7. Sanofi

A Sanofi spokeswoman said in March that the company is working on a succession plan for CEO Olivier Brandicourt. (Sanofi)

2018 revenue: $40.66 billion (€34.46 billion) 
2017 revenue: $40.91 billion (€36.20 billion) 
Headquarters: Paris 

Unfortunately for Sanofi, the French drugmaker was one of five companies in the rankings that posted a 2018 sales decline. Behind the numbers are several lingering issues. 

To start, diabetes continued to drag. The company has suffered years of pricing pressure in the key U.S. market as net prices have plunged and rebates swelled. Under those pressures, the company’s diabetes sales sank 10.5% last year. And because that unit is still an important piece of Sanofi's overall revenue—it turned in €5.47 billion last year—its decline had an outsized effect on the top line.

On the flip side, though, Sanofi's rare disease unit Genzyme shone. Immunology launches Dupixent and Kevzara leapt off the company's sales-by-drug chart with triple-digit growth. Dupixent jumped 265% at constant exchange rates to €783 million, while Kevzara sales grew 663% on the year to €83 million. And overall, Genzyme sales jumped 31% to €7.23 billion as the company's effort to emphasize rare diseases takes hold.

Not all of the company’s recent launches have performed as well, however. Dengue shot Dengvaxia, once pegged as a blockbuster, never took off. Instead, it’s been more of a liability, as a safety controversy in the Philippines continues to generate negative headlines for the company. Even so, Sanofi’s vaccine unit managed to grow sales 2.4% to €5.1 billion for the year. Flu shot sales were a bright spot, increasing 7.2% last year to €1.7 billion. 

RELATED: No raise for Sanofi CEO: Brandicourt’s 2018 pay slashed by 25% as sales fall short 

All told, the company’s sales sank 1.7% in 2018, and those flagging sales contributed to Sanofi CEO Olivier Brandicourt’s 2018 pay cut of 25%. When FiercePharma compiles the top-paid biopharma executive rankings, the figure will likely put him at or near the bottom. In mid-March, a Sanofi spokeswoman said the company was working on a succession plan for Brandicourt, who will be 65—Sanofi's mandatory retirement age—in February 2021. 

Sanofi says it sees better days ahead. Dupixent is slated for blockbuster sales down the line thanks to continued uptake in eczema and new nods in sinusitis and nasal polyps, analysts have said. Consensus estimates call for peak sales of more than $5 billion.  

RELATED: Sanofi, buoyed by Dupixent and rare disease drugs, expects a brighter 2019 

That would represent much-needed growth at a time when Sanofi is treading water. The company also expects rare disease launch Cablivi to chip in, although peak sales estimates for that first-of-its-kind nanobody drug are a much more modest $500 million. 

Sanofi picked up that drug in its early-2018 purchase of nanobody biotech Ablynx, worth €3.9 billion ($4.8 billion). Days later, the company moved to buy hemophilia-focused Bioverativ for $11.6 billion. Both deals were intended to move the company further into rare blood disorders.

7. Sanofi