The top 20 drugs by worldwide sales in 2020

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The ranks of the industry's top drugs feature the biggest names in the business, but behind the numbers are important trends to watch. (Getty/PraewBlackWhile)

While the global sales rankings of Big Pharma's superstar drugs naturally feature the biggest names in the business, new meds often pop up or old drugs exit the scene. And the moves within the list from year to year illustrate many of the trends shaping pharma on a daily basis.

The top three drugs—AbbVie's Humira, Merck's Keytruda and Bristol Myers Squibb's Revlimid—held steady year over year. The first big change comes at No. 4 with Bristol Myers and Pfizer's ascendant blood thinner Eliquis. In 2019, Bristol’s checkpoint inhibitor Opdivo held that spot. But the drug, initially a rival to Keytruda, couldn’t keep pace with Merck and fell to No. 8 in 2020.

Roche's aging cancer blockbuster Avastin took a dramatic plunge of its own. The drug generated $7.12 billion in 2019, enough for the No. 8 spot, but as biosim challengers gained steam, sales fell to $5.32 billion in 2020. Avastin ended up at No. 14. Rituxan, another Roche blockbuster with new biosimilar competition, fell 7 spots to No. 17.

Several big-selling drugs fell off the list altogether. Biogen's multiple sclerosis drug Tecfidera, under generic pressure, missed the cut in 2020, as did Roche’s cancer blockbuster Herceptin and Gilead's HIV drug Genvoya.

Three drugs—AstraZeneca's cancer med Tagrisso, Pfizer and Astellas oncology offering Xtandi, and Roche's multiple sclerosis launch Ocrevus—all made the list for the first time.

RELATED: The top 20 drugs by global sales in 2019

As biosims and generics hit sales of several of the industry's top drugs, Remicade's 2020 performance shows that entrenched biologics can keep churning even after competition hits the market. The drug has faced years of biosim competition but still generated blockbuster sales, holding onto the last spot in the global drug revenue rankings. 

That's likely positive news for AbbVie, which is bracing for competition to the world's top med—Humira—in 2023. Numerous biosim players are set to launch their copycats that year under deals with the branded drugmaker.

Meanwhile, generics are also coming for BMS' Revlimid early next year, but in a volume-limited launch to start. BMS execs have said the company can grow despite the forthcoming copycats to the megablockbuster.

Fierce Pharma compiled this list with assistance from EvaluatePharma. The intelligence firm provided global sales data for the industry's top drugs, including medicines that have multiple marketing partners, to our team in late March.