Keytruda's Enduring Reign in Oncology
In the ever-shifting pharmaceutical landscape, consistency at the top is rare. However, for 2024, Merck's Keytruda (pembrolizumab) not only maintained its top-selling position but also significantly increased its revenue. The drug generated approximately $29.5 billion in sales, a testament to its critical role in modern cancer care. Its success is built on a broad and expanding list of indications, covering over 40 types of cancer, including solid tumors in lung, breast, and gynecological areas.
Keytruda's mechanism involves blocking the programmed cell death protein 1 (PD-1), a crucial checkpoint in the immune system. By inhibiting this protein, Keytruda effectively releases the brakes on T-cells, allowing the body's immune system to more aggressively and effectively target and destroy cancer cells. This has made it a foundational therapy, often used in combination with other treatments, further solidifying its market footprint. Looking ahead, Merck is already taking steps to prolong Keytruda's market dominance, including developing a subcutaneous formulation, to prepare for its patent expiration around 2028.
The Rise of New Therapeutic Leaders and the Fall of Old Ones
The pharmaceutical industry is in the midst of a significant power shift. While Keytruda holds the top spot, the rankings below it are increasingly volatile. The most notable change is the meteoric rise of GLP-1 receptor agonists like Ozempic and Eli Lilly's Mounjaro. Originally developed for type 2 diabetes, these drugs have gained immense popularity for their weight-loss effects. In 2024, Ozempic surged into the second spot with around $17.5 billion in sales, while Mounjaro and its weight-loss-focused sibling, Zepbound, also posted explosive growth. This new therapeutic class is widely expected to continue its upward trajectory and reshape the market hierarchy in the coming years.
Conversely, the reign of the former top-selling drug, Humira (adalimumab) from AbbVie, has ended. The anti-inflammatory drug, once the world's most profitable, saw its sales decline by over 37% in 2024, plummeting to around $9 billion. The reason is simple: patent expiration. The influx of multiple biosimilars since 2023 has eroded Humira's market share, with major pharmacy benefit managers removing the brand-name drug from their formularies in favor of lower-cost alternatives.
Notable Blockbusters of 2024
The list of top-selling drugs in 2024 features a mix of oncology, immunology, and cardiovascular therapies, demonstrating a diverse range of high-demand treatments.
- Eliquis (apixaban): This anticoagulant, a joint venture between Bristol Myers Squibb and Pfizer, is a major revenue driver, with strong demand for preventing blood clots and strokes.
- Dupixent (dupilumab): Developed by Sanofi and Regeneron, this biologic for inflammatory diseases saw robust growth in 2024, fueled by expanded indications for asthma, atopic dermatitis, and COPD.
- Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide): A key HIV treatment from Gilead Sciences, Biktarvy continues to generate substantial revenue with strong market positioning and patent protection extending to 2033.
- Skyrizi (risankizumab-rzaa): AbbVie's successful replacement for Humira is an IL-23 inhibitor that grew significantly in 2024, demonstrating the company's ability to transition its portfolio.
A Market Comparison of 2024's Pharmaceutical Leaders
| Rank | Drug Name (Generic Name) | Manufacturer | 2024 Sales (approx. USD) | Therapeutic Area | Key Market Factor | Patent Status |
|---|---|---|---|---|---|---|
| 1 | Keytruda (pembrolizumab) | Merck & Co. | ~$29.5 billion | Oncology | Expanded indications; cornerstone therapy | Expires ~2028 |
| 2 | Ozempic (semaglutide) | Novo Nordisk | ~$17.5 billion | Metabolic Diseases | High growth; popular for weight loss | Price negotiations under IRA |
| 3 | Dupixent (dupilumab) | Sanofi / Regeneron | ~$14.1 billion | Immunology | Strong demand; approval for new indications | Exclusive until ~2031 |
| 4 | Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) | Gilead Sciences | ~$13.4 billion | Antiviral (HIV) | Sustained demand; leading regimen | Exclusive until ~2033 |
| 5 | Eliquis (apixaban) | BMS / Pfizer | ~$13.3 billion | Cardiovascular | Robust demand; market positioning | Expires ~2026/2031 |
| 7 | Skyrizi (risankizumab-rzaa) | AbbVie | ~$11.7 billion | Immunology | Rapid growth; Humira replacement | Exclusive until ~2031 |
| 14 | Humira (adalimumab) | AbbVie | ~$9 billion | Immunology | Former leader; decline due to biosimilars | Lost exclusivity in 2023 |
The Evolving Landscape: Forecasting Future Trends
The pharmaceutical market's future will be shaped by the same forces driving recent changes: innovation, competition, and shifting patient needs. While oncology remains a high-value area, the explosive growth of GLP-1 drugs for metabolic conditions points to a potential market rebalancing. The financial impact of biosimilars will also intensify as more biologic drugs lose their patent protection. Companies will need to continually innovate, expand indications, or develop next-generation formulations to stay ahead.
Technological advances in biotechnology are making complex therapies more prevalent, as evidenced by the dominance of biologics like Keytruda and Humira. However, cost pressures, exemplified by programs like the Inflation Reduction Act in the US, will increasingly influence pricing and revenue for top drugs.
For ongoing analysis of the market's trajectory, publications like Genetic Engineering and Biotechnology News offer valuable insights into the performance of these drugs and the strategies of their manufacturers.
Conclusion
Ultimately, the answer to what is the highest selling drug in the world is not a fixed, unchanging reality. For 2024, the title belonged to Keytruda, a leader in the oncology space that continues to build upon its success. The market's dynamic nature is best illustrated by the dramatic ascent of GLP-1 agonists like Ozempic and the swift decline of former champion Humira in the face of intense biosimilar competition. This continual shift underscores the importance of innovation and strategic market management for pharmaceutical companies seeking to maintain their place among the industry's top earners.
