As we enter 2024, the global competition for "King of Medicine" is becoming increasingly fierce.
In the first half of the year, Merck's PD-1 monoclonal antibody pembrolizumab (trade name: Keytruda, "Keytruda") successfully won the title of the world's "king of medicine" with $14 billion. Novo Nordisk's semaglutide (including 3 brands: Ozempic/Rybelsus/Wegovy) ranked second with sales of about $13 billion in the first half of this year, further narrowing the gap with Keytruda, and the year-on-year growth rate exceeded 40%, leaving suspense for the "king of medicine" competition in the second half of the year.
On the other hand, in terms of sales growth, Eli Lilly's tirpotide (including two brands: Mounjaro/Zepbound) grew 330% year-on-year in the first half of this year to $6.658 billion, making it the fastest-growing drug in history. Since its first indication was approved in 2022, it has grown into a super blockbuster with annual sales of over $10 billion in two years, and will be a strong competitor for the "king of medicine" in the future.
According to the semi-annual reports released by major pharmaceutical companies, the list of global best-selling drugs has been released.
The top ten drugs in terms of sales have a half-year sales threshold of US$5 billion, with the highest being US$14.2 billion, which is Keytruda, the PD-1 monoclonal antibody from Merck.
Keytruda (pembrolizumab, Keytruda) is an immune checkpoint inhibitor developed by Merck. It blocks the immune checkpoints between tumor cells and T cells by targeted inhibition of the binding of PD-1 and PD-L1, thereby enhancing the anti-tumor activity of T cells and activating the body's immune system to attack tumor cells.
The drug was first approved for marketing in the United States in September 2014 and in China in 2018. Although K drug is the second PD-1 drug approved for marketing in the world, its indications have expanded rapidly. Currently, the number of indications in the US market has reached 40, covering solid tumors and hematological tumors such as non-small cell lung cancer, small cell lung cancer, liver cancer, head and neck cancer, MSI-H tumors, Hodgkin lymphoma, large B-cell lymphoma, etc. And there are still hundreds of related clinical studies underway around the world.
In 2023, K drug sales reached $25 billion, becoming the new "king of medicine". In the first half of 2024, K drug sales reached $14.2 billion, a year-on-year increase of 17.8%, successfully defending its title as the "king of medicine".
But K drug also has its own difficulties. Its key patent will expire in 2028, and it will face challenges from biosimilar drugs. In addition, the two GLP-1 drugs ranked second and fourth have an astonishing growth rate, edging closer to the position of "king of medicine".
Ranked second is Novo Nordisk's Semaglutide. In the first half of this year, the sales of its three brands Ozempic/ Rybelsus/ Wegovy totaled US$13 billion, a year-on-year increase of 42%. Although there is still a gap of US$1 billion from Keytruda Pharma, the growth rate is much higher than that of Keytruda Pharma.
It is worth mentioning that the production capacity problem that has plagued Novo Nordisk for a long time has been alleviated, and the month-on-month growth rate has returned to the growth track. In February this year, Novo Nordisk announced that it had agreed to acquire three filling plants belonging to Catalent from its major shareholder Novo Holdings for an advance payment of US$11 billion. This acquisition is expected to achieve expansion of production scale and speed, providing a solid foundation for further growth in semaglutide sales.
Tipocapeptide, which ranked fourth, had sales of US$6.658 billion in the first half of 2024, a year-on-year growth rate of 330%. This is also the first time that the drug has entered the top 10 list of global best-selling drugs.
Tirzepatide is a GIPR/GLP-1R dual agonist developed by Eli Lilly. Its diabetes indication was first approved by the U.S. FDA in May 2022, under the trade name Mounjaro; its weight loss indication was approved in November 2023, under the trade name Zepbound.
After the launch of tipol, the speed of its sales growth shocked the market, making it the drug with the fastest growth rate in history.
At present, the weight loss market is still in the stage of new expansion. After the production capacity problem of semaglutide and telpotide is solved, the sales of semaglutide and telpotide are expected to continue to grow rapidly in the second half of this year.

The success of drug K is based on its excellent clinical data, which has promoted immunotherapy to become the mainstream of cancer treatment. On the other hand, it is due to its wide range of indications. With the continuous approval of indications, it continues to provide a growth engine.
GLP-1 drugs also have these two characteristics. On the one hand, they have changed the landscape of weight loss drug treatment. On the other hand, this type of drug also has the potential to treat cardiovascular, MASH, CKD and other diseases ( GIPR/GLP-1R dual agonists have exploded Eli Lilly's performance, with a comprehensive layout for blood sugar reduction, weight loss, and fatty liver disease ). In the future, both semaglutide and telpotide will have a lot of room for growth and will be strong competitors for the "King of Medicine".

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