6. Sanofi

At year’s end, Sanofi was able to say it did better than expected: Its vaccines sales soared, its diabetes unit actually grew by 1.9%, and its oral MS drug Aubagio zoomed ahead by almost 50% to €1.295 billion.

6. Sanofi
Headquarters: Paris
2016 revenue: €34.708 billion (about $36.57 billion)
2015 revenue: €34.861 billion (about $36.73 billion)

Sanofi entered 2016 with a big question mark hanging over its head. CEO Olivier Brandicourt, preparing for his first full year at the helm, had just unveiled a “strategic roadmap” for a turnaround.

Asset sales, yes; just how, undecided. Cost cuts, yes, €1.5 billions’ worth; how many jobs cut and where, unknown. M&A, yes; target types only loosely identified. And, key to company-watchers, continued struggles in the diabetes business; just how much Sanofi’s new meds could pick up the slack, too soon to tell.

The stated goals were these: reshape its portfolio, deliver outstanding launches, sustain innovation in R&D, simplify the organization. And, in all of that, zero in on areas where Sanofi can lead, which it tagged as rare diseases, vaccines, emerging markets, and cardiovascular and diabetes.

At year’s end, Brandicourt was able to say that Sanofi did better than expected; its vaccines sales soared, its diabetes unit actually grew by 1.9%, and its oral MS drug Aubagio got some market traction, zooming ahead by almost 50% to €1.295 billion.

Along the way, the company kept some promises. It struck a deal to trade off its animal health business, Merial, to Boehringer Ingelheim in return for the German drugmaker’s consumer health unit. It jumped into big deal shopping—if unsuccessfully—with forays toward Medivation, eventually nabbed by Pfizer for $14 billion, and Actelion, which struck a year-end deal with Johnson & Johnson for $30 billion-plus.

Plus, Sanofi cut jobs and costs, including 500 jobs squeezed out in France and a reported 20% of its diabetes workforce pared away in December. It made moves toward “streamlining” its manufacturing network, and boosted its margins a bit in the process, the company said in its annual securities filing in the U.S. In its 2016 earnings release, the company credited cost savings for boosting earnings.

But the company fell short in the “outstanding launches” category, partly because its PCSK9 cholesterol drug, Praluent, has struggled to win favorable reimbursement from payers. Prior authorization hurdles and some skepticism among doctors have held back the drug, sold in partnership with Regeneron, and now a hard-fought patent case against rival Amgen could push it off the market altogether.

Or take Dengvaxia, Sanofi’s dengue vaccine that won approval in December 2015. The jab brought in just €55 million last year, far short of its €200 million forecast, thanks to political and economic turmoil in Latin America.

And then there is the launch that didn’t happen as scheduled: sarilumab, for rheumatoid arthritis, now dubbed Kevzara. Also partnered with Regeneron, the drug failed to win the FDA nod on its October decision date, thanks to “manufacturing deficiencies” at a Sanofi fill-finish facility.

Sanofi isn’t looking for big changes in 2017, execs said during the company’s fourth-quarter earnings call. Despite biosimilar competition for its biggest drug, the basal insulin Lantus, the company figures earnings will be stable or decline by up to 3%. Much is riding on the Praluent patent fight, now in the appeals phase at the U.S. Circuit Court in Washington, D.C., and on the hoped-for launches of Kevzara and Dupixent, the atopic dermatitis drug set to be produced at the same plant as Kevzara.

Will those launches deliver as hoped? Will the Boehringer swap jump-start consumer health growth? How will newer diabetes meds—including the recent launch Soliqua—fare as payers continue their squeeze? Obviously, plenty of questions remain.

6. Sanofi