European drug forecasts – Xarelto sales not thinning out

Europe's pharma market has many similarities with the US, but also some differences. One surprising finding from the new EvaluatePharma European drug forecasts module is that Bayer’s anticoagulant Xarelto is set to be the number one product on the continent in 2022 – while globally it is only number 20.

Other entries are less surprising, with Astellas’s Xtandi, Bristol-Myers Squibb’s Opdivo and Celgene’s Revlimid making it into both the European and global top five. But the biggest global drug, AbbVie’s Humira, is forecast to be only at number 17 in Europe, probably reflecting greater acceptance of biosimilars and stronger pricing pressures (Can Humira still dominate in 2022?, April 21, 2016). 

X factor

Xarelto’s growth should be boosted by potential new indications such as heart failure, as well as approval of Portola’s factor Xa inhibitor antidote andexanet alfa, expected in the US in August.

The go-ahead for the antidote might seem trivial, but the lack of reversal agents could be a factor limiting the prescription of factor Xa inhibitors and keeping warfarin popular in spite of its drawbacks, Deutsche Bank analysts believe – although cost is probably also an issue.

But competition in the anticoagulant field is stiff. While Xarelto is the dominant factor Xa inhibitor, Bristol-Myers Squibb’s Eliquis is catching up, at least in the US – but outside the country Xarelto is still set to come out on top, according to a Deutsche Bank survey.

Top-five European marketed drugs in 2022
Europe sales (€m)
Project Company Therapy area 2015 2022e Year of first launch
Xarelto Bayer Anticoagulation 1,301 2,718 2008
Xtandi Astellas Pharma Oncology 586 2,500 2012
Opdivo Bristol-Myers Squibb Oncology 160 2,358 2014
Revlimid Celgene Oncology 1,115 2,216 2006
Triumeq GlaxoSmithKline HIV 242 2,048 2014

Contrasts in the global and European top five might stem from market dynamics, but there are also subtle differences in how the consensus figures are calculated.

The new European drug forecasts is a consensus based drug forecast for Europe, broken out on a country level using government and company reported historical sales data, as well as proprietary methodology, to forecast sales for the top 300 marketed drugs and 500 R&D projects.

R&D assets

While most of the €206bn in European 2022 drug sales will come from products that are already marketed, those currently in R&D will make up 16% of the total.

And the top five countries – France, Germany, Italy, Spain and the UK – will account for 68% of the European pharma market in 2022.


Most of the leading European R&D drugs come out as would be expected, with Roche’s Ocrevus and atezolizumab, Sanofi’s dupilumab and Intercept’s Ocaliva (obeticholic acid) all also making the global top five – although the last company's success in both markets is dependent on it getting the go-ahead in the bigger indication of non-alcoholic steatohepatitis (NASH).

Top five European R&D projects in 2022
Project Company Therapy area 2022e sales (€m) Launch expected
Ocrevus Roche CNS 877 2017
RVT-101 Axovant Sciences CNS 694 2018
Dupilumab Sanofi Autoimmune 620 2017
Atezolizumab Roche Oncology 588 2016
Obeticholic acid Intercept Pharmaceuticals Gastrointestinal 562 2016

But there is one unexpected entry: Axovant Sciences’ Alzheimer’s candidate, the 5-HT6 antagonist RVT-101, which surely will need to show a strong benefit in phase III to live up to its number two billing. The asset, which was previously ditched by GlaxoSmithKline after failing in phase II, seems on shaky ground. It will take a surprising turnarond in Axovant's hands to make these figures become more realistic.

To contact the writer of this story email Madeleine Armstrong in London at madeleinea@epvantage.com or follow  @medtech_ma on Twitter

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