Keytruda Projected to Reclaim Top Spot as World's Best-Selling Drug in 2026

On December 10, 2025, Nature Reviews - Discovery published an article predicting the top 10 best-selling drugs globally in 2026.

The total sales of the TOP10 drugs on this list are expected to reach $198 billion, which is 18% higher than the 2025 list. According to Nature's analysis,The growth was mainly driven by GLP-1 class metabolic disease drugs.

It is worth mentioning that, compared to 2025, there has been no change in the list of drugs, with the main changes reflected in the internal rankings.

Field of Oncology Treatment

In this list, two cancer drugs are included: Merck's pembrolizumab (Keytruda, hereinafter referred to as "K drug") and Johnson & Johnson's daratumumab.

K Medicine is a PD-1 inhibitor. As a humanized IgG4 monoclonal antibody, it blocks the binding of the PD-1 receptor to its ligands PD-L1/PD-L2, relieving tumor-induced immunosuppression, reactivating the anti-tumor activity of T cells, and enabling the immune system to recognize and attack cancer cells.

This list shows that the sales of K drug in 2026 are expected to be 33.8 billion US dollars, ranking first.

K drug was first approved for marketing by the regulatory authority (FDA) on September 4, 2014, with the first indication being advanced melanoma. Since then, it has been successively approved for dozens of indications. In July 2018, K drug first entered the Chinese market.

Keytruda Qlex (referred to as Qlex) is the subcutaneous injection version of Keytruda, with the active ingredients being pembrolizumab and hyaluronidase alpha-pmph. It is reported that this formulation can effectively overcome the "gel barrier" caused by hyaluronic acid, promoting drug diffusion and absorption, thereby potentially enhancing therapeutic efficacy.

Qlex was approved by the FDA for marketing on September 19, 2025. In China, the CDE accepted its marketing application in June 2025. The product's sales in 2026 are projected to reach 2.5 billion US dollars.

Daratumumab (Darzalex) is another oncology drug on the list, ranking 7th with projected sales of $16.1 billion. It is a humanized monoclonal antibody targeting CD38. CD38 plays a crucial role in promoting tumor cell growth and immune escape, and it is highly expressed in cancer cells. By targeting CD38, daratumumab activates the immune system to precisely attack cancer cells.

Daratumumab was first approved by the FDA for marketing in November 2015, with the indication for multiple myeloma. Since then, it has been successively approved for multiple myeloma-related indications. In May 2023, Daratumumab was approved by the NMPA for marketing in China, including six indications.

Nature predicts,Daratumumab is expected to maintain a strong position in multiple myeloma markets and sustain continuous sales growth.

Field of Metabolic Therapy

Overall, the market for metabolic disease drugs is growing rapidly, but competition is becoming increasingly fierce.. In this list, there are 4 metabolic disease drugs ranked.

Lilly's GLP-1/GIP dual receptor agonist tirzepatide has undoubtedly become the focus of attention. Tirzepatide sales officially surpassed Keytruda in October 2025, becoming the new "blockbuster drug." Nature predicts that tirzepatide will continue to maintain its strong momentum in 2026.

The diabetes version of Tirzepatide ranks 2nd on the list with an estimated sales revenue of $25.8 billion, while the weight loss version of Tirzepatide is ranked 5th with an estimated sales revenue of $19.7 billion. The total estimated sales revenue for both products amounts to $45.5 billion.

The hypoglycemic version of tirzepatide was first approved by the FDA for marketing on May 13, 2022. In the Chinese market, the drug received NMPA approval for marketing in January 2025 and officially entered the medical insurance system in December of the same year. The weight-loss version of tirzepatide was approved by the FDA for marketing in November 2023 and has not yet entered the Chinese market.

Novo Nordisk's flagship product —— two versions of Semaglutide both made the list, with its blood sugar-lowering version and weight loss version ranking 6th and 7th respectively. As the first approved GLP-1 receptor agonist to hit the market, NovoTide has become one of the company’s main growth engines. However, in recent years, intensified competition in this market has impacted the growth expectations of the blood sugar-lowering version of Semaglutide. Compared to the 2025 list, the projected sales of the weight loss version of Semaglutide in 2026 are $19.7 billion, a year-on-year decrease of 10.5%.

The hypoglycemic version and the weight-loss version were first approved by the FDA for marketing in December 2017 and June 2021, respectively. In the Chinese market, the two drugs were approved by the NMPA for marketing in August 2021 and June 2024, respectively, making semaglutide the first GLP-1 class drug to enter China.

Field of Immunotherapy

In the immunological disease market, four drugs also made the list: AbbVie's Risankizumab (Skyrizi), Sanofi's Dupilumab (Dupixent), Gilead's Biktarvy, and Bristol-Myers Squibb's (BMS) Apixaban (Eliquis). They ranked 3rd, 4th, 9th, and 10th on the list, respectively.

Risankizumab is an interleukin-23 inhibitor (IL-23i) and a first-line treatment option for moderate to severe active Crohn's disease. The drug was first approved by the FDA in April 2019 and subsequently received approval for four indications. In the Chinese market, it was approved by the NMPA on March 10, 2025, becoming the first interleukin-23 inhibitor in China equipped with a portable dosing device.

Dupilumab is a fully humanized monoclonal antibody targeting IL-4Rα, which effectively controls chronic diseases mediated by type 2 inflammation by blocking the IL-4/IL-13 pathway.

Notably, this drug was first approved for marketing in China. In November 2013, it received approval from the NMPA for use in the maintenance treatment of asthma in adolescents aged 12 years and older and adults. Subsequently, it gained approval in June 2020 and September 2023 for treating adult patients with moderate to severe atopic dermatitis and moderate to severe prurigo nodularis, respectively.

In the U.S. market, the drug was approved by the FDA for marketing in March 2017, and subsequently received FDA approval for a total of 16 indications.

Bictegravir, Emtricitabine, and Tenofovir Alafenamide Tablets are a type of HIV-blocking medication. This fixed-dose combination antiretroviral drug consists of bictegravir (50mg), emtricitabine (200mg), and tenofovir alafenamide (25mg). It is primarily used to treat adult patients with HIV-1 infection.

The drug was approved for marketing by the FDA in February 2018 and subsequently received approval for five indications. In the Chinese market, Bictegravir Emtricitabine Tenofovir Alafenamide Tablets were approved for marketing by the NMPA in August 2019.

Apixaban Tablets are a new type of Factor Xa inhibitor, used in adult patients undergoing elective hip or knee replacement surgery to prevent venous thromboembolic events (VTE). It directly, reversibly, and highly selectively blocks the active site of Factor Xa, preventing prothrombin from converting into thrombin, thereby preventing thrombosis.

Apixaban tablets were first approved for marketing by the EMA in May 2011, entering the European market, and then received FDA approval in December 2012. The drug was approved by the NMPA in January 2013, marking its first entry into the Chinese market.

The reference materials are from publicly available online information, including news reports, corporate official websites, and government documents.