A therapy for hemophilia A and B, the first weekly insulin, and an antipsychotic with an innovative mechanism of action are some of the latest drugs that will transform Medicine according to Clarivate's forecasts.
The consulting firm has just published its annual Drugs to Watch report, which in its 2025 edition highlights eleven drugs that are expected to achieve blockbuster status in the next five years and change therapeutic paradigms.
Ten of these innovations, some already on the market or recently approved, will surpass the $1 billion annual sales barrier by 2030 in the world's seven major pharmaceutical markets: the United States, Japan, Germany, France, Italy, the United Kingdom, and Canada.
Also this year, like last year, oncology stands out in terms of the number of future blockbusters, with three compounds. However, it is expected that drugs for diabetes and obesity, and atopic dermatitis will generate the highest revenues.
Thus, cagrisema, the evolution of semaglutide (Ozempic/Wegovy), takes the lead, with a forecast of $8.3 billion in annual sales: $4.7 billion for its indication in obesity and $3.6 billion in diabetes.
This Novo Nordisk drug is a combination of semaglutide with cagrilintide, a long-acting amylin analog that allows for slower glucose absorption and release. It promises a more potent effect on glycemic control and weight reduction than semaglutide and its main competitor, tirzepatide (Mounjaro/Zepbound).
The Danish company has another potential blockbuster with its icodec insulin (Awiqli) expected to generate $4.7 billion and is a milestone by allowing weekly administration.
Switching from daily injections to once a week represents a significant improvement in the quality of life for patients, can reduce adherence issues, and facilitate care for dependent individuals who cannot self-administer the injection.
Atopic dermatitis is welcoming a wave of new targeted therapies, as happened years ago with psoriasis. The report explains why Ebglyss (lebrikizumab), from Lilly and Almirall, ranks second with a forecast of $6 billion in revenue despite not being a first-in-class drug.
Lebrikizumab belongs to the same family of interleukin 13 inhibitors as Dupixent (dupilumab) and Adbry/Adtralza (tralokinumab), but it has the advantage of less frequent dosing, more selective IL-13 inhibition, and an efficacy and safety profile that could position it as a first-line treatment for moderate to severe dermatitis when topical corticosteroids are not considered suitable.
Oncology awaits three potential blockbusters: zanzalintinib from Exelixis for colorectal, kidney, and head and neck cancer; Imdelltra (tarlatamab) from Amgen for lung cancer; and vepdegestrant from Arvinas and Pfizer for breast cancer.
Zanzalintinib is a third-generation oral tyrosine kinase inhibitor targeting VEGF, MET, and TAM kinases involved in angiogenesis, metastasis, and immunosuppression. It is in advanced development stages for clear cell renal cell carcinoma, colorectal cancer, and head and neck squamous cell carcinoma. If approved for all three indications, it could generate $2.6 billion.
The second oncology drug by sales forecast ($2.1 billion) is Imdelltra, FDA-approved for small cell lung cancer, a particularly aggressive subtype.
Tarlatamab is a first-in-class immunotherapy, a bispecific T cell activator targeting DLL3. It activates the patient's T cells to attack tumor cells expressing DLL3. Its advantage is that DLL3 is expressed on the surface of lung cancer cells in over 85% of patients but minimally in healthy cells. Its targeted mechanism of action could position it as the standard treatment for previously treated advanced small cell lung cancer patients.
The third highlighted oncology therapy is vepdegestrant for HR+/HER2- breast cancer, which could reach $1.19 billion annually.
It is expected to become the first PROTAC (proteolysis-targeting chimeras) to reach the market. This protein degrader has been designed to target and degrade the estrogen receptor protein. Studies suggest that PROTAC-induced degradation is more complete than with selective estrogen receptor modulators.
This new class of compounds has the potential to overcome resistance to endocrine therapy in HR+/HER2- breast cancer. Further indications, including combination with the CDK4/6 inhibitor Ibrance (palbociclib), are being explored.
There is also room in the best-selling list for more restricted indications. SEL-212 from Sobi and Cartesian Therapeutics is a monthly biological drug for patients with refractory chronic gout, affecting 2% of gout patients, expected to generate $1.7 billion.
The drug contains pegadricase, Selecta's pegylated uricase, co-administered with ImmTOR, an immune tolerance technology designed to inhibit the formation of anti-drug antibodies. This approach may help overcome efficacy and tolerability limitations associated with immunogenicity with other biological drugs for chronic gout, such as Krystexxa (pegloticase).
Pharmaceutical innovation pays off, and the antipsychotic Cobenfy, FDA-approved last year, has generated much excitement by exhibiting the first new mechanism of action for schizophrenia in 30 years. It could reach $1.6 billion.
Cobenfy combines xanomeline, a dual agonist of muscarinic receptors M1 and M4, with trospium chloride, a muscarinic receptor antagonist. Compared to classic antipsychotics acting on the dopaminergic neurotransmission system, it is associated with a more comprehensive response to the range of schizophrenia symptoms and a better side effect profile. It is currently in development for treatment-resistant schizophrenia and psychosis in Alzheimer's patients.
Another area benefiting from new developments is hemophilia. Clarivate describes fitusiran from Alnylam and Sanofi as a "transformative therapy." It has demonstrated efficacy in phase III clinical trials as a prophylactic treatment for hemophilia A and B, with or without inhibitors. It is expected to reach $1 billion in sales.
Fitusiran is a small interfering RNA therapy allowing monthly or bimonthly subcutaneous administration. The drug has been designed to reduce antithrombin, a protein that inhibits blood coagulation, with the aim of promoting thrombin generation, rebalancing hemostasis, and preventing bleeding.
Prevention has its place in Clarivate's report with Moderna's mRNA vaccines mRESVIA against respiratory syncytial virus (RSV), and GSK's meningococcal vaccine.
Since May 2024, mRESVIA has been approved in the United States for preventing RSV respiratory infections in people over 60 years old. Its predecessors, the protein subunit vaccines Arexvy and Abrysvo, were included in last year's report. Forecasts suggest this vaccine will reach $1.4 billion.