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Special Report                                                                                                                                                                   Special Report



         Global value is highly concentrated in a few top therapy areas and driven primarily
                                                 by biologics                                                                    25% launches continue to drive ~80% sales, but still not exceeded
                                                                                                                                                             Pre-COVID levels

                                             Therapy area sales (2023)           CAGR     YoY  Biologics
                                                                                 2018-23 2022-23  share
                     Oncologics        47%            24%    6% 6% 8%  10% $213 bn  13%  13%    53%
         ~40% of
         global     Antidiabetics        75%            6% 3% 3%  10% $168 bn     15%    23%    64%
                                                           2%
         value                                             1% 4%                                                                              5.2
                     Immunology          76%             12% 2%  5% $166 bn       17%    17%    90%                                           16%            4.6
                  Antithrombotics  64%  17% 4% 10% $55 bn                          9%     -1%   15%                             4.3                                       -56%          -57%          -41%
                                      6%
                                       9%                                                                                                                   23%
                                      4% 11%
                Respiratory Agents  64%  13% 5% $53 bn                             4%     5%    18%                             26%
                                      3%
                                  6% 32%
                 Antihypertensives  25% 17% 11%  $39 bn                            4%     4%    0%                                                                                                     2.7
                                  10%
                                     3%
                    HIV Antivirals  76%  13% $39 bn                                5%     7%    0%                                            84%                         2.0            2.0          21%
                                    1%1%6%                                                                                                                  77%           20%
                          Pain  27% 17% 5% 29% $38 bn                              1%     2%    10%                             74%                                                     35%
                                 15%
                                   7%                                                                                                                                                                  79%
                                    20%
                   Mental Health  54%  13% 6% $34 bn                               3%     -1%   0%                                                                        80%           65%
                                  4%4%
                              13%
                    Antibacterials  13% 29% 3% 37%$32 bn                           1%     4%    0%
                                  5%
                                           US  EU4+UK  China  Japan  Rest of Europe  ROW
                                    Fig. 3: Global Bio/Pharma Market: Top Therapeutic Sectors
       Notes: Growth rates at constant exchange rates Bn in billion. EU 4 is France, Germany, Italy & Spain. Row is rest of world. CAGR is compound annual
       growth rate.
                                                                                                                                                     Fig. 4: Trend Analysis: New Activa Substances (NAS)
       Source: IQVIA MIDAS Q4 2023; RXonly; excludes Vaccines                                                        *Top 10 NAS launches ranked by 12 months post-launch cumlative sales
       cularly if antibody drug conjugates and  vous system (CNS) disorders is grow-  city, and their own internal challenges,   Source: IQVIA MIDAS Q4 2023, Rx only
       bispecifi c antibodies show signs of suc-  ing rapidly, accentuated  by COVID,  including  achieving higher returns on
       cess in hard-to-treat cancers and CART  but this is not yet refl ected in sales as  investment  in research and develop-
       therapies  can become  more widely  there has been little innovation in this  ment (R&D). He explained that pharma
       available.                        area over the past 15 years, and gene-  companies must develop a much more
                                         rics dominate therapies for many of the  rigorous  evaluation of  pipeline assets
          Innovative drugs  in immunology  disorders in the CNS space. However,  in relation to the standard of care:
       are  challenged  by  the  diffi culty  in  the slow but steady progress evident in  establish it in disorders with no previous
       replacing current standard-of-care  Alzheimer’s disease and a more promi-  treatment,  exceed it in disorders with                               289   307            100
       products and pricing pressures  in an  sing pipeline in other CNS conditions  existing  therapies, or alter  the value          262   266   281        26%            29%
       increasingly competitive market. In the  suggest there is likely to be signifi cant  proposition  for the system and/or    247  23%   23%   24%   25%
       diabetes sector, strong pricing pressures  growth in CNS sales over the next  patients by re-engineering existing treat-  22%         8%    8%    9%    9%            10%
                                                                                                                                                                             4%
                                                                                                                                       7%
       now exist, with gross-to-net discounts  decade. In terms of broader global health  ment modalities.                       7%   19%   18%   18%   17%   16%            12%
       of more than 70%. Looking ahead over  challenges, such as antimicrobial resis-                                           17%
       the  next  fi ve  years,  the  emergence  of  tance (AMR), there has been little prog-  Within this framework, overall    20%   20%   20%   20%   21%   22%            17%
       glucagon-like peptide 1 (GLP-1) drugs  ress in innovation despite the estimate  product innovation, as measured by the
       for obesity  in addition  to Type 2 dia-  that  AMR-related  deaths could reach  sales of new active substances (NAS),   33%    31%  31%   30%   28%   27%            28%
       betes, and growing evidence of benefi t  10-million annually by 2050, up from  shows mixed results in the US, by far
       across the wider cardiometabolic space,  1.25-million in 2019.     the most important market for new
       is likely to lead to them becoming the                             products. A consistent recent trend has
       second largest sector by 2030. The wil-  Pharma’s growth challenges  been that the top 10 NAS  launches
       lingness of consumers to pay for obesity   In looking at growth challenges,  (based on 12-month post-launch cumu-
       treatment is  another sign  that citizens  IQVIA’s Lewis explained that pharma  lative sales at ex-manufacturers’ prices)                         Fig. 5: Small-Molecule Generics Market
       are  beginning  to disrupt  conventional  companies are confronting three main  have accounted for approximately 80%   Notes: Generics include unbanded and branded generics, Rx only, biosimilars are excluded;
                                                                                                                     Argentina and Turkey excluded due to Fx fl uctuations Bn is billion. LATAM in Latin America. Row is rest of world. EU4 in France, Germany, Italy & Spain.
       modes of behaviour in healthcare man-  issues: payer  pressures, stressed and  of overall NAS sales, but NAS growth   CAGR is compound annual growth rate.
       agement. The morbidity of central ner-  evolving healthcare systems and capa-  has not returned to pre-COVID-19 pan-  Source: IQVIA MIDAS Q4 2023

       188                                                                     Chemical Weekly  June 25, 2024        Chemical Weekly  June 25, 2024                                                                  189


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