As Merck considers its survival post-Keytruda, much of it will depend on the performance of its respiratory products in a pricey acquisition designed to soften the blow from the blockbuster’s impending loss of exclusivity, expected to occur near the end of the century.
When Merck released its first-quarter results on Thursday, there was good news and bad news about two growth drivers approved three months apart in 2024.
Winreair, a pulmonary arterial hypertension (PAH) drug, continued its strong trajectory with sales of $525 million, up 12% sequentially, while Ootsweile, a chronic obstructive pulmonary disease (COPD) drug, made a U-turn with sales of $131 million, down 26% sequentially.
Autotubile, which Merck acquired nine months ago when it acquired Verona Pharmaceuticals for $10 billion, saw a positive trend at the end of the first quarter, although sales were hurt by the Medicare deductible reset and CMS reimbursement changes, Chief Financial Officer Caroline Litchfield said.
“We are encouraged by prescription trends that began to recover in March,” Litchfield said on a conference call. “In line with our strategy to maximize Autotubile’s strong potential, we are investing to reach more patients and physicians, which we expect to accelerate growth from the second half of this year onwards.”
Meanwhile, all is well with Winrevair, which became a blockbuster with its first full-year sales on the market reaching $1.4 billion in 2025. With the $11.5 billion acquisition of Acceleron in 2021 and the acquisition of a first-in-class activin receptor type IIA-Fc fusion protein, Merck has a good opportunity to develop a commercial strategy that is now coming to fruition.
“We continued to see steady progress in the U.S., with more than 1,600 new patients filling prescriptions and increased use by patients whose background therapy did not include prostacyclin,” Litchfield said, adding that new launches of Winreair outside the U.S. are also contributing to the upward trajectory.
Significant growth potential remains for Winrevair as it approaches an expanded indication in September, when the FDA decides to include the drug in patients with newly diagnosed PAH who have received the same drug plus background therapy.
Merck beat analysts’ expectations in the first quarter, posting revenue of $16.3 billion, up 5% from a year earlier. Keytruda accounted for nearly half of the company’s sales, increasing 12% to $8.03 billion. Sales of QLEX, Keytruda’s new convenient subcutaneous formulation, were $128 million, up from $35 million in the fourth quarter.
However, sales of the company’s HPV vaccine Gardasil continued to decline, and sales for the quarter fell 19% to $1.07 billion. Revenue from the shot is now down more than 50% from sales of $2.25 billion in the first quarter of 2024.
Merck had previously blamed the free fall on a sharp drop in demand in China and Japan, but now it is also citing “adverse purchasing patterns in the public sector” in the United States.
Merck also saw sales declines for two other vaccines. Sales of rotavirus vaccine RotaTeq fell 10% due to lower demand in China, and sales of pneumococcal vaccine Vaxneuvance fell 12% due to lower demand and “competitive pressures.”
On the positive side, Merck’s new pneumococcal vaccine, capvaxib, achieved a 33% increase thanks to its launch in Europe and increased uptake in the United States, the company said.
Merck also tweaked its 2026 revenue outlook, raising the lower end of that window by $300 million. The new forecast projects sales to fall between $65.8 billion and $67 billion.
