6. GlaxoSmithKline

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GlaxoSmithKline's pharma sales will grow about one third their 2017 level by 2024, according to Evaluate. (Eric Sagonowsky)

Headquarters: London, United Kingdom
2017 prescription sales: $28.7 billion 
Projected 2024 sales: $38.4 billion 

The year 2017 marked a transition for GlaxoSmithKline, as new CEO Emma Walmsley made her mark by focusing the company’s R&D capital on four areas and revamping about half of its top leaders. Key products from HIV, respiratory, vaccines and oncology have been identified as the company’s growth drivers in the near- to mid-term. 

By 2024, Evaluate Pharma analysts predicted GSK’s prescription drug revenue will rise to $38.4 billion, or about one-third above 2017’s $28.7 billion, with major contribution from the HIV franchise and vaccines. 

As HIV patients’ life expectancies grow longer, GSK hopes to cut the medicines they’re taking to reduce the risk of side effects and drug-drug interactions. Through its majority-owned ViiV Healthcare, GSK is pushing for wider use of two-drug regimens rather than the standard triplets. But it has a lot of convincing to do. 

GSK is currently in a two-way battle with Gilead Sciences in HIV. Sales of GSK’s antiviral portfolio will grow from 2017’s $5.89 billion to 2024’s $10.34 billion, per Evaluate’s estimate, but Gilead will still maintain a clear lead. 

Gilead’s Biktarvy, just approved by the FDA in February, will lead the 2024 HIV market with $6.10 billion in annual sales, while Genvoya will slightly drop to $3.40 billion. GSK’s three-drug cocktail Triumeq will take the second spot, with $4.73 billion in 2024 sales, and its backbone Tivicay (dolutegravir)—required to be paired up with other antivirals—will jump to $2.71 billion. Some of GSK’s dual-drug regimens will also chip in. These include Juluca, the first-ever complete regimen that contains just two drugs, a therapy that includes dolutegravir and lamivudine, which GSK’s seeking approval for treatment-naïve patients, and a long-acting injection of dabotegravir plus rilpivrine. 

The British pharma became the largest vaccine maker in 2017. Shingles vaccine Shingrix drew so much interest that only supply limited its initial uptake. As the company works to resolve the constraint, it expects 2018 sales of between £600 million and £650 million. 

Walmsley’s strategy for its vaccine business is quite clear: aiming for large volume rather than high prices. While Shingrix will not appear in the top five vaccine products in 2024, GSK will still lead the overall vaccines market, with projected revenue of $10.74 billion, thanks to “the diverse breadth of GSK’s portfolio in this space,” said Evaluate.  

Meanwhile, respiratory, a traditional GSK strength, represents a mixed opportunity. First, there’s the expected decline of Advair, which generated about $4.4 billion last year. For 2018, the company is looking at a 30% decline—and that’s assuming no substitutable generic entry.  

Newer products Trelegy and Nucala are reaping market share, but industry-wide pricing pressure in the U.S. aside, the two drugs have their own problems. GSK recently won a key indication expansion for Trelegy, which is now able to treat a broader COPD patient group beyond switch-overs from dual-drug regimens. However, in an editorial that accompanied the study, some experts argued GSK’s trial design “probably resulted in falsely exaggerating the benefit” of the triple therapy. As for asthma drug Nucala, an FDA panel recently nixed its hope to expand into COPD. 

In comparison, oncology is a renewed GSK focus under Walmsley after her predecessor Andrew Witty traded the business for Novartis’ vaccines portfolio. One drug will put Walmsley’s ambition to early test. A BCMA antibody drug dubbed GSK2857916 recently won an FDA “breakthrough therapy” designation, and was just pushed into phase 2 in multiple myeloma. Evaluate named it one of the top five most valuable R&D projects, projecting a 2019 launch and 2024 global sales of $1.37 billion. 

6. GlaxoSmithKline