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Feb 7, 2022 12:00am

Alzheimer’s Diabetes drug launch Oncology

Pill bottle with pills shaped into question mark — Tapping Evaluate Vantage’s figures, Fierce Pharma Marketing ranks and reviews the field of wannabe blockbuster drugs for 2022. (Getty Images)

After 55 new drug approvals at the FDA last year,

biopharma and the U.S. agency are still going all guns blazing in getting new therapies out to patients.

But what are the most hotly tipped—and potentially most lucrative—approvals on the horizon for 2022?

Well, there’s a real eclectic mix of targets here, from Alzheimer’s disease and diabetes to psoriasis and lung cancer. And, according to the life sciences data crunchers

at Evaluate Vantage, the top 10 most anticipated drugs are set to make a collective $26.9 billion by the middle of the decade.

It’s Eli Lilly’s year in 2022,

with the top two biggest prospects

belonging to the Big Pharma and taking nearly half that total with just shy of $11 billion in potential earnings from its prospective drugs in Alzheimer’s and diabetes, respectively.

Overall, it’s the Alzheimer’s drug prospects that dominate the sales

charts as a group, with Lilly’s donanemab worth potentially $6 billion by 2026 and Roche’s rival gantenerumab set to take $2.5 billion.

That’s $8.5 billion in total potential in a disease area that hadn’t produced a new therapy for nearly two decades. But with Biogen’s ongoing woes with Aduhelm—which

also had sky-high expectations last year but has faced what could be the worst launch in drug history—the Lilly and Roche predictions may be some of the riskiest we’ve seen in many years.

It’s also a good launch year for Bristol Myers Squibb,

which, like Lilly, has two drugs in the top 10. Its hopefuls mavacamten

in cardiomyopathy and deucravacitinib in psoriasis and autoimmune disorders are together worth $4 billion in predicted peak sales.

But it’s not been an easy path to 2022 for all of the top 10: Johnson &

Johnson and Legend Biotech were hit by an extended FDA review that pushed an expected decision from November to late February over manufacturing and technical concerns. And mavacamten had its own FDA delay to contend with.

And, while Alzheimer’s drugs may be the riskiest proposition launch-wise,

Reata Pharmaceuticals is at the highest risk of falling short of an approval.

An FDA advisory committee unanimously rejected its kidney disease

hopeful bardoxolone last year, putting its projected $2.2 billion in 2026 sales in serious jeopardy.

Check out the top 10 most anticipated drug launches of the year below. You can find last year’s edition here. As always, let us know your thoughts on these or any upcoming meds you think we missed.

1. Donanemab

Drug: Donanemab
Company: Eli Lilly
Used for: Alzheimer’s disease
Est. 2026 sales: $6 billion

It’s a case of déjà vu for the most hotly anticipated drug launches of the year as,

once again, it’s an Alzheimer’s disease drug that leads Evaluate Vantage’s highest-grossing potential list. Last year, that honor went to Biogen’s amyloid therapy aducanumab, which was approved in June as Aduhelm.

Evaluate had forecast peak sales for that drug at around $4.8 billion in 2026.

This year, it’s Eli Lilly’s turn to take the top spot, with Evaluate eyeing a beefier $6 billion in sales for its Alzheimer’s hopeful donanemab. Like Aduhelm, donanemab is also an anti-amyloid beta monoclonal antibody, but Lilly hopes to best its rival and thus gain greater market share.

These are big figures, but there’s also plenty of room for doubt that the

drugs using this approach to fight Alzheimer’s—and that includes No. 3 on our list, another Alzheimer’s hopeful from Roche—can actually measure up to these estimates. Biogen, in fact, only made $300,000 from Aduhelm in the third quarter of 2021.

And there’s a reason for that:

An FDA advisory panel originally rejected the drug, which has questionable

efficacy and fresh safety concerns, but the agency granted an accelerated approval based on biomarker evidence.

Biogen also priced the drug very high, at $56,000, before slashing

the sticker price in half at the end of last year. It’s had possibly one

of the worst drug launches in history, with a number of physicians and medical groups questioning its worth and refusing to prescribe it.

As Biogen’s biomarker evidence showed, the drug can clear sticky proteins, known as amyloid, that can clog the brain. It is believed that amyloid plaques could be an

underlying cause of Alzheimer’s, though this has not been directly proven, and the theory has seen many drugs fail in the past. It also remains an open question as to whether clearing it can actually help reduce Alzheimer’s symptoms.

But the FDA, in approving Aduhelm,

set a precedent that clearing

amyloid is an acceptable bar for getting an Alzheimer’s drug on the market.

Hence, after nearly two decades of no new drugs for the disease, Roche, Lilly and other

drugmakers have suddenly jumped back into action.

Lilly is not going in with blind optimism. Mindful of Biogen’s woes, the Big Pharma decided last year to run a head-to-head clinical trial for donanemab against Aduhelm.

Analysts from Evercore ISI see donanemab as reducing amyloid more

than other similar drugs—including Aduhelm—which could give it a market edge.

In comparing the data on Lilly’s drug to Aduhelm’s,

the Evercore ISI team saw an advantage for donanemab—and figured

those data gave Lilly confidence to run the head-to-head test.

Comparing different trials is always full of caveats, but, if Lilly can prove this thesis, it will be a major win for the pharma.

In preparation for donanemab’s potential launch, Lilly is already

working to build out its commercial capabilities in neuroscience, Lilly’s Chief Commercial Officer Anat Ashkenazi told Fierce Pharma recently. With the donanemab launch in mind, the company split its Bio-Medicines business into two units last July, one focused specifically on neuroscience.

Lilly has submitted the drug for an accelerated approval and expects

to complete its rolling submission by the end of the first quarter. If all goes to plan at the FDA, the company aims to launch donanemab toward the end of the year.

Donanemab is also slated to have results from a confirmatory trial

by 2023, three years ahead of Biogen,

which isn’t expecting data from its confirmatory trial until 2026.

Lilly says it expects limited sales when the drug first hits the scene,

but the arrival of phase 3 data in 2023 could serve as another “inflection point” for the drug, Ashkenazi said. By the middle of next year, Lilly expects to have data from that head-to-head trial against Aduhelm as well.

Should donanemab gain the green light, Lilly will, however, likely still

come up against some of the same issues that have been plaguing Biogen.

It may gain approval, but in the real world, it will still need to be priced competitively and show

it can actually help patients if it wants to hit that $6 billion sales figure.

2. Tirzepatide

Drug: Tirzepatide
Company: Eli Lilly
Used for: Diabetes
Est. 2026 sales: $4.9 billion

Eli Lilly landed a one-two punch on our most anticipated drug launch list this year.

Its Alzheimer’s disease asset donanemab took the top spot with $6 billion in estimated sales by 2026, and it’s also taking second place with its diabetes hopeful tirzepatide, which Evaluate Vantage reckons could be bringing in $4.9 billion by the middle of the decade.

This is much firmer market territory for Lilly compared to Alzheimer’s, given its long history in diabetes. And, like much of its competitive life in this disease, it’s going head-to-head against Danish rival Novo Nordisk.

Tirzepatide works as a dual GIP and GLP-1 agonist and has been acing

trials left and right over the past few years, helping Type 2 diabetes patients keep their blood sugar levels and weight down. It’s biggest win came last year when it beat Novo Nordisk’s GLP-1 blockbuster, Ozempic, in a direct head-to-head study.

In the phase 3 SURPASS-2 trial, the readout was clear: In terms of

reducing blood sugar levels and body weight, Lilly’s drug at all three doses tested was better than Novo’s GLP-1 drug at its highest approved dose.

As analysts noted at the time,

however, the differences between the two drugs were not huge,

but the size of tirzepatide’s benefit over Novo’s entrenched Ozempic

could make all the difference. “I still question usage of a dual agonist if efficacy is only slightly better,

” Bernstein analyst Wimal Kapadi told Fierce Pharma last March when the head-to-head data first came out.

In his investor note, fellow Bernstein analyst Ronny Gal said tirzepatide’s edge was “likely not sufficient to drive the transformation of the GLP-1 market,” so Lilly will need to work hard to win over this skepticism.

Ozempic already makes around $3.4 billion a year and is set to reach a peak of about $8 billion. It has racked up more indications since its initial approval, including obesity, where it is marketed as Wegovy.

Lilly, however, is going all in. The pharma already has a sizable diabetes commercial team in place thanks to its repertoire of insulins plus GLP-1 and SGLT2 meds Trulicity and Jardiance, respectively. And, while the company expects a diabetes indication first, it’s also eyeing a potential use in obesity to challenge Wegovy. buy Adderall 30mg Without Prescription Overnight Shipping.

Data for its obesity drive will be out in April. At the recent J.P. Morgan Healthcare Conference, Lilly CEO Dave Ricks said the company was mulling the idea of splitting the branding of tirzepatide into diabetes and obesity, as Novo had done, and marketing the pair separately.

3. Gantenerumab

Drug: Gantenerumab
Company: Roche
Used for: Alzheimer’s disease
Est. 2026 sales: $2.5 billion

Alzheimer’s disease (AD) is making a comeback after a long research drought. While Eli Lilly takes the top spot for sales potential with its AD hopeful, donanemab, which could bring in $6 billion in 2026, Roche takes the final podium position with its rival drug gantenerumab.

Sales for the drug, which has a similar mechanism to Lilly’s as an anti-amyloid beta monoclonal antibody, aren’t expected to reach the heights of donanemab. Evaluate Vantage sees it bringing in less than half of its potential rival, at $2.5 billion by 2026.

This would still be a good haul of blockbuster cash for the Swiss major, however, as it would help the company expand beyond its oncology staple and move more deeplyinto central nervous system disorders.

But, as with all AD drugs—and, in fact,

CNS research in general—with great sales potential comes great risks, and gantenerumab has already endured a rocky path through development.

Roche, in fact, put the drug on the shelf in 2014 after it failed a phase 3 study but revived it in 2018, with the company saying it suspected a higher dose could spur an effect. A second Washington University School of Medicine study of the candidate failed as well.

So, whether gantenerumab can build the clinical data needed to back up an approval remains to be seen. Genentech is working on a number of phase 3 studies, and executives including Rachelle Doody, M.D., Ph.D., global head of neurodegeneration and franchise head in product development, told Fierce Biotech last year that they remain focused on that task rather than on how Biogen’s activities around controversially approved Aduhelm might affect their regulatory prospects.

4. Deucravacitinib

Drug: Deucravacitinib
Company: Bristol Myers Squibb
Used for: Psoriasis
Est. 2026 sales: $2.4 billion

With deucravacitinib, Bristol Myers Squibb took on an opportunity cost in losing out on Otezla; this year, industry watchers will start to see whether that bet could pay off.

When faced with an antitrust roadblock for its $74 billion megamerger with Celgene in 2019, BMS chose to keep experimental deucravacitinib and offload growing blockbuster Otezla to Amgen for $13.4 billion. Despite their different mechanisms, the U.S. Federal Trade Commission thought the two meds’ oral dosing—in an inflammatory disease market filled with injectables—raised an anti-competition red flag.

Phase 3 results backed BMS’ decision in that binary choice: Deucravacitinib topped Otezla, helping more patients with moderate to severe plaque psoriasis achieve skin clearance in the POETYK PSO-1 and POETYK PSO-2 trials. The FDA is expected to rule on deucravacitinib’s use in that indication by Sept. 10.

BMS has been billing deucravacitinib as the potential

new oral of choice in psoriasis, with expansion opportunities in psoriatic arthritis and inflammatory bowel diseases. The company has pegged the drug to possibly reach over $4 billion in peak sales, while Evaluate Vantage in its 2022 preview report put its 2026 sales estimate at $2.4 billion.

In the first nine months of 2021, Otezla—first approved in the U.S. in 2014—brought in global sales of $1.62 billion.

Deucravacitinib may be able to shake Otezla’s leader status as an oral option, but injectables are a different story. The proportion of patients who achieved at least 75% skin symptom relief as measured by the psoriasis area severity index looked smaller in the two BMS phase 3 trials than newer injectables like Novartis’ Cosentyx, Eli Lilly’s Taltz and AbbVie’s Skyrizi achieved in their studies.

The FDA might also make commercial life difficult for deucravacitinib. The agency recently slapped classwide safety warnings on oral JAK inhibitors about increased risks of cancer and heart-related events and limited their use to after a patient has tried existing meds.

Deucravacitinib’s target, TYK2,

is a member of the JAK family. If the FDA paints deucravacitinib with the same brush, it would hurt the drug’s opportunity as a front-line treatment.

BMS’ argument for deucravacitinib centers around it being a first-in-class drug with a different mechanism than other JAK drugs. The med hasn’t shown any of the concerning side effects linked to JAK inhibitors—such as low blood platelet count, abnormal cholesterol levels or liver dysfunction—in its clinical trials up to one year, BMS Chief Medical Officer Samit Hirawat, M.D., noted in a recent interview with Fierce Pharma.

But, as Amgen commercial chief Murdo Gordon noted in an investor call in April 2021, it took a yearslong large-scale postmarketing study of Pfizer’s Xeljanz to really understand the safety problems of that JAK med. That means BMS might need longer-term data to fully convince doctors of deucravacitinib’s safety profile. Until then, the TYK2 inhibitor will likely be first used in patients who fail on Otezla, which is about a third of the Otezla-treated population, Amgen management told SVB Leerink during a recent event, analyst Geoffrey Porges said in a December note.

Beyond plaque psoriasis, deucravacitinib recently hit a snag in ulcerative colitis when a phase 2 trial failed to meet its primary and key secondary goals. BMS is now taking a second shot at the indication with deucravacitinib at a higher dose.

In psoriatic arthritis, the company is running two phase 3 trials in moderate to severe disease, with Otezla once again in its crosshairs. Initial data from the studies are expected in 2024.

5. Bardoxolone

Drug: Bardoxolone
Company: Reata Pharmaceuticals
Used for: Chronic kidney disease in Alport syndrome
Est. 2026 sales: $2.2 billion

The FDA is slated to decide the fate of Reata Pharmaceuticals’ chronic kidney disease (CKD) drug bardoxolone Feb. 25. If approved, it would be the first therapy for Alport syndrome patients, a disease that damages the tiny blood vessels in the kidneys and can lead to kidney disease and renal failure.

There’s $2.2 billion in peak sales on the line, but the likelihood of approval for the rare indication took a major hit last year when an expert review body for the FDA unanimously knocked down the drug for approval. Reata’s stock sank more than 60% during that week of the Dec. 8 decision.

The FDA doesn’t have to follow its advisory committee’s decision. For example, a year ago, the agency went against the panel’s rejection of Biogen’s Alzheimer’s disease med Aduhelm and gave it an approval. Nonetheless, such a reversal remains a rarity.

The committee for bardoxolone said

Reata did not prove the therapy was effective in slowing the progression of CKD in Alport syndrome patients. The experts noted that the drug’s benefits did not outweigh its risks based on the data Reata submitted.

While bardoxolone achieved its primary and key secondary goals in its phase 3 registrational trial dubbed CARDINAL, the agency’s review team questioned whether the drug actually reduced CKD progression.

The expert reviewers specifically wanted an explanation on why Reata used eGFR—an estimate of the kidney’s filtration rate—as the main measure for CKD in its phase 3 trial given other measures might have been better able to show efficacy.

Based on the eGFR measure,

Reata said patients treated with bardoxolone experienced a statistically significant improvement in kidney function compared to patients treated with placebo.

But the FDA reviewers didn’t agree that this proved efficacy. Panelist Paul Palevsky, M.D., who is chief of the kidney medicine section at the VA Pittsburgh Healthcare System, summed up the dissent: “[I am] quite concerned that the data provided does not meet the bar of showing this will slow the time to end-stage kidney disease,” he said at the meeting in December.

Reata said after the 13-0 rejection that it planned to provide additional information and data leading up to decision day, including potential data from non-Alport studies. It has not publicly announced any new results since then. Bardoxolone is currently in a 550-patient late-stage trial in patients with autosomal dominant polycystic kidney disease and in a 70-patient midstage study in people with CKD at meaningful risk of progression to end-stage kidney disease.

The drug has a long development history.

In 2014, Reata moved the drug into a midstage study in pulmonary arterial hypertension. In 2017, it began trials in Alport, but, two years later, AbbVie walked away from its pact with the company. Reata paid $75 million to regain the rights to its drug, while AbbVie would no longer be eligible to royalties from bardoxolone sales.

AstraZeneca's Discovery Centre in Cambridge, U.K. — (AstraZeneca)

6. Tezepelumab-ekko

Drug: Tezspire (tezepelumab-ekko)
Companies: AstraZeneca and Amgen
Used for: Asthma
Est. 2026 sales: $2 billion

AstraZeneca and Amgen got the party started early, nabbing an approval in December 2021 ahead of schedule and launching tezepelumab-ekko, now branded as Tezspire, in mid-January 2022 for certain forms of asthma. buy Adderall 30mg Without Prescription Overnight Shipping.

As an add-on maintenance treatment, the monoclonal antibody has a chance to challenge the dominance of Regeneron and Sanofi’s blockbuster Dupixent, because it has shown effectiveness across a broad range of patients with the severe form of the lung disease.

Among the 339 million people worldwide with asthma, 10% have the severe version the drug is targeting. Amgen said at the recent J.P. Morgan Healthcare Conference that it is eyeing a market of about 1.3 million patients with uncontrolled asthma in the U.S. alone.

Use of the therapy will likely begin with the low eosinophilic population, which currently does not have a biologic treatment option. Analysts at SVB Leerink predict Tezspire can nab about 30% of the uncontrolled asthma population within that group of patients.

Uptake could, however, be slow initially,

because the drug is launching during the omicron surge and also carries a high price, analysts warn. But it’s still slated to reach a peak of $2 billion: The drug’s list price comes in at $47,229, a full $10,000 higher than Dupixent when it was launched in 2017.

The companies are also trialing the therapy in several other indications—including chronic rhinosinusitis with nasal polyps—which together could eventually take a bite out of Dupixent’s market dominance.

Dupixent, which made $4 billion in 2020,

is indicated to treat moderate to severe atopic dermatitis and also as a maintenance treatment for chronic rhinosinusitis with nasal polyposis. In 2018, it grabbed an FDA nod as a maintenance treatment for moderate to severe eosinophilic, oral steroid-dependent asthma in patients whose condition is not controlled with their current asthma medicines.

One big plus for Tezspire in its comparison to the Dupixent in the asthma setting is its label: While Dupixent’s says the drug does not show benefit in patients with low levels of eosinophils, there is no such qualifier for Tezspire, which can thus edge in on this market.

In trials, Tezspire indeed showed success in helping a subgroup with low levels of eosinophil white blood cells. Existing asthma drugs such Dupixent and AstraZeneca’s older asthma drug Fasenra target eosinophilic forms of the disease. Patients with non-eosinophilic disease have limited treatment options.

The tezepelumab collaboration agreement between Amgen and AstraZeneca began in 2012 and was updated in 2020, with both agreeing to share costs and profits equally after a milestone payment paid to Amgen. buy Adderall 30mg Without Prescription Overnight Shipping.

AstraZeneca, which brings expertise

in respiratory diseases, is leading the development process, while Amgen, with a proven name in biologic drugs, is handling the manufacturing and is also joining forces on the marketing side. buy Adderall 30mg Without Prescription Overnight Shipping.

Last year, in anticipation of the approval, Amgen and AstraZeneca launched an unbranded awareness website for asthma, “Break the Cycle,” which features E! host Nina Parker. AstraZeneca said it will have more marketing campaigns but is already tapping medical influencers on Instagram and running ads on TikTok to help spread its awareness campaign.

Sanofi and Regeneron are of course spending big on marketing Dupixent, leading the TV spend list for last year by plowing $288 million to take the crown.

Yvonne Greenstreet Alnylam — (Business Wire)

7. Vutrisiran

Drug: Vutrisiran
Company: Alnylam
Used for: Amyloid transthyretin amyloidosis
Est. 2026 sales: $1.8 billion

Alnylam may already have a marketed therapy for amyloid transthyretin (ATTR) amyloidosis, but a newer candidate could give it an edge in its competition with Pfizer. Vutrisiran is Alnylam’s follow-on candidate to its ATTR amyloidosis drug Onpattro. The marketed therapy is given as an infusion every three weeks, which makes vutrisiran’s less cumbersome proposed under-the-skin dosing every three months more attractive.

Evaluate Vantage projected the new med could reach $1.8 billion in 2026 sales, and an approval decision is expected April 14. As its predecessor does, vutrisiran is targeting a hereditary form of ATTR amyloidosis called polyneuropathy (PN), which affects the nerves. About 50,000 patients live with hereditary ATTR worldwide. Both are RNA interference therapies that target TTR mRNA to reduce disease-causing TTR protein deposits in tissues.

In the phase 3 HELIOS-A study, vutrisiran data were better than results from the placebo group of an earlier Onpattro trial called APOLLO. On the primary endpoint of nine-month change in a measure called modified neuropathy impairment score that evaluates neurologic problems, patients on vutrisiran showed a 2.2-point improvement, while the placebo group deteriorated by 14.8 points.

In addition, vutrisiran also nailed key secondary measures including patient-reported quality of life and a 10-meter walk test

Although the primary endpoint pitted vutrisiran

against placebo in a different trial, the HELIOS-A trial did also have an Onpattro arm. There, the older therapy led to a a 1.4-point improvement.

While vutrisiran looks on track to secure an FDA nod in PN, another form of ATTR called cardiomyopathy (CM), which causes heart problems, represents a much larger market. Most ATTR-CM cases are the result of aging-related destabilization of TTR, while some others inherit the condition from a parent. Nonhereditary ATTR is estimated to affect 200,000 to 300,000 people worldwide, according to Alnylam.

Thanks to an FDA approval in ATTR-CM in 2019, Pfizer’s Vyndaqel/Vyndamax has enjoyed enviable growth. In the first nine months of 2021, the once-daily oral med sold $1.45 billion globally, a 69% increase year over year. The drug isn’t approved in ATTR-PN in the U.S.

All eyes are on Onpattro’s Apollo-B trial to gauge the strength of Alnylam’s RNAi approach in the more prevalent ATTR-CM disease. The company expects to have those data mid-2022. Vutrisiran’s own ATTR-CM trial, dubbed HELIOS-B, is further out.

A recent competitor’s failure gave Alnylam some bittersweet feelings.

In a surprising revelation, BridgeBio found its TTR stabilizer acoramidis failed to beat placebo on a six-minute walk test in ATTR-CM patients. Industry watchers had hoped for better results than Pfizer’s Vyndaqel/Vyndamax showed.

The fact that patients in the placebo arm barely declined on the walk test marks a baffling departure from what was seen in Pfizer’s ATTR-ACT trial along with prior natural history data, Stifel analysts wrote in a December note. As BridgeBio noted, the decline in walking distance in its ATTRibute-CM trial’s placebo group was more than 70% lower than the decline observed in ATTR-ACT’s treatment group.

Removing a potential rival from the equation could have meant a big relief for Alnylam, but, as the Stifel team noted, if BridgeBio’s well-performing placebo arm is really the “new standard,” the hurdle for success for Onpattro in APOLLO-B could be higher, given that trial also uses the six-minute walk test as its primary outcome measurement.buy Adderall 30mg Without Prescription Overnight Shipping

For vutrisiran’s HELIOS-B, though,

Alnylam has set clinical improvement—specifically, a composite of death and recurrent cardiovascular events—as the primary target, while the six-minute walk test is a secondary endpoint. buy Adderall 30mg Without Prescription Overnight Shipping

Alnylam’s founding CEO John Maraganore, Ph.D., won’t be steering the wheel for vutrisiran’s launch. The longtime chief executive has handed the reins to Yvonne Greenstreet, who was the company’s president and chief operating officer.

Elsewhere in the ATTR arena, Ionis’ Tegsedi also holds a small market share, and AstraZeneca just paid $200 million upfront for the company’s follow-on med eplontersen, which is currently in phase 3 testing. The British pharma also recently in-licensed an early-stage asset from Neurimmune. That drug, dubbed NI006, is an antibody targeted at misfolded amyloid conformation.

(Bristol Myers Squibb )

8. Mavacamten

Drug: Mavacamten
Company: Bristol Myers Squibb
Used for: Hypertrophic cardiomyopathy
Est. 2026 sales: $1.7 billion

Mavacamten, the centerpiece of Bristol Myers Squibb’s $13.1 billion acquisition of MyoKardia in 2020, will likely start its commercial journey this year. BMS CEO Giovanni Caforio said from the outset that the drug’s potential as a first-in-class therapy that addresses the underlying cause of obstructive hypertrophic cardiomyopathy (HCM) justified the purchase price, not to mention additional opportunity in the less common nonobstructive form of the disease.

For BMS, mavacamten could be the company’s

next big cardiovascular asset when Pfizer-shared blood thinner Eliquis, currently BMS’ top-selling drug, falls off the patent cliff in the latter half of the decade. BMS figures mavacamten could reach over $4 billion in nonrisk-adjusted revenues in 2029. Evaluate Vantage, for its part, projected $1.7 billion for the drug’s 2026 sales in a 2022 preview report.

Mavacamten seemed on track to get an FDA decision in symptomatic obstructive HCM in January, but the agency in November postponed the deadline by three months, as the agency needed more time to work out a safety monitoring program, known as a Risk Evaluation and Mitigation Strategy, according to BMS. The BMS filing included such a program, which is usually set up for drugs with important side effect concerns. The drug’s phase 3 trial found that its safety and tolerability were similar to the placebo arm.

HCM is the most common genetic heart disease,

affecting about 1 in 500 people by BMS’ estimate. It’s marked by increased thickening of heart muscle and hence harder contraction. Many cases are asymptomatic, while others can cause various problems as serious as sudden death. Existing treatments such as beta blockers only deal with symptoms.

Mavacamten targets the underlying HCM disease by inhibiting cardiac myosin to reduce heart muscle contractility.

Before the BMS buyout, MyoKardia had reported positive pivotal trial results in patients with symptomatic, obstructive HCM. In the phase 3 EXPLORER-HCM trial, 36.6% of patients on mavacamten responded and achieved meaningful improvements in oxygen consumption and heart function after 30 weeks, compared with 17.2% of those in the placebo group.

BMS has followed up with more data showing the drug could improve patients’ perception of their health status and that it worked in patients who were also taking beta blockers.

Competition is also brewing in HCM. Last year, Cytokinetics rolled out encouraging phase 2 data for its HCM contender, aficamten (previously known as CK-274). The med showed competitive results in terms of hitting a target resting gradient, a marker of heart pressure. The drug, with a newly earned FDA breakthrough designation in obstructive HCM, is heading to a phase 3 dubbed SEQUOIA-HCM.

Meanwhile, BMS expects a 2022 readout from the phase 3 VALOR-HCM study, which is meant to expand mavacamten’s obstructive HCM label to include information on the drug’s ability to reduce the need for highly invasive septal reduction therapy in high-risk patients.

The company also plans to start a phase 3 trial for nonobstructive HCM this year. And it recently launched a proof-of-concept phase 2 study in heart failure with preserved rejection fraction.

9. Cilta-cel

Drug: Cilta-cel
Companies: Johnson & Johnson and Legend Biotech
Used for: Multiple myeloma
Est. 2026 sales: $1.7 billion

Chinese company Legend Biotech and U.S. partner Janssen,

the R&D unit of Johnson & Johnson, were the darlings of the American

Society for Clinical Oncology (ASCO) annual meeting a few years ago. Their CAR-T therapy known as cilta-cel wowed the crowd, and last year, it won a speedy review by the FDA for its use in multiple myeloma.

Janssen and Legend swiftly set up a sales team and put marketing

platforms in place, ready to jump into action as soon as that expected green light came in. But then, things took a left turn.

In November last year, the FDA unexpectedly hit the brakes on its review,

which was focused on the relapsed/refractory setting in multiple myeloma. The agency had questions about the BCMA-directed CAR-T therapy, specifically around nonclinical data and chemistry, manufacturing and controls.

The original date set for its approval under its priority review was late November,

but the FDA pushed its decision back to Feb. 28 this year. Analysts at the time, including Jefferies, remained confident of approval and saw little long-term impact on the companies as a result of the delay.

And speaking at the recent J.P. Morgan Healthcare Conference,

Legend CEO Ying Huang, Ph.D.,

was also still bullish about cita-cel’s prospects and chances of approval, adding that it was “ready to go” if the FDA says yes in February. Legend has ramped up its manufacturing base to avoid the supply pitfalls that has befallen some of its competitors.

But there are a lot of competitors: GSK’s BCMA-targeted

antibody-drug conjugate Blenrep for certain types of relapsed/refractory patients, approved in 2020, as well as Bristol Myers Squibb and bluebird bio’s CAR-T therapy Abecma, approved last March, are some of its more direct rivals in this space.

Blenrep is expected to achieve $2 billion in peak sales and made

67 million pounds ($90 million) for GSK during last year’s third quarter. Abecma, slated to make $1.9 billion in 2026, made $71 million in the third quarter of 2021.buy Adderall 30mg Without Prescription Overnight Shipping

Also in the game are J&J’s own Darzalex,

Bristol’s Celgene-inherited Revlimid and Takeda’s proteasome inhibitor Velcade, all three of which bring in blockbuster sales. Takeda also has the follow-on drug Ninlaro,

while Amgen has Kyprolis, which is also paired with Darzalex for myeloma patients who’ve already tried between one and three previous therapies.

But J&J and Legend still believe they can carve out a good chunk

of the relapsed/refractory multiple myeloma market with cilta-cel, and Evaluate Vantage sees $1.7 billion in sales by 2026 despite the FDA prolonging its decision.buy Adderall 30mg Without Prescription Overnight Shipping

The pair is hoping to hit the ground running on the awareness front,

too.

Last year, it set up a specialized patient support program and a

dedicated sales team, and J&J plans to roll out a customized program to help patients who receive cita-cel navigate the treatment journey.

To help with this, J&J has set up Janssen Compass, which allows

a single point of contact—a nurse—assigned to help bring the right resources to a patient to manage obstacles along the way, including access challenges and side effects.

In Janssen Compass, this “care navigator” will help set expectations,

educate each patient on how to manage potential obstacles and support them in developing a care plan to communicate with doctors. J&J has been using it for other drugs including Darzalex but is boosting its use for cita-cel to maximize use of the therapy.

Lungs illustration (Image: Pixabay) — (Pixabay)

10. Adagrasib

Drug: Adagrasib
Company: Mirati Therapeutics
Used for: Non-small cell lung cancer
Est. 2026 sales: $1.7 billion

Rounding off our top 10 most anticipated drug launches for the

year is Mirati Therapeutics with its Amgen-rivaling cancer hopeful adagrasib.

Mirati is, in fact, already at the FDA’s doorstep for its first potential

drug approval and expects a decision in the coming months, with a launch ready to go for its blockbuster-in-waiting KRAS inhibitor.

Adagrasib is Mirati’s attempt to catch up to Amgen, which beat Mirati to the punch. Last May, the Big Pharma won approval in the U.S. for its KRAS drug, Lumakras,

for non-small cell lung cancer (NSCLC) with a particular genetic mutation called KRAS G12C.

In the final weeks of 2021, Mirati asked the FDA to approve

adagrasib in KRAS G12C patients as a single treatment in second-line NSCLC, new CEO David Meek said at the recent J.P Morgan Healthcare Conference.

Lumkras itself is approve as a monotherapy

and in the second-line setting. The drug booked $36 million in the third quarter, the first full quarter after it launched.

It’s slate to make $1.3 billion by 2025, less than the $1.7 billion adagrasib is set to make a year later despite getting on the market 12 months after its rival—if it gets approve, of course.

At the JPM conference, Mirati’s CEO said the company has been working on building its commercialization team for the past two years. “Adagrasib is going to be a very big drug for a very long time,” Meek says.

Why the bigger estimate for little Mirati?

Undeterred by not being first, the biotech is already hard at

work in the clinic to find an edge over Amgen, and that includes in indications outside NSCLC.

At the European Society of Medical Oncology (ESMO) cancer

conference last September, Mirati showed an early win in colorectal cancer (CRC) patients that trumped Amgen.

Amgen linked Lumakras to an overall response rate (ORR) of

just 7% in CRC, leading it last summer to drop work in CRC as a monotherapy.

Meanwhile, data released at ESMO showed that the response

rate in the 45 evaluable patients who received adagrasib as a single agent stood at 22%. The 10 patients listed as responders include one person with an unconfirmed partial response who remains on study. Absent that unconfirmed response, the ORR would be 20%. Median duration of response was 4.2 months.

Mirati has said that an ORR of 20% and median duration of four

months are the threshold to potentially seek accelerated approval of adagrasib. The data in the ESMO abstract put it over that bar—but only by a whisker.buy Adderall 30mg Without Prescription Overnight Shipping

Amgen is, however, still pursuing CRC,

but with help: Lumakras is in a phase 1/2 trial couple with Amgen’s approve CRC drug Vectibix.

But Mirati appeared to take another win just last month when

adagrasib led to a 41% response rate in patients with pancreatic and other gastrointestinal tumors.

This came from the phase 2 KRYSTAL-1 study that featured

patients with cancers of the biliary tract, appendix, small bowel, gastro-esophageal junction or esophagus who have a mutation of the KRAS gene. Mirati disclosed the findings at the 2022 American Society for Clinical Oncology Gastrointestinal Cancers Symposium. buy Adderall 30mg Without Prescription Overnight Shipping

A specific breakdown of adagrasib’s impact shows

the drug worked better in patients with pancreatic cancer than in those with other gastrointestinal tumors. Patients with pancreatic cancer notched a 50% objective response, whereas others with GI cancers achieved a 35% response. Patients responded for a median of 7 months and 7.9 months, respectively.

The disease control rate was 100% across the 27 patients in the subset. Patients with pancreatic cancer did not see progression of their disease for a median of 6.6 months; for GI tumors, the duration was 7.9 months. buy Adderall 30mg Without Prescription Overnight Shipping.

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