Keytruda wins 2018’s biggest sales upgrade

Vantage takes a look at the sellside’s naughty and nice list for 2018: prospects improved considerably for Merck & Co’s Keytruda and Abbvie’s Mavyret, the latter standing out among other hepatitis C disappointments. 

Over the course of this year a huge $2bn was added to Keytruda’s consensus sales forecast for 2019, according to EvaluatePharma. Thus Merck & Co wins the biggest upgrade of the year; second on the list, Abbvie’s Mavyret, achieved half this figure, also a commendable performance. 

The flip side also sees Merck featuring highly. Its hepatitis C blockbuster Zepatier proved even shorter-lived than the sellside had assumed, joining Gilead’s Harvoni and Vosevi among the biggest downgrades of the year. 

This analysis shows just how quickly prospects can change, even for established products. The figures are derived from EvaluatePharma’s sellside-based consensus, ranked to find the biggest upgrades and downgrades over the course of 2018. 

On the up… biggest upgrades of 2018
Product Company  Current 2019 sales estimate ($bn) Change over 2018 ($bn)
Keytruda Merck & Co  9.3 2.1
Mavyret Abbvie  3.2 1.4
Biktarvy Gilead Sciences  3.0 1.3
Opdivo Bristol-Myers Squibb  7.1 1.2
Shingrix Glaxosmithkline  1.5 1.0
Symdeko Vertex   1.4 0.9
Gardasil Merck & Co  3.4 0.8
Truvada Gilead Sciences  2.8 0.8
Trulicity Lilly  3.8 0.7
Zytiga Johnson & Johnson  2.4 0.7
Source: EvaluatePharma.    

Among the risers, it is interesting to see that the near-term prospects for Opdivo, the biggest competitor to Keytruda, also improved over the year. This demonstrates the broad utility of these checkpoint inhibitors. So, for example, while Bristol-Myers Squibb can no longer expect to be a force in first-line lung cancer, the company has made inroads in other tumour types like renal cell carcinoma. 

Roche will not be happy with its performance, however, with its anti-PD-L1 antibody, Tecentriq, featuring among the biggest downgrades of the year. Investors will hope that a recent first-line lung cancer approval injects some life into the product.

It is also notable that, while hep C is in decline, Abbvie managed to win huge upgrades for Mavyret. Taking a big price cut to win coverage appears to have worked; as an individual product Mavyret is forecast to be the bestselling hep C drug from next year, and could actually outsell all the Gilead hep C products combined. 

Lilly will also be pleased with the uplift in Trulicity; the first once-weekly GLP1 agonist has performed very well, and investors will be keen to see these inflated numbers met next year as Novo Nordisk prepares to launch the first oral candidate in this class. Still, Novo’s new insulin Tresiba features in the downgrades, largely owing to the pricing pressure in diabetes, something that will continue to be an issue next year. 

The inclusion of two vaccines also demonstrates how this often overlooked subsector continues to be an important sales growth driver for those that still operate in it. Glaxo’s shingles vaccines Shingrix has performed much better than expected since it was launched in late 2017, while the addition of more strains to Merck’s HPV vaccine Gardasil, which protects against cervical cancer, has given sales a boost. 

On the down... biggest downgrades of 2018
Product Company  Current 2019 sales estimate ($m) Change over 2018 ($m)
Harvoni Gilead Sciences  943 -773
Humira Abbvie  19,745 -746
Zepatier Merck & Co  200 -682
Orkambi Vertex   1,104 -681
Vosevi Gilead Sciences  477 -618
Zostavax Merck & Co  100 -516
Invega Sustenna Johnson & Johnson  2,464 -494
Triumeq Glaxosmithkline  3,743 -461
Tresiba Novo Nordisk  1,563 -455
Tecentriq Roche  1,524 -436
Source: EvaluatePharma.    

Several of the other drugs listed here feature thanks to lifecycle management – older products fade as new arrivals take over – rather than fundamental shifts in the market. Examples include HIV therapies from Glaxosmithkline, and Gilead and Vertex’s cystic fibrosis drugs.

Some of the downgrades had clear triggers, however. Abbvie’s Humira, for example, was downgraded after the company aggressively cut its price in Europe to retain market share as biosimilars arrived.

A close eye will be kept on all of these medicines next year, by both their manufacturers and the financial community, to see if the shifting predictions are close to the mark. 

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