11. AstraZeneca

AstraZeneca chalked up an impressive 10% product sales growth in 2020, even though development of its COVID-19 vaccine wasn't so smooth. (AstraZeneca)

2020 revenue:
$26.62 billion
2019 revenue: $24.38 billion
Headquarters: Cambridge, United Kingdom

AstraZeneca represents the rare example of a Big Pharma company pulling off a double-digit sales increase despite the pandemic, partly because only two of its top 10 best-selling drugs are administered at a healthcare facility. It's also one of the few companies with an authorized COVID-19 vaccine, and the drugmaker inked the biopharma world's largest M&A deal in 2020.

PD-L1 inhibitor Imfinzi, one of the two top AZ drugs administered at healthcare facilities, delivered a solid revenue increase last year despite challenges from pandemic lockdowns. The oncology drug, first approved in 2017, posted a 39% revenue increase to $2.04 billion. Most of the drug's revenues and growth potential come from its use in stage 3 non-small cell lung cancer.

Aside from that use, Imfinzi last year scored an FDA nod in extensive-stage small-cell lung cancer. At the same time, a double trial failure led to the company's voluntary withdrawal of the med's original U.S. indication of previously treated bladder cancer. That development came amid an industry-wide review of accelerated approvals that have failed in confirmatory trials.

RELATED: After Imfinzi's double flop, AstraZeneca walks away from FDA bladder cancer nod

Looking forward, the drug is slated for important trial readouts in 2021. These include the key life extension data from the phase 3 Poseidon trial testing Imfinzi plus chemotherapy with or without investigational CTLA4 inhibitor tremelimumab in newly diagnosed NSCLC. 

Elsewhere in AZ's portfolio, aging asthma drug Pulmicort, or inhaled budesonide, is the other top med that’s given in a healthcare facility. The drug was still growing at double-digit percentages in 2019, but COVID-19 caused a sharp reduction in patient visits to nebulization centers. That led to a sharp revenue decline last year when Pulmicort's sales fell 32% to $996 million.

In addition to Imfinzi, targeted NSCLC drug Tagrisso and the Merck-partnered PARP inhibitor Lynparza represented the driving forces behind AZ’s 10% year-over-year product sales growth to $25.89 billion last year. Tagrisso sales jumped 36% to $4.33 billion, while Lynparza revenues grew 48% to $1.78 billion.

RELATED: AstraZeneca, Merck's Lynparza wins bid to challenge GSK's Zejula in wider ovarian cancer pool

Those drugs form the pillars of AZ’s business, but the general public’s attention to the company has lately been focused on its COVID-19 vaccine, AZD1222.

Though it's not a vaccine maker, AZ hopped on the COVID vaccine bandwagon early by licensing an adenovirus-vectored candidate developed by the University of Oxford.

Early on, AZ enjoyed positive headlines, including encouraging early-stage immunogenicity data and CEO Pascal Soriot’s promise to not make a profit off the vaccine during the pandemic. But things took a turn for the worse when AZ halted its phase 3 trial after a participant in Britain fell ill. The study later resumed, but that was only the first of several problems to come for the program.

The drugmaker then unveiled its Phase 3 data in November. The 62% efficacy for the trial’s intended dosing regimen came in far lower than the 90%-plus bar the shots from Pfizer/BioNTech and Moderna had set.

Investigators recorded 90% efficacy for a small cohort of participants who were mistakenly given a half-dose primer followed by a full-dose booster. AZ grasped the 90% as an unexpected blessing, but the misstep, for such an important trial under the world's watch, didn't help the program.

AZ then started another trial to confirm its half-dose efficacy, but in December, the U.K. cleared the vaccine at its full dose. Europe authorized the shot in January.

These days, the AZ vaccine has been plagued with mysterious supply delays and a round of vaccination halts in several European countries due to concerns of blood clots. 

RELATED: The top 10 largest biopharma M&A deals in 2020 - 1. AstraZeneca/Alexion Pharmaceuticals

Amid the whirlwind of COVID vaccine headlines, AZ unveiled the biopharma world’s largest acquisition in 2020. In a deal worth $39 billion, the British drugmaker plans to buy rare disease player Alexion Pharmaceuticals. The transaction gives AZ several marketed drugs, led by blockbuster complement inhibitors Soliris and Ultomiris. In 2020, Alexion recorded $6.07 billion in sales, up 21.6% over 2019.

For AZ, the focus isn’t solely about a near-term top-line boost but also about the Boston company’s immunology expertise. AZ thinks the complement system can be targeted for more common diseases in the fields of oncology, neurology and respiratory. It remains to be seen whether a newly unveiled FTC effort to crack down on pharma mergers will affect the deal.

11. AstraZeneca