Notes: Growth rates at constant exchange rates; sales are at ex-manufacturer list price; excludes COVID-19 vaccines and therapeutics; EMEA – Europe, Middle East and Africa; APAC – Asia and Pacific; LATAM – Latin America. Other EMEA includes Russia
Source: IQVIA EMEA Thought Leadership; IQVIA MIDAS QTR Q4 2023; Rx-only; Copyright © 2024 IQVIA. All rights reserved

From a therapy area perspective, oncology remained top globally in 2023, worth $221 bn at ex-manufacturer list price. Oncology has historically been a growth engine of the biopharmaceutical industry and will continue to be so for the next five years.²

Solid tumour therapies comprise three quarters of the global oncology market. For the three highest-value solid tumour types – breast cancer, non-small cell lung cancer (NSCLC) and prostate cancer – growth has historically been high, and will increase further in the next five years, as Figure 2 illustrates. As a result, together these three tumour types are expected to account for over half of all oncology absolute value growth in the next five years.

For haematological malignancies, recent market growth has been less consistent, partly due to the entry of generics. Multiple myeloma currently has the largest market share, but its growth will continue to decelerate in the coming years as lenalidomide and bortezomib generics drive down treatment cost.

Among the smaller indications, small cell lung cancer and liver cancer have stand-out historical growth: in both cases, this is caused by two checkpoint inhibitors. Checkpoint inhibitors have become major growth drivers for the oncology market overall, and other classes of innovative biologics are also growing rapidly. Notable examples include antibody-drug conjugates (ADCs) and bi-specific antibodies, although they have relatively small market shares.

Figure 2: Oncology market dynamics by tumor type, 2018-28

Notes: *includes Q4 2023 forecast data; NSCLC – Non-Small Cell Lung Cancer; NHL – Non-Hodgkin Lymphoma; Leukaemia data includes Chronic Myeloid Leukaemia, Chronic Lymphoid Leukaemia, Acute Myeloid Leukaemia; constant exchange rate for sales
Source: IQVIA EMEA Thought Leadership, IQVIA Analytics Link accessed March 2024; Copyright © 2024 IQVIA. All rights reserved

Biologics also have a central role in immunology – the third-largest therapy area at list price, at $167 bn in 2023 (Figure 3). Immunology indications can be classified as either autoimmune or allergic inflammation, and the autoimmune indications dominate immunology sales, with a market share of 91% in 2023. Of these, rheumatoid arthritis and psoriasis are the most valuable indications, each making up around 25% of autoimmune sales.

Despite its relatively small market size, the allergic inflammation segment is growing at nearly three times the rate of autoimmune, although it is now beginning to mature. The stand-out product in allergic inflammation has been dupilumab (Dupixent), which dominates sales in both atopic dermatitis and allergic asthma – the major indications in allergic inflammation.

For immunology as a whole, the United States is by far the largest market, with a 76% market share in 2023. This is partly due to the successful biosimilars penetration in Europe, which has increased competition and lowered prices.

Figure 3: Immunology market performance and growth

Notes: Total spending calculated at Constant Exchange Rate (CER) Immunology market defined as following diseases and ATC3 codes: Rheumatoid Arthritis, Crohn’s Disease, Psoriasis, Psoriatic Arthritis, Hidradenitis Suppurativa, Ulcerative Colitis, Ankylosing Spondylitis and other spondylarthritis, Allergic Asthma, Urticaria, Lupus, Nasal polyps, Esophagitis, Prurigo Nodularis, Alopecia Areata, Vitiligo. ATC3 codes: A7E, D5B, D5X, L4B, L4C, L4X M1C,
Source: IQVIA EMEA Thought leadership; IQVIA MIDAS Disease MTH 12 2023; Copyright © 2024 IQVIA. All rights reserved

Biosimilars are important not just in immunology, but across the whole pharmaceutical market, especially the highest-value therapy areas. Biosimilars can drive down treatment cost, and as healthcare systems and doctors have become more comfortable with prescribing biosimilars since the first launched in 2006, uptake rates have increased.

In January 2023, adalimumab biosimilars entered the US market, following entry in Europe in 2018. Figure 4 shows that in Japan and the UK, adalimumab biosimilar uptake by volume is comparable to that of other molecules, whereas in the US, uptake in the first year is notably lower. The primary reason for low uptake is the challenging “rebate wall” biosimilar manufacturers need to overcome to incentivise their biosimilars on formularies. Despite their low uptake rates, adalimumab biosimilars have driven down the cost of treatment in the US by increasing discounts and rebates offered by AbbVie, the originator.

Figure 4: Biosimilar uptake rates by country

Notes: Includes subcutaneous formulations for trastuzumab
Source: IQVIA EMEA Thought Leadership; IQVIA MIDAS MTH Dec 2023; Copyright © 2024 IQVIA. All rights reserved

In 2023, interest in obesity treatments exploded, following the commercial success of weight-loss products such as semaglutide (Wegovy). Forecasts place the obesity market at anywhere from $39 - $131 bn by 2028, as Figure 5 indicates, which could make obesity the fourth-largest therapy area in just a few years’ time.²

The size of the future market is highly dependent on payers’ appetite for reimbursement. Spending on obesity agents is currently mainly out-of-pocket, and in some countries – such as Germany, where until very recently weight-loss products were seen as purely cosmetic – public reimbursement is either heavily restricted or entirely prohibited³. The SELECT trial readout showed that semaglutide significantly reduces MACE-3 cardiovascular events, and compelling evidence of this nature will be crucial to convincing payers of the cardiovascular benefits of other obesity products, and the need for reimbursement.⁴

Figure 5: Global obesity spending and growth forecast