1. Roche

Despite biosimilars dealing a $10 billion blow to its top line, Roche will still top pharma's 2026 sales list. (Roche)

Estimated 2026 sales: $61.9 billion
2019 sales: $48.2 billion
2019-26 CAGR: 3.62%

Roche’s making the top of pharma’s 2026 sales ranking is somewhat surprising given that biosimilars to its trio of cancer megablockbusters—Avastin, Herceptin and Rituxan—are expected to poke a $10 billion hole in its top line. But newer drugs are expected to step up and more than fill the gap.

Between 2018 and 2023, Roche is projecting a CHF 9.6 billion erosion from biosimilars to the three antibody drugs. The trio's sales tally already slid to CHF19.6 billion last year from CHF 20.6 billion ($21.8 billion) the prior year after copycats started hitting the U.S. scene in mid-2019.

The prediction assumes the company’s HER2 franchise will remain stable as a whole despite Herceptin's decline. In the first quarter of 2020, Herceptin saw sales plummet by 24% to CHF 1.21 billion, and for the first time, it was surpassed by Perjeta and Kadcyla, with combined sales of CHF 1.44 billion.

The question now, though, is how long Kadcyla’s double-digit sales growth can last. AstraZeneca and partner Daiichi Sankyo are pushing to make their Enhertu into the leading HER2 antibody-drug conjugate by running a head-to-head study against the Roche drug in previously treated breast cancer.

Roche has a broad oncology portfolio, too. Tecentriq, like other PD-1/L1 inhibitors, is a pipeline in a drug. This year, a Tecentriq-Avastin combo added a first-in-class nod for previously untreated liver cancer, and Tecentriq gained FDA approval as a monotherapy for first-line non-small cell lung cancer. It also posted a clinical win in combination with chemotherapy used ahead of surgery to improve outcomes for triple-negative breast cancer patients.

Other late-stage Tecentriq trials include post-surgery head and neck cancer, adjuvant and neoadjuvant non-small cell lung cancer, kidney cancer, MSI-H colorectal cancer, other combos for first-line TNBC, and more. A previous Credit Suisse analysis found Roche could be looking at $7 billion in peak sales for Tecentriq in the adjuvant cancer setting alone.

New molecular entities are also on the horizon, such as AKT inhibitor ipatasertib, which just showed promise in a subset of prostate cancer patients.

But don’t mistake Roche for a one trick pony focused solely on cancer. In fact, the title of the most successful launch in Roche’s history belongs to a neuroscience drug: multiple sclerosis antibody Ocrevus. In the crowded MS market, Ocrevus has carved out 21% of total U.S. patient share with more 40% of new and switching patient share as of first quarter 2020. Sales in the three-month period jumped 38% year over year to CHF 1.11 billion.

The drug could face an imminent threat from Novartis’ repurposed ofatumumab, which boasts the advantage of self-administration, while Ocrevus requires help from a healthcare professional. To improve on Ocrevus’ convenience, though, Roche recently won EMA approval to cut infusion time to 2 hours from the conventional 3.5 hours. Roche hopes the shortened time, plus its twice-yearly infusion frequency could help hold its ground against the new in-class rival and its monthly dosing schedule.

RELATED: The 10 most-anticipated drug launches of 2020 - 10. Risdiplam

Down the neuroscience pipeline, Roche has risdiplam, which could be the first oral SMA therapy, as both Biogen’s standard Spinraza and Novartis’ up-and-coming Zolgensma are infusions. EvaluatePharma previously estimated risdiplam could reach $803 million in 2024 sales.

Meanwhile, IL-6 antibody satralizumab currently awaits an FDA decision to challenge Alexion’s Soliris in the rare disease of neuromyelitis optica spectrum disorder (NMOSD), while Alexion’s follow-on drug Ultomiris is in phase 3. The drug has just been approved in Japan under the brand Enspryng.

Other growth drivers for Roche include hemophilia A drug Hemlibra, whose first-quarter haul of CHF 521 million marked a 146% year-over-year increase. To protect its hemophilia franchise, Roche just bought gene therapy specialist Spark Therapeutics. However, its lead hem A candidate is currently around two years behind BioMarin’s valoctocogene roxaparvovec.

1. Roche