would be the first biologic licensed for COPD and the first meaningful therapy advancement in the elusive disease in over ten years. The FDA rejected it in October 2023 for chronic spontaneous urticaria (CSU), a severe inflammatory disease characterized by deep skin edema, persistent itching, and hives. The results were satisfactory enough to pass test in Japan, where it has been approved for CSU as an add-on treatment with antihistamines, despite the U.S. regulator asking the company for more efficacy data, which are due to come from a second trial in late 2024. 

• BioNTech, Pfizer's COVID-19 vaccine partner, also revealed a sharp decline in the first quarter of Comirnaty's ranking, which dropped to seventh by 2023. While Johnson & Johnson's antibody hero Stelara continued to generate megablockbuster sales in the future while securing 8th spot in year 2023 J&J devoted a significant portion of the year on negotiating patent settlements with biosimilar competitors Amgen, Samsung Bioepis, Sandoz, Teva, and Alvotech. This cleared the path for biologic knockoffs of its profitable drug to become available in the United States beginning in early 2025.[4] 

• BMS’ second-largest brand Opdivo, the PD-1 inhibitor continued to grow in 2023 by securing 9th best selling spot, but it also continued to fall further behind its rival, Merck & Co.’s Keytruda, which in 2023 became the world’s top-selling medicine. 

• Johnson & Johnson’s Darzalex being at 10th spot, secured its initial FDA approval in 2015 as a fourth-line multiple myeloma treatment and the first monoclonal antibody for the blood cancer. J&J had licensed the anti-CD38 antibody from Genmab in 2012 and Darzalex partnership between two hasn't always been cordial. Besides its royalty payments to Genmab, J&J also pays royalties to Halozyme for using the latter company's subcutaneous drug delivery technology, Enhanze. Likewise other top 20 list of drugs been projected in the graph with the net sales against indication for year 2023.[5]

Figure: Graph showing the top 10 list of medicine sale in US$ billion for year 2023.

Table: List of top 20 medicine by company & respective indications use.

In conclusion, the top 20 medications by global sales in 2023 showcased a dynamic and evolving pharmaceutical landscape. Several factors contributed to this shift, including patent expirations, the rise of weight-loss medications, and the ongoing development of innovative therapies.

References:

1. Hanna Bruke, Top 10 drugs with patents due to expire in the next five years. Post date : Feb. 16,2024; accessed on  Sep. 02, 2024 URL: https://www.proclinical.com/blogs/2024-2/top-10-drugs-with-patents-due-to-expire-in-the-next-5-years

2. Linda Rath, Humira Gets More Competition. Post on: Jan. 23, 2023 ; Accessed on: Sep. 02, 2024 URL: https://www.arthritis.org/news/news-and-events/humira-biosimilars

3. Eshe Nelson, How Ozempic and Weight Loss Drugs Are Reshaping Denmark’s Economy. Post on: Aug. 28, 2023; Accessed on: Sep.02, 2024. URL: https://www.nytimes.com/2023/08/28/business/denmark-ozempic-wegovy.html

4. Kevin Dunleavy, Sanofi, Regeneron get a step closer on Dupixent COPD nod with FDA priority review. Post on: Feb.22, 2024; Accessed on Sep. 02, 2024 URL: https://www.fiercepharma.com/pharma/sanofi-regeneron-get-step-closer-dupixent-copd-nod-fda-priority-review

5. Zoey Becker, Angus Liu, Kevin Dunleavy, Fraiser Kansteiner, Eric Sagonowsky, The top 20 drugs by worldwide sales in 2023. Post on: May 28, 2024; Accessed on: Sep. 02, 2024 URL: https://www.fiercepharma.com/special-reports/top-20-drugs-worldwide-sales-2023