The Top Five Drug Launches of the 21st Century: A Personal Opinion

My career in the pharmaceutical industry began in research and then took a swerve to the commercial side in the early 1980s. So my working life has involved nearly 40 years of studying, selling, marketing and writing about drugs. 

Needless to say, pharmaceutical R&D focus and direction has changed dramatically in that time, and hence so too have the drugs that are developed and launched. It’s remarkable to think that in my early stint as a GP medical representative, I was selling a very basic pain killer (a variant of ibuprofen) and a first generation cephalosporin antibiotic – hardly cutting edge medicine!

Over the years there have been some standout ‘super’ brands – Losec and Lipitor instantly come to mind – and usually the reason for them achieving that blockbuster status was the fact that they were very effective (and ‘safe’) at fixing common problems that every GP encountered. But around the turn of the century, it became clear that all the low-hanging fruit had been harvested. Common conditions such as hypertension, asthma, hypercholesterolaemia and others had largely been ‘fixed’ and we see the evidence of that now in the rapid growth of the elderly population. So it was necessary for the industry to focus on more difficult challenges such as cancers, rare diseases, autoimmune disorders and so on. 

In this endeavour, the pharmaceutical industry has been phenomenally successful and doesn’t receive the recognition it deserves amongst the general population. This is sad, but industry shareholders around the world probably don’t care about reputation, as long as the commercial returns from this intense R&D investment continue to be realised. So I could have written this article about the ‘best-selling’ drugs of the 21^st century, but instead I wanted to focus on those that have made the greatest medicinal impact – the ones that have changed the way doctors think about disease management and have expanded the horizons of what we believe to be possible. This is purely a personal list and no doubt arguments could be made for lots of others. If you feel strongly that I’ve missed some obvious contenders then please get in touch – I would love to discuss them with you!

Number 5. Adcetris

The mode of action of this drug is a thing of beauty and that’s why it makes my list. It’s not the only modern drug that has an elegant MOA, but for me it just has the edge. The reason is that it can be described in layman’s terms in a way that is easily understandable, for example as follows:

Such simplicity belies the incredible science behind its development, so it’s important to remind ourselves that this isn’t about science, but people’s lives. In this regard, Adcetris doesn’t disappoint. I’ve heard on the grapevine that oncologists treating Hodgkin’s lymphoma were ‘blown away’ by its efficacy. Just a great story all round. 

Number 4. Gleevec

A diagnosis of chronic myeloid leukaemia in the last century was a fairly certain death sentence and the treatments that did exist were harsh and invasive. Enter Gleevec: a once or twice daily pill and bingo – disease controlled. (I know this is a gross simplification, but its availability really was transformational). As part of its mode of action description, I simply love the words ‘programmed cell death’ – a marketer’s dream. 

Number 3. Atripla

I’m old enough to remember reading in medical journals of the 1980s reports of a mysterious illness that was soon known as AIDS and fairly soon after, HIV was identified as the cause. It’s remarkable to consider the achievements of the pharmaceutical industry in transforming a deadly disease into a manageable chronic condition in only a few years. The early treatments were unpleasant oral therapies but the improvements and refinements came quickly. Once HAART (highly active anti-retroviral therapy) was identified as the way forward, the race was on to deliver this complex regimen as conveniently as possible. 

This was the genesis of Atripla – one pill, once a day, containing an effective trilogy of anti-retroviral drugs. For the HIV+ve person used to popping sometimes dozens of pills per day in complex regimens, Atripla really was a game changer. 

Number 2. Keytruda

After my early stint as a GP representative, I spent 18 months as an oncology specialist account manager selling a range of cytotoxins known as vinca alkaloids. In those days, for patients with advanced cancers (of virtually any description) oncologists were trying to eke out a few more weeks or months of life by using highly toxic regimens. But that’s all they had at their disposal. A particularly knotty problem was NSCLC (non-small cell lung cancer), which seemed impervious to any treatment. 

If, at the time, you were to present them with the kind of efficacy results delivered by a Keytruda-enhanced chemotherapy regimen, they just wouldn’t have believed it possible. 

That’s why it gets my vote, because my personal dealings with oncologists tells me that this was a very high mountain to climb. 

Number 1. Humira

Not only a great drug, but a great name. Humira was the first monoclonal antibody blockbuster and thanks to that status, it spawned innumerable MABs and other variations of immunomodulatory drugs. But most importantly, it transformed the lives of patients who hitherto had had little relief from chronic diseases such as RA, Crohn’s and psoriasis. It now has 14 indications, which is a testament to its incredible utility.

So that’s it. Whether you agree with my list or not, these five drugs are exceptional and there are millions of people around the world whose lives have been enhanced and saved by their development. There are so many that nearly made the list, such as Revlimid and Spinraza, but my arbitrary opinion made me reluctantly leave them outside the top five.

Please email me if you would like to discuss this article or propose an alternative ‘Top 5’.

To share your views on this article please contact me directly on neil@dice-comms.co.uk