"King of Medicine" Replacement, Teriparatide's annual sales surpass $36.5 billion to reach the top

Recently, major pharmaceutical companies worldwide have sequentially disclosed their 2025 financial reports, revealing the top-selling drugs globally in 2025 with sales exceeding one billion dollars. Novo Nordisk’s dark horse Semaglutide temporarily topped the “King of Drugs” chart after surpassing Merck’s Pembrolizumab (commonly known as “K Drug”) in Q1 2025, but was ultimately overtaken by Eli Lilly’s Tirzepatide. All three drugs achieved sales of over 30 billion dollars in 2025. Additionally, Bristol-Myers Squibb’s Nivolumab (commonly known as “O Drug”), Johnson & Johnson’s Daratumumab, AbbVie’s Luspatercept, Sanofi’s Dupilumab, and BMS/Pfizer’s Apixaban each surpassed 10 billion dollars in sales in 2025.

Note: Due to different accounting methods for partnership revenue sharing, the sales figures for Apixaban disclosed by BMS and Pfizer cannot be directly summed. Reported by The Beijing News.

GLP-1 Market Battles Intensify, Tirzepatide Reaches the Top

In recent years, the “King of Drugs” title has seen rapid changes, with emerging stars gaining momentum. Before 2023, AbbVie’s Adalimumab (Humira) held the “King of Drugs” throne for 11 consecutive years. Merck’s “K Drug” topped the chart in 2023 but only held the position for two years. In the fields of glucose control and weight loss, two “dark horses,” Semaglutide and Tirzepatide, have surged forward aggressively.

With Novo Nordisk expanding capacity in 2024, Semaglutide, which was previously limited by production capacity, experienced strong sales growth. In Q1 2025, its sales surpassed “K Drug.” In the first half of 2025, three Semaglutide products achieved a combined sales of $16.683 billion, solidifying its position as the “King of Drugs.” However, with the full-year financial data for 2025 disclosed, Tirzepatide moved from the top 3 of the global bestsellers in the first half to the number one spot on the 2025 list, with sales reaching $36.507 billion. The sales gap between Tirzepatide and Semaglutide in 2025 is not large, but Tirzepatide’s year-over-year growth rate is as high as 121%, compared to Semaglutide’s 13%. Moreover, Tirzepatide has been included in the new national medical insurance catalog in China, and its sales in the Chinese market are expected to continue expanding. Meanwhile, the core compound patent for Semaglutide in China will expire on March 20 this year, and numerous domestic companies have already entered the biosimilar development of Semaglutide, creating significant competitive pressure for the original drug. Novo Nordisk previously stated that the expiration of Semaglutide’s compound patent in certain international markets is expected to have a low single-digit negative impact on the company’s global sales growth in 2026.

In recent years, competition in the GLP-1 market has been fierce, with intense development of single-, dual-, and multi-target GLP-1 drugs. Both Tirzepatide and Semaglutide are GLP-1 receptor agonists. Data from MoE Medical shows that as of December 2025, there are nine original GLP-1 receptor agonists approved in China, including five imported and four domestic drugs. A research report from Huibo Investment Research indicates that GLP-1 has become a core target for treating diabetes, obesity, and related metabolic diseases, with the industry undergoing rapid iteration and market expansion. Currently, the global market is dominated by Novo Nordisk and Lilly, but Chinese pharmaceutical companies are active and achieving notable results in this field.

Both Novo Nordisk and Lilly are developing new-generation GLP-1 drugs. In December 2025, Novo Nordisk submitted new drug registration applications to the U.S. FDA for its novel glucagon-like peptide-1 analogs, Cagrilintide and the fixed-dose combination injection CagriSema, for weight loss indications. If approved, CagriSema will become the first GLP-1 receptor agonist and glucagon-like peptide-1 analog combination injection therapy. Lilly’s once-daily oral small-molecule GLP-1 drug Orforglipron completed phase 3 trials last April; a key focus is the tri-agonist retatrutide, which targets GLP-1, GIP, and GCG receptors. Clinical data suggest its weight loss potential may surpass Tirzepatide. Lilly recently announced an investment of over $3.5 billion to build a new manufacturing facility in Pennsylvania, USA, to support production of its next-generation obesity drugs, including retatrutide.

Domestically, Innovent Biologics and Lilly’s co-developed MASHIDU peptide (GCG/GLP-1 dual-target) has been approved in China for weight loss and glucose lowering indications. Hengrui Medicine’s (600276) independently developed GLP-1/GIP dual-target receptor agonist HRS9531 has shown positive topline results in phase 3 trials for obesity or overweight indications and has submitted a new drug application in China, with a cumulative upfront payment of up to $6 billion plus milestone payments for “going overseas.” Zousen Pharmaceuticals’ RAY1225, Huadong Medicine’s (000963) oral small molecule HDM1002, and other multi-target pipelines have also made significant clinical progress.

Multiple Oncology and Autoimmune Drugs Make the List

In addition to the currently popular metabolic therapies, new oncology and autoimmune disease drugs remain key R&D areas for major pharmaceutical companies.

In oncology, the PD-1 inhibitor “K Drug” Pembrolizumab, which dropped from the “King of Drugs” to the top 3, still achieved global sales of $31.68 billion in 2025. As one of the best-selling PD-1 monotherapies in recent years, “K Drug” has been approved for over 30 indications, covering the widest range of tumor types and having the most comprehensive lung cancer indications among immune checkpoint inhibitors. In 2022, “K Drug” narrowly lost to Humira ($21.937 billion vs. $21.237 billion), but in 2023, it surpassed Humira with sales of $25.011 billion, claiming the “King of Drugs” title. In 2024, sales rose to $29.6 billion, maintaining the crown. Despite this, in 2025, its sales exceeded $30 billion but was overtaken by Tirzepatide and Semaglutide.

“Former competitor” PD-1 inhibitor Nivolumab (“O Drug”) reached $10.29 billion in sales, ranking within the top 7 based on disclosed financial data from multinational companies. As the first approved PD-1 inhibitor globally, “O Drug” has seen its market share decline as “K Drug” gained more indications, overtaking it in 2018. In 2025, “O Drug” (including subcutaneous formulations) achieved sales of $10.287 billion, far below “K Drug.” Nonetheless, in the highly competitive PD-1/PD-L1 field, entering the top 10 is still a notable achievement.

Additionally, Daratumumab targeting CD38 achieved global sales of $14.35 billion in 2025, a 22% increase year-over-year. It is a key drug for multiple myeloma, with industry projections estimating sales could surpass $16.1 billion in 2026.

In the autoimmune field, Dupilumab and Luspatercept ranked in the top 5 and top 6 respectively, with sales of $17.8 billion and $17.562 billion. Among the top 10 innovative drugs globally in 2024, one of the leading autoimmune drugs—Ustnuzumab—was driven out of the top 10 in the first half of 2025 due to patent expiration and biosimilar competition.

The world’s best-selling old anticoagulant, Apixaban, continued to grow in 2025, with BMS’s sales reaching $14.443 billion, an 8% increase. Pfizer disclosed that its Apixaban revenue was $8 billion, making it its second-largest product. Approved in the EU in 2011, Apixaban has seen strong global sales growth and attracted many companies’ attention. In China, dozens of local companies have obtained approval for generic versions. However, the core patent for Apixaban has not yet expired, and patent protection battles remain fierce, leaving limited time for original manufacturers to maintain market exclusivity.