Blockbusters & Breakthroughs: Who Ruled the Pharma Market in 2024—and Who’s Next?

The pharmaceutical world saw some big winners in 2024, with drugs like Keytruda, Dupixent, and Eliquis proving their staying power in oncology and immunology. Merck’s Keytruda topped the charts with $29.5 billion in sales, treating cancers such as melanoma and lung cancer by boosting the immune system’s cancer-fighting abilities. Sanofi and Regeneron’s Dupixent brought in $14.1 billion, tackling eczema and asthma by reducing inflammation, while Pfizer and Bristol Myers Squibb’s Eliquis earned $13.3 billion by preventing blood clots. 

Meanwhile, Novo Nordisk’s Ozempic and Eli Lilly’s Mounjaro highlight a surging demand in diabetes and obesity treatments. Ozempic, with around $17.5 billion in sales, helps manage type 2 diabetes by regulating blood sugar, while Mounjaro, at $11.5 billion, offers a dual approach to glycemic control. Clinical trials show Ozempic reduced HbA1c by 1.8%, and Mounjaro by 2.1%, fueling their growth as obesity treatments gain traction. This shift reflects broader industry trends, with seven of the top 2024 drugs being biologics—large, targeted molecules like Keytruda and Dupixent—and three small molecules, such as Ozempic and Mounjaro, which work inside cells for metabolic conditions.

2024 Top Selling Drugs Dominate Pharmaceutical Market

In 2024, the pharmaceutical industry witnessed remarkable gains from several blockbuster drugs, with a clear dominance of biologics and a rising interest in metabolic therapies. Leading the charge was Merck’s Keytruda, which pulled in an impressive $29.5 billion in sales. This immunotherapy powerhouse, used in treating cancers like melanoma, lung, and head and neck cancers, works by activating the immune system to better identify and destroy cancer cells. Backed by robust clinical data, a Phase III trial even reported a reduced mortality risk for certain lung cancer patients—cementing Keytruda’s position as a top performer in oncology.

Shifting focus to metabolic health, Novo Nordisk’s Ozempic emerged as a major player with $17.5 billion in revenue. Primarily used to manage type 2 diabetes, Ozempic mimics the GLP-1 hormone to regulate blood sugar and slow gastric emptying. A 2023 study confirmed a 1.8% reduction in HbA1c levels, further validating its growing role in both diabetes and emerging obesity care.

Meanwhile, Sanofi and Regeneron’s Dupixent generated $14.1 billion, continuing its momentum in treating chronic inflammatory conditions like eczema, asthma, and nasal polyps. By targeting the IL-4 and IL-13 cytokines, Dupixent reduces inflammation effectively, with trials showing marked improvement in skin clearance for eczema patients.

In the infectious disease space, Gilead’s Biktarvy brought in $13.4 billion, reinforcing its status as a go-to treatment for HIV-1. Combining bictegravir, emtricitabine, and tenofovir alafenamide, this antiretroviral therapy showed a 98% viral suppression rate in treatment-naive patients according to a 2024 study.

Similarly, Pfizer and Bristol Myers Squibb’s Eliquis maintained strong sales of $13.3 billion. As a factor Xa inhibitor, Eliquis helps prevent blood clots and strokes in atrial fibrillation patients and post-surgical cases. Clinical trials have shown it to reduce stroke risk by 21% compared to warfarin, underscoring its continued clinical relevance.

The trend of high-performing biologics continued with AbbVie’s Skyrizi and Johnson & Johnson’s Darzalex, each hitting $11.7 billion. Skyrizi, used in autoimmune conditions such as psoriasis, Crohn’s disease, and ulcerative colitis, works by inhibiting IL-23 to lower inflammation—showing 75% skin clearance in psoriasis patients in a 2023 trial. Darzalex, on the other hand, targets CD38 on multiple myeloma cells, promoting immune-driven cell destruction. New 2025 data showed significant gains in progression-free survival for patients.

Also making headlines was Eli Lilly’s Mounjaro, which posted $11.5 billion in sales. Like Ozempic, it acts on GLP-1 receptors, but also engages GIP receptors, enhancing its efficacy in controlling blood sugar and fueling optimism for its use in obesity treatment.

Further bolstering Johnson & Johnson’s portfolio was Stelara, earning $10.4 billion. Stelara treats inflammatory conditions like psoriasis and Crohn’s disease by blocking IL-12 and IL-23. A 2021 study showed that Crohn’s patients experienced a 60% improvement in symptoms, making it a cornerstone therapy in its class.

Rounding out the list, Vertex’s Trikafta reached $10.2 billion in revenue. This cystic fibrosis treatment combines three molecules—elexacaftor, tezacaftor, and ivacaftor—to enhance CFTR protein function. Clinical results were promising, with a 13.8% increase in lung function, a meaningful improvement for patients with this genetic disorder.

Biologics vs. Small Molecules in the Drug Landscape

The 2024 top sellers include seven biologics—Keytruda, Dupixent, Skyrizi, Darzalex, Stelara, Trikafta, and Eliquis—and three small molecules—Ozempic, Mounjaro, and Biktarvy. Biologics, derived from living organisms, target specific proteins or cells, offering precision for complex diseases like cancer and autoimmune disorders. Famous biologics include Humira and Rituxan. Small molecules, chemically synthesized, penetrate cells easily, suiting metabolic or infectious diseases like diabetes and HIV. Notable examples are Lipitor and Viagra. This split highlights biologics’ dominance in high-value markets, though small molecules remain critical.

Predicted Profit Drivers for 2025

Looking ahead, the drug landscape in 2025 is set for dynamic shifts, with market leaders expected to consolidate their dominance while emerging therapies aim to break into the top tier. Keytruda is projected to maintain its top spot, with estimated sales approaching $26.6 billion, fueled by its expanding clinical pipeline and potential new indications in oncology. Ozempic could climb to $22 billion—a 22% increase—thanks to growing adoption for cardiovascular risk reduction beyond type 2 diabetes. Mounjaro may see a dramatic 50% surge to reach $20 billion, driven by its dual GIP/GLP-1 mechanism and likely regulatory approvals for obesity treatment.

Dupixent is also poised for a strong year, with sales forecasted at approximately $17 billion, buoyed by anticipated approvals in chronic obstructive pulmonary disease (COPD) and other inflammatory conditions. These forecasts reflect a broader market pivot toward high-impact metabolic and immunological therapies.

The Patent Cliff Challenge

However, the horizon isn’t without challenges, especially with the looming patent cliff. Keytruda’s main patent expires in 2028, opening the door to biosimilars that could cut into its $29.5 billion sales. Eliquis faces a similar fate that year, potentially losing its $13.3 billion revenue to generics. This wave of exclusivity losses, affecting over $100 billion in sales by 2028, pushes companies to innovate. Merck is bolstering its oncology pipeline, while Bristol Myers Squibb aims to offset Eliquis losses with cost-cutting and new launches. The rise of biosimilars, already impacting Humira’s sales, could reshape the market, making 2025 a pivotal year for strategic pivots and new drug introductions.

Industry Shifts and Future Outlook

The dominance of seven biologics versus three small molecules signals a move toward precision medicine, with biologics like Humira and Rituxan leading historically, and small molecules like Lipitor still vital in metabolic care. As biosimilars threaten post-2028, the industry’s focus on oncology and metabolic drugs—fueled by aging populations and obesity rates—suggests these areas will shape 2025’s profit drivers. Companies are already adapting through mergers and pipeline growth, setting the stage for a competitive yet innovative year ahead.

Author

Bernice Lottering