In 2025, the global pharmaceutical market landscape underwent another major reshuffle.
The GLP-1 drug market continued to expand, with Semaglutide reaching nearly $8 billion in Q1 sales and Tirzepatide at $6.15 billion, making it the fastest-growing segment. In oncology, although Keytruda maintained a 4% year-over-year increase, it began to decline quarter-over-quarter. In the autoimmune field, following the patent expiration of HUMIRA, STELARA also experienced a sharp drop in sales and fell out of the TOP10 list. Meanwhile, the new autoimmune drug DUPIXENT showed weak growth and is in urgent need of a breakthrough.
As a revolutionary cancer treatment, Keytruda (Pembrolizumab), first approved by the U.S. FDA in September 2014, has continually expanded its indications to 40 approved and over 100 in research. In 2023, it became the top-selling drug globally with $25.011 billion in sales, and it grew 18% in 2024 to reach $29.5 billion.
However, after years of high growth, Keytruda is now facing unprecedented competition, with signs of peaking sales.
According to Merck’s financial report, Keytruda’s Q1 2025 sales reached $7.21 billion, up 4% year-over-year, but with a quarter-over-quarter decline for the first time.
Ranked second is Novo Nordisk’s diabetes drug Ozempic (Semaglutide), which generated DKK 32.721 billion (~$4.6 billion) in Q1 2025, an 18% YoY increase (exchange rate: 1 DKK = $0.141).
Interestingly, Wegovy, another brand of Semaglutide used for weight control, ranked 10th with Q1 sales of DKK 17.36 billion (~$2.4 billion), up 85% YoY.
Additionally, Semaglutide’s oral formulation Rybelsus recorded DKK 5.695 billion (~$803 million) in sales.
Combined, Semaglutide’s total Q1 sales reached approximately $7.9 billion—surpassing Keytruda and becoming the new “King of Drugs.”
Next is Eli Lilly’s Mounjaro (Tirzepatide), a dual GLP-1/GIP receptor agonist offering excellent blood glucose control and weight loss benefits. Though launched five years after Semaglutide (in 2022), it achieved $3.84 billion in Q1 sales.
Zepbound, the weight-loss version of Tirzepatide, added $2.31 billion in Q1 sales, bringing the total to $6.15 billion, making it Semaglutide’s biggest rival and a strong candidate for future top drug status.
However, competition in the GLP-1 market is heating up, especially in the U.S., where the battle is fierce. Novo Nordisk's slides show Tirzepatide is eating into Semaglutide’s market share in both diabetes and weight loss. Tirzepatide’s total and new prescriptions have surpassed Semaglutide’s. Despite YoY growth exceeding 100%, Tirzepatide’s quarter-over-quarter growth slowed to just 13%, indicating the market might soon shift into a stock competition phase.
To respond, Eli Lilly launched a low-dose version of Zepbound for pricing advantage.
Novo Nordisk is securing support from U.S. PBM companies. CVS Health recently announced that starting July 1, Zepbound will be removed from its “preferred formulary,” giving priority to Wegovy instead—a sign of an intensifying GLP-1 price war.
Novo is also expanding into new markets such as China. In June 2024, Semaglutide was approved for weight management in China under the brand “Novo Nordisk,” launching in November and generating DKK 686 million in Q1 2025.
Outside the GLP-1 class, other segments showed less robust growth.
In oncology, Keytruda appears to have peaked and faces challenges from patent expirations and emerging therapies such as bispecific antibodies. However, Johnson & Johnson’s Darzalex (Daratumumab) for multiple myeloma, launched a decade ago, still posted a 20% YoY increase and has more room to grow.
In autoimmune disease, after HUMIRA’s patent expiration, Sanofi and Regeneron’s IL-4R antibody Dupixent became the top seller, with €3.48 billion in Q1 sales, a 20.3% YoY increase. However, QoQ growth was just 0.69%, signaling growth fatigue. Though Dupixent gained approval for COPD last year, the impact on sales has been limited. In April, it gained another indication for chronic spontaneous urticaria, which may help push quarterly sales past €3.5 billion.
In contrast, AbbVie’s IL-23 monoclonal antibody Skyrizi saw Q1 sales soar to $3.43 billion, up 71% YoY. AbbVie’s Rinvoq (Upadacitinib) reached $1.72 billion, up 57% YoY—likely to join the TOP10 soon. This growth could help AbbVie reclaim leadership in the autoimmune space.
The TOP10 list also includes three small molecule drugs, though their outlook is less optimistic.
Bristol Myers Squibb’s anticoagulant Eliquis (Apixaban) remains widely used, but Q1 sales declined to $3.57 billion (-4%). Its key patent expires in 2026, suggesting further declines.
Gilead’s HIV combo drug Biktarvy (Bictegravir + Emtricitabine + TAF) had $3.15 billion in Q1 sales, up 7% YoY, but down 17% QoQ, signaling a slowdown.
Still, Gilead is preparing for Biktarvy’s future loss of exclusivity (2033), with plans to launch nine new HIV drugs, including the long-acting injectable Lenacapavir—approved in 2022 and named a 2024 breakthrough by *Science*. It’s expected to gain PrEP approval by summer 2025.
Vertex’s cystic fibrosis treatment TRIKAFTA/KAFTRIO exceeded $10 billion in 2024, but Q1 2025 sales plateaued at $2.54 billion, up just 2% YoY and down 7% QoQ.
In Q1 2025, diabetes and obesity drugs have overtaken oncology and autoimmune treatments to become the largest contributors to blockbuster sales—reflecting the evolving pharmaceutical market cycle.
Ozempic, Mounjaro, and Wegovy are now firmly in the TOP10, with Zepbound on track to join soon.
Since the advent of PD-1 therapies in 2014, oncology immunotherapy has seen a decade of rapid growth, but Keytruda’s dominance marks a turning point with slowing momentum.
New-generation cancer treatments like ADCs and bispecifics show promise. Enhertu (Trastuzumab deruxtecan) from Daiichi Sankyo and AstraZeneca has quarterly sales over $1 billion and is projected to reach $5 billion in 2025. In the bispecific space, Akeso’s Ivonescimab has outperformed Keytruda and is seen as a next-generation cancer immunotherapy.
In autoimmune diseases, after the patent expirations of Humira and Stelara, AbbVie’s Skyrizi and Rinvoq are emerging powerhouses. Skyrizi is now second only to Dupixent in this field, and Rinvoq, currently in the top 30, is expected to break into the TOP10 soon.
Other future blockbusters are also emerging. Argenx’s FcRn inhibitor Vyvgart (Efgartigimod), approved in December 2021, entered the billion-dollar club by 2023. It now has three approved indications: generalized myasthenia gravis (gMG), primary ITP, and CIDP. Q1 2025 revenue reached $790 million, up 99% YoY. With over 10 new indications under development, Vyvgart’s peak sales may exceed $10 billion.
As pharmaceutical R&D deepens and market needs shift, the blockbuster drug landscape will continue to evolve—let’s stay tuned for more changes ahead.
