Pharmaceutical industry forecasts to 2026

One of the major issues currently plaguing the pharmaceutical sector relates to clinical trials. Since the spread of the coronavirus, hundreds of trials have been suspended and the issuing of opinions on those that have been conducted is delayed. This problem means that the longer this situation continues, the more likely it is that regulatory decision-making will be slowed down. This, of course, could affect patient access to new medical solutions. And from a macroeconomic perspective, the loss of jobs and productivity indicates that a global economic downturn is coming. If this proves true, governments and patients will have less and less money to spend on healthcare. In this context, investors seem to have sidelined the economic risks of a pandemic, hoping they will be offset by the potential of new treatments for the disease.

Market share growth

The only companies that have reported projected market share gains by 2026 are AstraZeneca, BMS and AbbVie. In the case of BMS, the deal that has contributed most to this growth is the acquisition of Celgene. For AbbVie, the acquisition of Allergan has had a very positive impact, being a strategically favourable move to diversify its drug portfolio, also in view of the impending loss of exclusivity for Humira in 2023.

AstraZeneca's market share is expected to grow steadily; mainly driven by sales of drugs such as Tagrisso, Lynparza and Imfinzi, which continue to be the UK company's growth drivers. Takeda will remain on the sidelines in the ranking of the top ten best-selling prescription drugs for 2026. Despite the acquisition of Shire in 2019 and its contribution to the company's revenue growth, there are downsides. One of the most notable is the patent expiration of the Advate drug in 2019, resulting in a drop in sales of about a billion dollars. Overall, the top ten pharmaceutical companies will lose 6.2% of total market share. And the main impact of this phenomenon will be Pfizer.

The rise of biotechnology

It is worth noting that biotechnology is set to change direction in the coming years. By 2026, biotech drugs are expected to occupy a major share of the top 100 drugs, accounting for 55% of the total, up 16% from 2012. In this context, Roche will remain the largest company in biologic drugs. A detailed analysis of Roche's data shows that despite losing 5.8% of market share due to the loss of biologics patents, the company is still the largest biologics manufacturer in the world. These include Avastin, Herceptin and Rituxan, which account for the company's largest sales. According to another forecast in the report, Amgen will drop two positions due to the loss of market share of its Enbrel (autoimmune diseases) drug compared to similar drugs from competitors.

Following it, Novo Nordisk will move to the third position, boosted by strong sales growth of Ozempic and Ribelsus (diabetes drugs), which will have sales of about $15 billion by 2026. The paper also predicts that AbbVie will drop out of the top ten leaders in this field. This will occur as a result of the loss of the Humira patent in the US by 2023. Novartis will join the top ten in this segment due to sales growth of Cosentyx and Entresto (psoriasis and heart failure drugs respectively); also among the drugs driving the company's growth will be the launches of Arzerra (chronic lymphocytic leukaemia) and Inclisiran (an experimental molecule being studied for the treatment of atherosclerotic cardiovascular disease).

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Diversified research

The EvaluatePharma report also looks at the most promising R&D projects up to 2026. The list of initiatives is diversified across several therapeutic areas, with large corporations actively participating, but there is also room for mid-cap companies to sneak into the ranking. In first place is tirzepatide, Eli Lilly's diabetes and obesity drug. It moved up in the rankings thanks to Eli Lilly's focus on it, comparing it in trials to its drug Trulicity, which brings the company big sales. Novartis is in second place thanks to Inclisiran, a molecule being investigated for the treatment of atherosclerotic cardiovascular disease. Inclisiran became part of Novartis Group's armoury through its acquisition of The Medicines Company earlier this year. Approval of the therapy is expected in the second half of this year, and the drug is expected to compete directly with Repatha (Amgen) in the atherosclerotic disease drug line-up.

There are also high hopes for Biogen's Alzheimer's disease drug aducanumab. The drug, which targets the beta-amyloid protein, was due to be submitted to the FDA in early 2020; delays caused by the current situation could make investors nervous, given that it could be the first new drug to treat this type of dementia in 15 years. In the area of autoimmune diseases, Bristol-Myers Squibb has BMS-986165, an investigational tyrosine kinase inhibitor for the treatment of psoriasis. The drug is expected to show good results and help BMS recover sales in psoriasis following the sale of its Otezla drug following its merger with Celgene.

Diverse specialities

GlaxoSmithKline's multiple myeloma drug belantamab mafodotin made the ranking. Roche also made the top 10 due to promising research projects with its drug for the treatment of spinal muscular atrophy, rizdiplam. The therapy has received a priority review from the FDA, but the Swiss company is awaiting a final decision due by the end of August.

Among the smaller companies' projects, four made it into the top 10. In first place is argenx with its immunosuppressant efgartimod, which has had good results in trials on patients with generalised myasthenia gravis. Then there is the collaboration between Vir Biotechnology and Alnylam to develop ALN-HBV02, an RNAi therapy for the treatment of chronic hepatitis B infections. Also in this group of mid-cap companies is Iovance Biotherapeutics with its cell therapy that has received FDA fast track status for the treatment of advanced melanoma. Rounding out this group is Allakos with its esophagitis and gastritis drug currently in Phase 3 clinical trials.

Product ranking

While not grouping drugs by speciality, the consultancy also ranked the ten drugs expected to be the top-selling drugs by 2026. As mentioned above, the list will be topped by Keytruda, an anti-PD-1 immunotherapy drug. Second place will also go to immunotherapy drugs, in this case Opdivo, whose mechanism of action is similar to Keytruda. In third place is Eliquis (apixaban), an anticoagulant used to prevent venous thromboembolism and stroke in patients suffering from atrial fibrillation. Bictarvi (bictegravir sodium; emtricitabine; tenofovir alafenamide fumarate), an antiviral drug from Gilead Sciences used in patients with HIV, ranked fourth.

In the middle of the table, in fifth place, would be Imbruvica (ibrutinib), a drug developed by AbbVie and Janssen, a Bruton's tyrosine kinase inhibitor used to treat patients with mantle cell lymphoma. Oncology is also in sixth and seventh places with Pfizer's Ibrance (palbociclib) for the treatment of certain breast cancers and Tagrisso (osimertinib mesylate), an EGFR inhibitor for the treatment of non-small cell lung cancer.

The last three positions in the table are occupied by drugs from different fields. In eighth place is Sanofi's Dupixent (dupilumab), an interleukin 4 and 13 inhibitor for patients with atopic dermatitis, asthma and chronic rhinosinusitis with nasal polyposis. Ninth place went to Vertex Pharmaceuticals' Trikafta (elexacaftor, ivacaftor, tezacaftor), an advanced therapy for the treatment of cystic fibrosis. Finally, closing the table in tenth place is Ozempic (semaglutide) from NovoNordisk Pharmaceuticals, used as a diabetic drug - which can be combined with other therapies - to prevent the development of cardiovascular disease in these patients.