J&J Just Lost 43% of Stelara Revenue. Why Is Wall Street Cheering?

The first replacement is Tremfya (guselkumab), J&J's next-generation immunology drug. Tremfya treats many of the same conditions as Stelara, including psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis. It posted Q1 2026 sales of $1.6 billion, up a staggering 64% year over year. Analysts project Tremfya could eventually reach $6 to $9 billion in peak annual sales.

The second replacement is nipocalimab (branded as Imaavy), an antibody approved for generalized myasthenia gravis. J&J has FDA Fast Track designations for nipocalimab across lupus, rare blood disorders, and neurological conditions, with a Phase 3 trial underway in lupus, projecting over $5 billion in peak sales. That kind of multi-indication reach gives it "pipeline-in-a-product" status: one drug, many markets.

The Magic Trick That Impressed Wall Street

Here's what makes this story unusual. Most companies stumble when their biggest drug falls off a cliff. J&J somehow didn't.

Despite Stelara's 43% nosedive, J&J's pharmaceutical division continued to post strong results. After Q1 2026, management raised full-year guidance.

CEO Joaquin Duato made a bold claim: no other healthcare company has grown through the first-year loss of exclusivity on a multibillion-dollar product like Stelara. Whether that's technically true is debatable, but the numbers lend credibility. Strip out Stelara entirely, and J&J's portfolio was growing at a double-digit rate.

Zacks maintained a Hold rating but revised earnings estimates upward for 2025 and 2026.

The Bigger Picture: What Stelara Tells Us About Biosimilar Erosion

Stelara's decline is a case study in how fast biosimilar competition can dismantle a franchise. But the speed and severity vary wildly depending on the drug.

Consider AbbVie's Humira (adalimumab), the best-selling drug in history. Humira peaked at about $21 billion in 2022 and had nine biosimilars enter the U.S. market starting in 2023. Yet the erosion has been surprisingly slow; it took nearly 18 months for biosimilars to gain meaningful traction. PBM formulary changes drive adoption in big, sudden chunks rather than a smooth decline.

J&J's own Remicade (infliximab) is the older benchmark. It peaked at about $6 billion and saw steadier, more traditional erosion once biosimilars arrived.

Stelara's erosion has been faster and steeper than Humira's early trajectory, partly because so many competitors launched simultaneously and partly because the PBM infrastructure for switching patients has matured since the Humira wave began.

Research firm BCG notes that immunology biosimilars typically reach about 25% market share within five years, classified as "slow uptake" compared to oncology. But that average masks enormous variation. When a PBM flips a formulary (as CVS did with Humira biosimilar Hyrimoz), the erosion in that book of business can happen rapidly.

For drugmakers watching from the sidelines, the message is clear: patent cliffs aren't theoretical risk factors buried in an annual report. They are revenue earthquakes, and the aftershocks hit faster than they used to.

What Comes Next

J&J's Stelara era isn't over yet, but it's winding down quickly. The company is executing a deliberate transition, actively moving patients from Stelara (and its cheaper biosimilar copies) to the still-patent-protected Tremfya. Payers have noticed; some are implementing prior authorization rules to ensure Tremfya is reserved for patients who don't respond to biosimilar ustekinumab first.

The broader immunology portfolio is being rebuilt around three pillars: injectable Tremfya, oral IL-23 inhibitor icotrokinra (completing Phase 2b for ulcerative colitis with Phase 3 being initiated), and FcRn-blocker nipocalimab for autoimmune diseases. Add in a dominant oncology franchise led by Darzalex (nearly $4 billion in Q1 2026 alone) and you can see why analysts are modeling growth rather than decline.

J&J made a bet that it could survive losing its biggest drug. So far, that bet is paying off. But the next few quarters will reveal whether Tremfya's growth can truly fill an $11 billion hole, or whether the math eventually catches up.

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