In recent weeks, major multinational pharmaceutical companies have been unveiling their financial results for 2024, revealing striking trends in the industry. Overall, the sector showcases significant revenue growth, a notable increase in innovative product availability, and an accelerated pace of strategic mergers and acquisitions. Among these developments, China's pharmaceutical market continues to capture the attention of leading global companies, remaining a focal point in their competitive strategies.

The battle for market supremacy among these pharmaceutical giants is intense. Johnson & Johnson has retained its position at the top with impressive total revenues of $88.821 billion. Following closely, Roche, Merck, and Pfizer have also reported revenues exceeding $60 billion, placing them in the second, third, and fourth spots, respectively. AbbVie, AstraZeneca, and Novartis are not far behind, each surpassing the $50 billion mark. Furthermore, Bristol Myers Squibb (BMS), Eli Lilly, Sanofi, Novo Nordisk, and GlaxoSmithKline have each reported revenues exceeding $40 billion.

A revenue milestone of $10 billion is often viewed as a threshold for individual products to be recognized as blockbuster drugs globally. Competition is fierce in this arena, and the current struggle for the title of "king of drugs" is particularly noteworthy.

The explosive growth of semaglutide, a drug developed by Novo Nordisk, demonstrates the vast potential within this category. The semaglutide product line, which includes Ozempic, Rybelsus, and Wegovy, garnered significant success in 2024. Novo Nordisk's report indicates that total sales of these products reached an astounding $29.296 billion, marking a 38.43% increase year-over-year and accounting for 69.5% of the company's overall revenue. Notably, Wegovy, aimed at weight loss, saw a remarkable sales increase of 86%.

Despite this remarkable performance, the title of "drug king" appears to have been snatched by Keytruda (pembrolizumab), developed by Merck, by a slim margin. Since its introduction in 2014, Keytruda has become a shining star in the global pharmaceutical market. After a decade of market presence and scientific validation, the drug continues to break sales records.

According to Merck's 2024 financial disclosures, Keytruda's sales grew by 18% to reach $29.482 billion, representing approximately 46% of the company's total revenue for the year. With about 40 approved indications globally, Keytruda solidifies its dominance in oncology treatment. Over its ten-year lifespan, the drug has achieved cumulative sales totaling an impressive $131 billion.

Another remarkable entry is Sanofi's Dupixent, a biologically targeted therapy for chronic obstructive pulmonary disease (COPD), which reported sales of €13.072 billion (approximately $14.179 billion) in 2024—an impressive 23.1% growth—making it the currently leading therapy in its category.

While Pfizer reported total revenues of $63.627 billion in 2024, a 7% increase, it still fell short of the top three spots. However, Pfizer's pharmaceutical segment alone achieved revenues of $62.6 billion, making it the leading player in global pharmaceutical revenue for 2024.

After swiftly adjusting to the "COVID cliff," Pfizer was able to return to a growth trajectory. Sales from COVID-related treatments contributed over $11 billion to its bottom line. Additionally, a co-developed anticoagulant drug with BMS garnered $13.3 billion in sales for Pfizer, yielding revenue of $7.366 billion for the company.

Despite maintaining its status as the world’s largest pharmaceutical giant, Pfizer faces criticism for a lack of innovation and multiple products approaching patent expiration, leading to a negative impact on its market value compared to other leading multinationals.

Among the top ten multinational pharmaceutical firms, Eli Lilly exhibited the highest year-on-year revenue growth in 2024.

Eli Lilly's financial results reflect a total revenue of $45.043 billion for 2024, a substantial 32% increase, with net profits reaching $10.59 billion, marking a whopping 102% growth. The company’s key driver is its cardiovascular metabolism segment, which reported revenues of $29.521 billion in 2024, accounting for 66% of the total revenue, primarily bolstered by the rapid uptake of tirzepatide.

China stands out as a significant market opportunity for these multinationals. As the world’s second-largest pharmaceutical market, the performance of companies in China profoundly impacts overall business results.

AstraZeneca experienced remarkable growth in China, reporting a robust 11% increase in 2024 with an income of $6.413 billion, making up 12% of its global market share. The company credits its success in the Chinese market to the PARP inhibitor Lynparza, which saw its ovarian cancer indication included in the national healthcare system in 2024. Revenue from emerging markets, with China as the primary driver, reached $655 million, reflecting a 30% year-on-year increase.

In 2024, AstraZeneca announced increasing investments in China, including the construction of a new small molecule innovation drug factory in Wuxi. Additionally, a project to establish an inhalation aerosol production base in Qingdao, initiated in 2023, is progressing steadily.

Novartis has also established itself as a significant player in China, reporting an impressive $3.9 billion in sales for 2024, a 21% increase that outpaced global averages. The much-anticipated radiopharmaceutical Pluvicto generated $1.392 billion in revenue in 2024, achieving a remarkable 42% growth. Novartis submitted an application for Pluvicto’s market entry in China in 2024 and commenced construction of its first nuclear medicine production base in July, with investments amounting to approximately $600 million, expected to be operational by the end of 2026.

Sanofi's performance in the Chinese market shows slight signs of decline, reporting revenues of €2.666 billion (approx. $2.892 billion) in 2024, down 0.5%. Nonetheless, the company made a significant €1 billion investment to establish a new production base in Beijing, aimed at enhancing local manufacturing capabilities for insulin, specifically targeting the needs of Chinese diabetes patients.

Merck faced challenges in China, with its 2024 revenue amounting to $5.394 billion—representing a nearly 20% drop and making it the multinational with the largest revenue decline in this market. The company's four-valent/nine-valent HPV vaccine Gardasil witnessed a significant sales decline in the fourth quarter of 2024. Furthermore, competition from generics led to reduced supplies of Merck's sitagliptin and saxagliptin in this market.

Despite these setbacks, Merck maintains that the Chinese market represents a long-term opportunity for Gardasil and is committed to maximizing this potential in the future.

Recent industry reports indicate that more than one-third of candidate molecules sourced by large pharmaceutical companies in 2024 came from China. Experts believe that as the second-largest pharmaceutical market globally, how multinationals “discover value pipelines in China and realize that value outside of China” will be a true test of their vision and resolve moving forward, with the Chinese market likely becoming a pivotal battleground for these companies.