Johnson & Johnson must pay $2.1bn in damages to women who blamed their ovarian cancer on asbestos in the drugmaker’s baby powder, after the US Supreme Court refused to review the case.

The judgment was the largest against the company, which has battled a wave of litigation and lost several cases as thousands of people claimed the products led to cancer. The appeal that was denied on Tuesday related to a case filed in Missouri in 2018 involving 22 women.

“The decision by the court to not review the Ingham case leaves unresolved significant legal questions that state and federal courts will continue to face,” J&J said, adding that “decades of independent scientific evaluations confirm Johnson’s Baby Powder is safe, does not contain asbestos, and does not cause cancer.”

Last year, the company said it would stop selling its baby powder in the US and Canada after sales plunged by 60 per cent in three years.

The Supreme Court judges kept in place a ruling by a Missouri state court in which the jury ordered J&J to pay $4.7bn in damages, although that penalty was later reduced to $2.12bn.

The lawsuit featured high-level attorneys on both sides, with Kenneth Starr, former solicitor general of the US, representing the women. In court documents filed in April, he claimed that J&J “knew for decades that their talc powders contained asbestos” and “launched a decades-long cover-up”.

In November, the Missouri state court refused to hear J&J’s appeal, sending the case to the country’s highest court. The drugmaker had argued that by bringing together several separate talcum powder-related claims for trial in front of a single jury, the trial had violated J&J’s due process rights under the US constitution.

Neal Katyal, former US acting solicitor general, represented J&J and had urged the court to focus on due process.

J&J’s share price fell 1.9 per cent by Tuesday lunchtime in New York after it became clear the company would not be given a chance to air its arguments and would instead have to pay the award. J&J said that there were “no additional avenues to appeal this case”.

Several large US business groups including the Business Roundtable and US Chamber of Commerce had backed the company’s appeal.

Talcum powder is made from the mineral talc, which, in its natural form, contains asbestos, a substance that can cause cancer. The healthcare industry agreed in 1976 to ensure that all talc products do not contain detectable levels of asbestos.