In a way, every drug is successful for the patients it has helped, be it for a common chronic illness, a prevalent type of cancer, or a rare disease affecting 1 in 10,000 people. But some drugs turn out more rewarding than others, financially speaking.
After years of laborious drug R&D finally turn into a regulatory approval, biopharma companies look forward hopefully to a continuous and abundant flow of revenue to make the investment worthwhile. And it all starts with a successful launch.
The first phase of promotion is important because a company only gets to launch any drug once—a single shot at making a good first impression.
And so many things can go wrong. Reimbursement pushback, manufacturing hiccups, new safety flags, physicians’ reluctance to try a new option, the immediate entry of a rival, ineffective marketing, management snafus, or simply bad timing.
In fact, according to a 2014 analysis by McKinsey & Co. on drugs launched between 2003 and 2009, about two-thirds of new drugs fail to meet prelaunch sales expectations for the first year, and that early shortfall really is a harbinger of things to come. Most of the underperformers continued to lag behind early hopes for the next two years, the analysis showed.
Consider the slow launch of PCSK9 cholesterol fighters—Amgen’s Repatha, and Sanofi and Regeneron’s Praluent. Payer pressure, pricing mistakes and fierce competition held them back. CAR-T therapies from Gilead Sciences and Novartis have suffered because of their high prices, complicated manufacturing process and competitive clinical trials stealing away commercial patients.
Early sales of Tesaro’s Zejula and Clovis Oncology’s Rubraca paled compared to AstraZeneca’s first-to-market Lynparza, a combination of Lynparza's head start and the two smaller firms’ limited commercial power. GlaxoSmithKline’s two-drug HIV combos face an uphill fight in persuading doctors to turn from tried-and-true triplets.
But a slow launch doesn’t doom a drug completely. Take Novartis’ first-in-class heart failure med Entresto. Early on, payers were skeptical and cardiologists reluctant to prescribe given the generic mainstays already available. Despite multibillion-dollar sales expectations, Entresto only sold $170 million for 2016, its first full year on the market. But by 2019, sales had mounted to $1.73 billion, up 70% year over year.
Similarly, a fast launch doesn’t guarantee long-term strength. Just consider Gilead’s hepatitis C drug Epclusa. As the first antiviral to treat all six major forms of HCV, it reeled in $1.75 billion for the first six months after its June 2016 approval. But the entire HCV market shrank, and Gilead's Epclusa franchise brought in $1.97 billion in 2019, flat over the prior year. Its archrival, AbbVie’s Mavyret, the top drug on our list, saw the same fate.
Here, we rank the top 10 drug launches since 2017 by sales for their first four full quarters on the market. Drugs approved toward the end of a quarter had a shorter runway into their first full three months of sales, but however we counted the dollars, the roster was largely the same. Among them, three work against viral infections and four are immunology agents. As always, we welcome your comments. — Angus Liu email