Excluding special items, Lilly earned 70 cents per share, matching the analysts' average estimate compiled by Thomson Reuters I/B/E/S.
Revenue fell 16 percent to $4.68 billion. Wall Street was expecting $4.8 billion.
"Overall, (it) was not a great quarter," ISI Group analyst Mark Schoenebaum said in a research note. But he said investors were far more focused on promising new and experimental drugs that could revive Lilly's fortunes.
BMO Nesbitt Burns analyst Alex Arfaei said lower research spending and a tax benefit had enabled Lilly to meet its first-quarter profit forecast despite disappointing revenue.
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"We believe the quarter reflects weakening core franchises," Arfaei said, adding that lower sales of drugs for diabetes, cancer, osteoporosis and other conditions increase the importance of Lilly's experimental drugs.
Lilly's sales and earnings have been badly hurt since late 2011, when its Zyprexa schizophrenia drug lost U.S. patent protection and was slammed by cheaper generics. Cymbalta, which had $5 billion in annual sales at its peak, began facing generics in December. And the company's Evista osteoporosis drug lost U.S. marketing exclusivity last month.
First-quarter sales of Cymbalta fell 64 percent to $478 million, while Evista's dropped 38 percent to $150 million.
Lilly is counting on new drug approvals to put its sales and earnings back on track. Among those approvals may be two new diabetes treatments later this year.
U.S. regulators on Monday approved the company's new Cyramza (ramucirumab) treatment for gastric cancer. Analysts expect the product to become a blockbuster brand, especially if it proves effective later against lung cancer.
Lilly is testing other cancer drugs, as well as treatments for Alzheimer's disease, arthritis and psoriasis.
Global sales of lung cancer drug Alimta rose 2 percent to $632 million.
Sales of Humalog, a leading insulin brand, rose 3 percent to $650 million, while those of Humulin, another type of insulin, rose 1 percent to $316 million. But combined sales of the three products were about $50 million below expectations.
For all of 2014, Lilly said it still expected earnings of $2.72 to $2.80 per share, excluding items. It forecast full-year revenue of $19.4 billion to $20 billion, slightly above its prior outlook