10. Sanofi  $14.6B ▲19.9%

Global revenue: $40B (3rd); up 8.1%
Top brands: Lantus Solostar ($4.5B); Lantus ($3.4B); Renagel/Renvela ($491M); Aubagio ($345M); Synvisc/Synvisc-One ($290M)
Promotional spend: $456M (15th); 3.1% of rev.
R&D spend: $5B (6th); up 2%; 12.5% of rev.
Planned launches: alirocumab (CV); sarilumab (RA); lixisenatide (diabetes)
Patent expirations: Aubagio (2017); Multaq (2018); Toujeo (2018)

Sanofi’s new CEO Olivier Brandicourt, who replaced ousted CEO Chris Viehbacher, faces a number of challenges, none of which are more important than finding a revenue replacement for blockbuster insulin Lantus, which came off patent in February 2015. Making matters more challenging, Lantus’s heir-apparent, Toujeo, has already faced a serious setback: When it was approved in February, it received what some analysts considered a “limiting” label. “All the label shows is non-inferiority of Toujeo to Lantus and the trends in blood-sugar reduction are not uniformly in favor of Toujeo,” wrote Bernstein’s Tim Anderson. Sanofi execs said at a November pipeline presentation that current Lantus patients would be prime targets for Toujeo, leaving questions about potential new markets for the new drug. It’s not all doom and gloom for the Paris-based drugmaker, however. Sanofi’s PCSK9 Praluent (alirocumab), one of a new highly touted class of cholesterol-lowering treatments, has shown in testing that it can reduce bad cholesterol levels by 60%. It could also be the first PCSK9 to market: Sanofi redeemed a purchased priority review voucher, which places it ahead of Amgen’s Repatha (evolocumab) in the FDA queue. 

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