As Merck considers its life after Keytruda, much will depend on the performance of a pair of respiratory products it gained in pricey buyouts designed to cushion the blow from the megablockbuster's looming exclusivity loss, which is expected to happen near the end of the decade.
When Merck reported its first-quarter earnings on Thursday, there was good and bad news on the two growth drivers, which were approved three months apart in 2024.
While pulmonary arterial hypertension (PAH) treatment Winrevair continued its positive trajectory, generating sales of $525 million for a 12% sequential gain, chronic obstructive pulmonary disease (COPD) medicine Ohtuvayre took a U-turn, pulling in sales of $131 million, which were down 26% from its showing in the previous period.
As for Ohtuvayre, which was gained in Merck’s $10 billion buyout of Verona Pharmaceuticals nine months ago, sales were adversely impacted by Medicare deductible resets and a CMS reimbursement change, but the company saw a positive trend at the end of the first quarter, according to chief financial officer Caroline Litchfield.
“We are encouraged by the prescription trends we began to recover in March,” Litchfield said during a conference call. “Consistent with our strategy to maximize Ohtuvayre’s strong potential, we are making investments to reach more patients and physicians, which we expect will accelerate the growth in the second half of the year and beyond.”
Meanwhile, all is well with Winrevair, which became a blockbuster in 2025, reaching $1.4 billion in sales in its first full year on the market. Acquiring the first-in-class activin receptor type IIA-Fc fusion protein with its $11.5 billion buyout of Acceleron in 2021 gave Merck a better chance to line up its commercial strategy, which is now bearing fruit.
“In the U.S. we continued to see steady progress with more than 1,600 new patients having received a prescription and an increase in usage by patients whose background therapies do not include a prostacyclin,” Litchfield said, adding that new launches of Winrevair outside of the U.S. are contributing to the upward trajectory, too.
There is much growth potential with Winrevair remaining as it nears a potential label expansion in September, when the FDA will decide on its application in newly diagnosed PAH patients who received the drug plus background therapy.
Merck exceeded analyst expectations in the first quarter, achieving revenue of $16.3 billion, which was up 5% year over year. Keytruda accounted for nearly half of the company’s sales, pulling in $8.03 billion, for a 12% increase. Keytruda’s new convenient under-the-skin formulation, dubbed QLEX, drew sales of $128 million, which were up from $35 million in the fourth quarter.
The company’s HPV vaccine Gardasil continued its slide, however, with sales down 19% to $1.07 billion in the quarter. Revenue from the shot has now declined by more than 50% from its first quarter sales of 2024, which were at $2.25 billion.
While Merck has previously chalked up the free fall to plummeting demand in China and Japan, it is now also citing “unfavorable public-sector purchasing patterns” in the United States.
Merck also saw a decline in sales for two of its other vaccines—rotavirus shot RotaTeq, which was down 10% on lower demand in China, and pneumococcal shot Vaxneuvance, which fell by 12% due to lower demand and “competitive pressures.”
On the plus side, Merck's new pneumococcal vaccine, Capvaxive, realized a 33% increase thanks to launches in Europe and increased uptake in the U.S., the company said.
Merck also tweaked its 2026 revenue guidance, increasing the bottom end of its window by $300 million. The new projection anticipates revenue falling between $65.8 billion and $67 billion.