Top 10 Drugs by Worldwide Sales in 2025

The pharmaceutical market in 2025 continues to be led by innovative therapies addressing cancer, metabolic diseases, autoimmune conditions, and chronic illnesses. Below is an updated overview of the top 10 drugs by projected global sales in 2025.

Summary

1. Keytruda (Merck): 31B

2. Ozempic (Novo Nordisk): 21 B

3. Mounjaro (ELi Lilly): 19 B

4. Dupixent (Sanofi and Regeneron): 17 B

5. Wegovy (Novo Nordisk): 14 B

6. Biktarvy (Gilead Sciences): 13.4 B

7. Skyrizi (Abbvie): 13 B

8. Eliquis (Bristol-Myers Squibb): 13 B

9. Darzalex (Johnson & Johnson): 13 B

10. Humira (Abbvie): 12.5 B

Highlights and Market Trends

Keytruda (Pembrolizumab) remains the global leader in drug sales with projected revenues exceeding $31 billion in 2025. This cancer immunotherapy has expanded to over 40 approved indications since its launch in 2014, including multiple cancer types, driving strong sales growth. Merck reported $21.6 billion in sales for the first three quarters of 2024, an 18% increase year-on-year (2, 5, 7) .

GLP-1 receptor agonists dominate the metabolic therapy segment with four drugs in the top 10: Ozempic and Wegovy (both semaglutide-based), Mounjaro and Zepbound (tirzepatide-based). These drugs are primarily used for type 2 diabetes and obesity management, reflecting the growing global focus on metabolic diseases (2, 5).

Dupixent (dupilumab) and Skyrizi (risankizumab) are prominent autoimmune therapies, addressing conditions like atopic dermatitis, asthma, psoriasis, and Crohn’s disease, maintaining strong market positions with combined sales near $30 billion (2, 5).

Eliquis (apixaban), an anticoagulant, continues to be a top seller due to its widespread use in stroke prevention for atrial fibrillation and treatment of thromboembolic disorders (3, 5).

HIV treatment Biktarvy and cancer drug Darzalex also maintain high sales, each expected around $13 billion, underscoring continued demand in infectious disease and oncology (5).

Keytruda (Pembrolizumab)

Keytruda is the world's bestselling cancer drug by a large margin. (Merck & Co.)
Company: Merck & Co.
2024 sales: $29.5 billion

Diseases: 

1. Melanoma, (KEYNOTE-006 and KEYNOTE-054 trials)
2. Non-small cell lung cancer, (KEYNOTE-010, KEYNOTE-407, KEYNOTE-189, KEYNOTE 671 trials)
3. head and neck cancer, (KEYNOTE-012 and KEYNOTE-048)
4. kidney cancer (renal cell carcinoma), (KEYNOTE-426)
5. classical Hodgkin lymphoma, (KEYNOTE-204)
6. primary mediastinal large B-cell lymphoma, 
7. bladder cancer, (EV-302/KEYNOTE-A39) 
8. microsatellite instability-high or mismatch repair deficient cancers,
9. gastric cancer, 
10. esophageal cancer, 
11. cervical cancer, 
12. liver cancer, 
13. biliary tract cancer, 
14. Merkel cell carcinoma, 
15. endometrial cancer, 
16. tumor mutational burden-high cancer, 
17. cutaneous (skin) squamous cell carcinoma, 
18. Triple-negative breast cancer. (ASCENT-04/KEYNOTE-D19 Study)

In 2024, Merck's Keytruda (pembrolizumab) achieved global sales of approximately $29.5 billion, representing an 18% increase compared to 2023. Excluding foreign exchange impacts, the growth was about 22%. Keytruda remained the world’s best-selling drug, with multiple FDA approvals in 2024 expanding its indications, including treatments for cervical and endometrial cancers (1, 2, 3, 4, 6).

After AbbVie's Humira lost U.S. market exclusivity and as demand for COVID vaccines plummeted at the end of the pandemic, Merck & Co.’s Keytruda was finally able to claim the title of the world’s bestselling medicine in 2023. But its reign may be short-lived. 

In 2023, Keytruda’s sales grew 21% at constant exchange rates, reaching $25 billion. At the same time, as GLP-1 diabetes and obesity drugs take the world by storm, Novo Nordisk’s semaglutide franchise—Rybelsus, Ozempic and Wegovy—together generated 145.8 billion Danish kroner ($21.1 billion). That marked a nearly 90% surge over 2022. 

The three semaglutide brands continued their seemingly unstoppable growth into 2024. Their first-quarter sales collectively jumped 48% year over year to 42.2 billion Danish kroner ($6.1 billion), inching even closer to Keytruda’s $6.9 billion haul, which represented a 20% increase over the same period last year. 

Keytruda is no doubt the world's bestselling cancer drug. The next oncology asset on our list, Bristol Myers Squibb and Ono Pharma’s rival PD-1 inhibitor Opdivo, generated $10 billion last year. Johnson & Johnson recorded $9.7 billion for its anti-CD38 multiple myeloma drug Darzalex. 

Keytruda scored two high-profile FDA approvals last year, although one of them wasn’t specifically about the PD-1 drug itself. 

In October 2023, the FDA greenlighted Keytruda as part of a continued neoadjuvant-adjuvant therapy used around surgery in resectable non-small cell lung cancer, making it the first PD-1/L1 inhibitor regimen that’s used both before and after surgery. 

The approval was accompanied by phase 3 data from the KEYNOTE-671 trial showing that, compared with presurgical chemo alone, the addition of Keytruda around surgery significantly cut the risk of death by 28%. Despite perioperative Keytruda’s overall survival win, it remains unclear whether a checkpoint inhibitor is necessary both before and after surgery for all approved non-small cell lung cancer cases. The FDA has indicated it wants to tease out the exact contribution of each phase of treatment to the entire regimen. The ultimate length of treatment will affect Keytruda’s long-term sales potential.

In another major feat, a combination of Keytruda and Astellas and Pfizer’s Padcev won full FDA approval as a first-line treatment for advanced bladder cancer—regardless of the patient’s eligibility for chemotherapy. The approval came after the phase 3 EV-302 trial linked the Keytruda-Padcev combo to a 53% reduction in the risk of death compared with chemo. 

But the EV-302 readout was viewed as more of a success for Padcev and the antibody-drug conjugate modality, especially given Keytruda’s previous stumbles (Lancet Oncology 2021) in first-line bladder cancer as a monotherapy and as part of a combination with traditional chemotherapy. Nevertheless, the EV-302 regimen speaks to Keytruda’s appeal as the combination partner of choice for newer drugs. Another candidate taking that approach is Moderna and Merck’s individualized cancer vaccine, mRNA-4157 (V940). The shot’s cocktail with Keytruda has drawn much interest because of its promising midphase data in resected melanoma.  

However, not all attempts to pair Keytruda up have been successful. Some of the notable failures include Keytruda’s combos with AstraZeneca-partnered Lynparza and Eisai-shared Lenvima.

As Keytruda is slated to fall off the patent cliff in 2028, Merck has been working on a subcutaneous version to potentially soften the blow. However, Merck is behind its rivals BMS and Roche in terms of developing more convenient injections of their PD-1/L1 offerings. A dispute over a microscopic enzyme is threatening Merck & Co. plans to sell a new version of Keytruda, the cancer drug that generates nearly half of the company’s sales. Merck has been tweaking Keytruda to make it easier to use—and to protect billions of dollars in revenue the company could lose after U.S. patent protection runs out in 2028 and rivals can begin selling copycats. The enzyme in the new Keytruda allows it to be injected, rather than given intravenously. It is the subject of a brewing patent dispute between Merck and a biotech called Halozyme Therapeutics. (Wall Street Journal) 

While biosimilars for pembrolizumab are on the horizon, as of mid-2025 no biosimilar versions are yet widely available or approved for commercial use in key global markets. These drugs are biologics (monoclonal antibodies), which are complex to manufacture and subject to patent protections. Pembrolizumab’s patent (held by Merck) is expected to expire in the US around 2028, potentially allowing biosimilars (not generics, due to biologics’ complexity) to enter the market thereafter. Biosimilars are highly similar versions of biologics, requiring clinical trials to demonstrate equivalence, unlike small-molecule generics.

Some countries (e.g., India, China) may produce biosimilar or off-patent versions of ICIs, but these are not FDA- or EMA-approved and lack global standardization. For example, biosimilars for other biologics (e.g., rituximab) exist in India, but no specific pembrolizumab biosimilar is available in major markets.

The Biologics Price Competition and Innovation Act (BPCIA) grants a 12-year exclusivity period for original biologics in the US. Since Keytruda was first approved by the FDA on September 4, 2014, this exclusivity* is scheduled to expire on September 4, 2026 (Eureka). While this could theoretically allow for biosimilar applications, the stronger patent protections, which expire in 2028, are the main barrier to market entry.

*Note: Patent Protection vs Regulatory Exclusivity: Patent protection protects the inventor's intellectual property, including the drug molecule itself and its manufacturing process. Regulatory exclusivity prevents competitor products from entering the market, regardless of patent status. This is distinct from patents and applies to biologic drugs like Keytruda.

Update (May 2025): KEYTRUDA® (pembrolizumab) Plus Trodelvy® (sacituzumab govitecan-hziy) Reduced Risk of Disease Progression or Death by 35% Versus KEYTRUDA Plus Chemotherapy in First-Line PD-L1+ Metastatic Triple-Negative Breast Cancer (TNBC) (ASCENT-04/KEYNOTE-D19 Study)

Conclusion

The 2025 pharmaceutical sales landscape is led by innovative immunotherapies and metabolic drugs that address some of the largest global health burdens—cancer, diabetes, obesity, and autoimmune diseases. Merck’s Keytruda solidifies its position as the top-selling drug worldwide, while Novo Nordisk and Eli Lilly capture significant market shares in metabolic therapies. The sustained success of these drugs highlights the pharmaceutical industry's focus on chronic and complex diseases with high unmet medical needs (2, 5, 7).

Related: 

Top 10 Healthcare Companies by Revenue in 2025

Top 20 Selling Cancer Drugs 2025