Johnson & Johnson recently released its financial results for the first quarter of 2026.

In terms of overall performance, the company achieved sales of US$24.06 billion during the reporting period, representing a year-on-year increase of 9.9%. Johnson & Johnson also raised its full-year guidance: it expects full-year sales in 2026 to reach US$100.3 billion to US$101.3 billion , with a median growth rate of 7.0%.

Of these, global revenue from innovative pharmaceuticals grew by 11% to $15.4 billion. Oncology remained the mainstay of performance, with revenue of $6.97 billion, a significant year-on-year increase of 22.8%.

However, the immunology business is entering a period of adjustment , with revenue of $3.38 billion, a year-on-year decrease of 8.8%. Stelara, the immunology powerhouse with annual sales of tens of billions of dollars, is shrinking rapidly due to the impact of biosimilars, while Tremfya and Icotyde are emerging as new hope.

01
The Rise of the Twin Stars

Stelara (ustekinumab) was once the crown jewel of Johnson & Johnson's immunology, with annual sales exceeding $10 billion in 2023.

However, since the patent expires in 2025, approximately ten ustekinumab biosimilars have been approved for marketing globally. The drug's sales in 2025 have already plummeted to $6.1 billion. In the first quarter of this year, Stelara's sales continued to plunge to approximately $656 million, a decline of nearly 60% compared to the same period last year. This signifies the end of an era for this once multi-billion dollar blockbuster product.

However, Johnson & Johnson has not fallen into the passive predicament of the "patent cliff". The immunology twins consisting of Tremfya and Icotyde are taking the lead strongly.

These two drugs targeting the IL-23 pathway not only made up for Stelara's sales slump, but also became the core source of Johnson & Johnson's confidence in moving toward the $100 billion mark in annual revenue.

Tremfya (Gusejuzumab) has been the main player replacing Stelara's declining sales, with its peak annual sales expected to exceed $10 billion , a figure directly comparable to Stelara's size at its peak.

This drug is a fully human monoclonal antibody that targets the IL-23 receptor. It can bind to the p19 subunit of IL-23 with high affinity and specificity, precisely blocking IL-23-mediated signal transduction and inhibiting the cascade reaction of downstream pro-inflammatory factors such as IL-17A, IL-17F and IL-22.

Compared to biologics that target only IL-17, gusejinumab has a more thorough inhibitory effect; compared to first-generation inhibitors that target the IL-23p40 subunit, gusejinumab does not interfere with the IL-12 pathway and does not affect related functions such as pathogen defense and tumor immune surveillance, thus reducing the risk of side effects.

This drug was first approved by the US FDA in 2017 for moderate to severe plaque psoriasis, and its indications have been continuously expanded since then. Currently, gusejinumab has been approved for multiple indications in more than 40 countries and regions worldwide, covering four major categories of diseases: moderate to severe plaque psoriasis (adults + children), psoriatic arthritis (adults + children), Crohn's disease, and ulcerative colitis, making it one of the IL-23 inhibitors with the broadest indication coverage.
With its excellent efficacy, long-lasting effects and safety, Tremfya has become one of the preferred first-line biologics in the field of psoriasis.

In 2025, Tremfya's sales exceeded $5 billion, and in Q1 2026, sales reached $1.6 billion, representing a year-on-year increase of approximately 67%, once again exceeding market expectations.

It is foreseeable that Tremfya will play a crucial role in Johnson & Johnson's immune business over the next 3-5 years, becoming another blockbuster product worth tens of billions of dollars.

If Tremfya represents "predictable success," then Icotyde (icotrokinra) represents the greatest potential for Johnson & Johnson's immune business.

In March of this year, Icotyde received FDA approval for the treatment of moderate to severe plaque psoriasis, becoming the world's first and only oral peptide drug targeting the IL-23 receptor.

IL-23 is one of the most successful targets in the field of autoimmune diseases. AbbVie's Skyrizi has already exceeded $17 billion in sales by 2025, and Johnson & Johnson's Tremfya is also aiming for a sales peak of $10 billion.

Previously, all IL-23 inhibitors were injectable biologics. Icotyde utilizes peptide technology to achieve oral administration while retaining the ability to selectively block the IL-23 receptor. This drug provides a novel once-daily oral alternative to the existing psoriasis market, which is primarily dominated by injectable biologics.

In four phase 3 clinical trials involving approximately 2,500 patients, Icotyde met all primary efficacy endpoints and demonstrated a favorable safety profile . In the superiority head-to-head study, approximately 70% of patients achieved clear or near-clearance of skin lesions (IGA 0/1) at week 16, and approximately 55% of patients achieved a Psoriasis Area and Severity Index (PASI) response of 90, which is superior to deuterocelexitinib and represents a more potent oral treatment option.

Johnson & Johnson's CEO revealed in an earnings call that Icotyde was launched on the same day it received FDA approval, and the company immediately observed "strong demand." Within just a few weeks, approximately 1,500 patients had received prescriptions.

Tremfya and Icotyde are both IL-23 inhibitors, but one is an injectable formulation and the other is an oral formulation. They are expected to work synergistically to maximize coverage of patients with various autoimmune diseases such as psoriasis and lock in a larger market share.

02
The confidence behind the $100 billion target

Of course, Johnson & Johnson's confidence in achieving $100 billion in revenue by 2026 does not solely stem from its two autoimmune twins.

In the field of immunology, Johnson & Johnson also has a potential BIC therapy, Nipocalimab . This drug is an FcRn inhibitor, approved in April 2025 for the treatment of myasthenia gravis, with other indications in Phase II/III clinical trials.

FcRn targets have become increasingly popular in the field of autoimmune diseases in recent years, showing potential for the treatment of a broad spectrum of autoimmune diseases. Argenx's new drug Efgartigimod, which targets the same target, is projected to reach $4.2 billion in sales by 2025, representing a 90% year-on-year increase. Nipocalimab's peak sales are also expected to exceed $5 billion.

In recent years, the oncology field has become a "pillar of strength" for Johnson & Johnson's performance.

In the first quarter of 2026, Johnson & Johnson's oncology business achieved revenue of $6.973 billion, a significant year-on-year increase of 23%. This not only contributed nearly half of the revenue from the innovative medicines segment but also demonstrated strong resilience through patent cycles with double-digit growth. Johnson & Johnson's CEO has publicly stated that the company's goal is to become the world's number one oncology giant by 2030, achieving $50 billion in revenue.

Supporting this goal is the "therapeutic ecosystem" it has built in the field of multiple myeloma, and its steady expansion into solid tumors such as lung cancer.

Darzalex is Johnson & Johnson's "number one product" in oncology, with sales revenue of $14.4 billion in 2025. In the first quarter of this year, the drug's sales were approximately $4 billion, representing a year-on-year increase of 22.5%.

Carvykti is Johnson & Johnson's dark horse product in the oncology field, with global sales reaching $600 million in Q1 2026, a year-on-year increase of 62%. At the current growth rate, Carvykti is expected to exceed $3 billion in sales by 2026.

In the solid tumor field, Johnson & Johnson's combination therapy of the EGFR/c-Met bispecific antibody Rybrevant and the EGFR amino acid kinase inhibitor Lazcluze has accelerated its penetration in first-line treatment of EGFR-mutant non-small cell lung cancer, with first-quarter sales surging 82.7% to $257 million. With the continued expansion of lung cancer indications, Rybrevant is expected to become the next major growth driver for Johnson & Johnson's oncology segment.

Johnson & Johnson's neuroscience segment is rapidly emerging. In the first quarter of 2026, the segment's revenue grew by 32%, making it the company's fastest-growing business line.

This high growth was driven by two core products: Spravato, an antidepressant, generated $468 million in revenue, a year-on-year increase of 46.4%; and Caplyta, a new antipsychotic drug acquired from the $14.6 billion acquisition of Intra-Cellular Therapies, contributed $270 million in revenue.

03
Conclusion

While autoimmune diseases, a traditional strength of Johnson & Johnson, have recently faced the challenge of a patent cliff, their successor products, Tremfya and Icotyde, have demonstrated strong market potential and are expected to surpass previous successes. In the fields of oncology and neuroscience, Johnson & Johnson is experiencing rapid growth across multiple areas, bringing its $100 billion target within reach.

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