The pharmaceutical sector is one of the main actors in the play field of the Covid-19 emergency, as the race to find new treatments and vaccines is supporting new investments in R&D. But there is also another side of the pandemic to be considered, with many medical visits and hospital procedures cancelled or postponed, and many people at the four corners of the globe experiencing economic issues which might reflect on their possibility to access medicines. 

This persistent uncertainty impacts on the capacity of analysts to provide robust indications on the future evolution of the market. “The long-term impact of the pandemic on the biopharma industry is still largely unknown. As such, many of the forecasts in this year’s report will have been made in something of a vacuum”, wrote the authors of the EvaluatePharma World Preview 2020. 

The impact of the pandemic

Just four among the top 15 pharma companies are expected by the report to close the year with positive sales. The stand-by of many medical activities led to a generalised decrease of prescriptions. Looking at the different therapeutic areas, losses appear to be particularly relevant for CNS drugs, followed by Oncology, Musculoskeletal, Blood and Endocrine sectors. 

GSK should especially benefit from increases in sales of Tivicay (dolutegravir) to treat HIV (+ 5.2%) and Ventolin (salbutamol, +10.5%), while at the other end of the rank there is Merck experiencing losses for its leading products Keytruda (pembrolizumab, -3.1%), Bridion (sugammadex, -12.0%) and Gardasil (HPV vaccine, -2.6%). Gilead may benefit from the Emergency Use Authorisation received at the beginning of May for Veklury (remdesivir) to treat Covid-19. 

Trends for the next five years

The EvaluatePharma’s report expects a 7.4% CAGR (compound annual growth rate) increase of prescription drug sales for the period 2020-2026, supported mainly by the Oncology sector (21.7% of expected market in 2026) and orphan drugs (+10.8% CAGR). Prescription drugs sales are expected to reach $ 1.4 trillion in 2026, with Keytruda ($ 24.9 bln) almost doubling its competitors. 

Expected launches for 2020 include Palforzia (peanut (Arachis hypogaea) allergen powder-dnfp), Trodelvy (sacituzumab govitecan-hziy, for patients with metastatic triple-negative breast cancer) and Tukysa (tucatinib, for metastatic breast cancer), and the potential Covid’s treatments Veklury (remdesivir) and Actemra (tocilizumab).

More than 500 new molecular entities are expected to be approved by the FDA in the coming years. The sales of biotechnology products should grow $ 239 bln in 2026, compared to the values of 2019. This is paralleled by a possible $ 252 bln loss of sales due to patent expiry; this trend may impact especially anti-rheumatics.

Immunosuppressants are expected to grow 14.3% CAGR up to 2026; representatives of this therapeutic class include Dupixent (dupilumab, to treat atopic dermatitis), the products for psoriasis Otezla (apremilast) and Cosentyx (secukinumab), and the nephrology active ingredient bardoxolone methyl.

Roche is forecasted to maintain the leading position among top companies, before Johnson & Johnson and Novartis, thanks to its products Ocrevus (ocrelizumab, for multiple sclerosis), the oncology drugs Tecentriq (atezolizumab) and Perjeta (pertuzumab), and Hemlibra (emicizumab-kxwh, for hemophilia A), with a possible total sales volume of $25.4 bln in 2026.

Clinical trials are also delayed

The Covid-19 emergency also impacted on the regular prosecution of many clinical trials, thus slowing down the corresponding development projects. R&D expenditure is expected to grow 3.2% CAGR up to $232.5 bln in 2026. Roche ($ 12.9 bln), Merck ($ 11.00 bln) and J&J ($ 10.7 bln) should be the top investing companies in R&D in the next five years. GSK and Pfizer should increase their R&D spend by 0.9% and 0.7% respectively, while Eli Lilly and AstraZeneca are expected to reduce it by 5.2% and 4.6% respectively.

Looking at new products in the pipelines, oncology remains the leading therapeutic area; new approaches are expected to reach the market in the gastro-intestinal and cardiovascular sectors, and according to EvaluatePharma “blood products are most likely to be approved by the FDA with an average product-specific probability of technical and regulatory success (PS-PTRS) of 70%”.

Among the most interesting products in the pipelines, the EP World Preview 2020 mentions Eli Lilly’s anti-diabetic and obesity drug tirzepatide and The Medicines Company’s (part of Novartis) antihyperlipidaemic inclisiran. The small company Argenx is conquering the third place, thanks to the positive results of trials with its immunosuppressant efgartigimod in patients with generalised myasthenia gravis.

Biotechnological medicines shall represent up to 55% of top 100 global sales in 2026 (+12% vs 2012, + 9.6% CAGR 2019-2026), says the report. In this sector Roche may suffer the recent (2018-2019) patent expiration of its blockbusters Avastin (bevacizumab), Herceptin (trastuzumab) and Rituxan (rituximab); AbbVie is also expected to exit the top 10 position due to the loss of exclusivity of Humira (adalimumab) in 2023.