Surveyed gastroenterologists (n=101) estimate that 80% of their patients with ulcerative colitis (UC) who were started on a biologic in the past year would have preferred to start with an oral instead, highlighting the massive opportunity not just for Xeljanz, but also for other JAK inhibitors and small molecule agents in the pipeline
EXTON, Pa., March 23, 2018 /PRNewswire/ — AbbVie’s Humira and Janssen’s Remicade have been the dominant agents in the moderate-to-severe ulcerative colitis market for years. Recently, Takeda’s Entyvio has been gaining momentum, and survey results predict significant gains for Entyvio in UC over the coming six months. However, this projected growth for Entyvio is seriously challenged in a scenario where oral Xeljanz is approved. With the recent FDA advisory committee’s unanimous recommendation on Xeljanz dosing in UC1, a mid-year approval for the drug seems increasingly likely.
Assuming Xeljanz is ultimately approved in UC, it is likely to have a long runway before other oral options reach commercialization. In addition to other JAK inhibitors, such as AbbVie’s upadacitinib and Gilead/Galapagos’ filgotinib, another class of novel drugs known as the S1P agonists shows promise. Of note, earlier this week Arena Pharmaceuticals posted favorable Phase 2 results for etrasimod in UC, triggering the initiation of Phase 3 trials.
In Crohn’s disease, Janssen’s Stelara continues to grow in both share and user base, while Humira saw share dip from 43% in Q1 2017 to 36% in the current quarter. Collectively, alternative mechanism agents (Stelara and Entyvio) account for nearly one-quarter of the biologic share, and while both are projected to increase significantly in the next six months, for the first time Stelara is projected to eclipse Entyvio in this setting. Stelara’s growth is likely being fueled by increased promotion as nearly half of the respondents report that promotion levels for Stelara have increased in the past six months compared to just 25% for Entyvio.
Although the anti-TNF drugs are expected to continue domination in both UC and Crohn’s disease in the foreseeable future, not all TNFs are created equal. In fact, only 23% of those surveyed view the TNFs as clinically interchangeable. UCB’s Cimzia is a small player within the TNF segment, with only 11% of the surveyed physicians selecting it as one of their top two biologic choices in Crohn’s disease. However, with the recent release of data from the CRIB and CRADLE studies which evaluated the effects of Cimzia in women who were pregnant or breast-feeding, UCB could carve out a nice niche. Indeed, more than half agree that they are more likely to prescribe Cimzia to women of child-bearing age than any other biologic, and importantly, only about one-quarter believe these results can be extrapolated to other TNFs.
RealTime Dynamix™: Inflammatory Bowel Disease is an independent report series published on a quarterly basis. The series provides a close-quarters analysis of key performance metrics, focusing on brand gains and losses, industry contact rates, familiarity and adoption rates of recently launched products and awareness of products in development. The next wave of the study will field in April and will continue to track emerging trends.
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1Source: www.pfizer.com; Press release dated March 8, 2018