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IL-23 Inhibitors Take Over the US Psoriasis Switching Market at the Expense of the IL-17 and TNF Inhibitors

AbbVie’s Skyrizi now garners the greatest switch-to rate, capturing the majority of new business from patients previously treated with sister-brand Humira and Amgen’s Otezla

 EXTON, Pa., November 17, 2020 /PRNewswire/ — The 2020 audit included in Spherix’s RealWorld Dynamix™: Biologic/Small Molecule Switching in Psoriasis (US) service focuses on a critical facet of overall therapy prescribing for plaque psoriasis (PSO) patients – advanced therapy switching. The study captures the myriad of data surrounding the process by which PSO patients are switched from one biologic/small molecule agent to another.

Since the introduction of AbbVie’s Skyrizi in April 2019, switch-to share for the IL-23 inhibitor class has nearly tripled. The newest market entrant now garners the greatest switch-to rate among all commercial biologics in PSO and has made great strides in the second- and third-line setting compared to 2019.

Which brands are taking the biggest hit? Two biologics in particular who once held their position as leaders in the market year over year, Novartis’ Cosentyx and AbbVie’s Humira, have seen consecutive declines in switch-to share since the introduction of Skyrizi.

However, the AbbVie portfolio remains strong, as patients who were switched to Skyrizi often switched from sister brand Humira – offsetting any deficits the TNF inhibitor experienced. Of note, the percent of current Skyrizi patients being switched from Amgen’s Otezla (a commonly used first-line agent in addition to the TNF inhibitors) has substantially increased from the prior year. This, coupled with the fact that switches from IL-17 inhibitors (which are more commonly used in later lines of therapy) are decreasing, suggests that Skyrizi is being prescribed earlier in the treatment algorithm.

The Spherix study, which assesses reasons behind prescribing behavior, found that efficacy in both skin and joints remains a top reason for current brand selection in PSO, highlighting the importance of treating psoriatic disease. Although IL-17 inhibitors are prescribed more often than IL-23 inhibitors when joint involvement is a factor, the IL-23 class is gaining momentum. In July 2020, Janssen’s Tremfya became the first IL-23 inhibitor to gain FDA approval for the treatment of moderate to severe psoriatic arthritic (PsA).

Indeed, nearly one-third of Tremfya patients included in the study present with any joint symptoms, a figure that is not far off from the rates seen in patients being treated with IL-17 inhibitors. The audit also found that considerably more PSO patients overall present with mild joint involvement than moderate to severe – indicating the “mild PsA” patient segment in PSO presents a greater opportunity for brands to capture more share.

When examining the switch-to brand based on the severity of joint involvement, the IL-23 inhibitors are being prescribed more often for patients with concomitant mild PsA than moderate to severe – and that number has grown since the prior year. On the other hand, slightly less PSO patients with mild joint involvement were switched to an IL-17 inhibitor, and that figure has declined year over year.

As the PSO market is expected to further expand in 2021 with UCB’s bimekizumab, a dual IL-17A and IL-17F inhibitor, switching market dynamics are likely to continue shifting. In fact, the majority of PSO patients are considered potential candidates for bimekizumab (pending approval) should their current switch-to agent deem unsuccessful – followed by Eli Lilly’s pipeline IL-23 inhibitor, mirikizumab.

Patients currently prescribed TNF and IL-17 inhibitors are more likely to be considered for bimekizumab than patients being treated with other mechanisms of action. Interestingly, patients currently on an IL-23 inhibitor are more likely to be considered for mirikizumab, while current Otezla patients are more likely to be considered for other oral agents, such as BMS’ TYK2 inhibitor, deucravacitinib – highlighting further in-class competition in the PSO switch market.

About RealWorld Dynamix™
RealWorld Dynamix™: Biologic/Small Molecule Switching in Psoriasis (US) is an independent, data-driven service unmasking real patient management patterns through annual reports based on chart audits of ~1,000 patients. The report uncovers the “why” behind treatment decisions, includes year over year trending to quantify key aspects of market evolution, and integrates specialists’ attitudinal & demographic data to highlight differences between stated and actual treatment patterns.

About Spherix Global Insights
Spherix Global Insights is a hyper-focused market intelligence firm that leverages our own independent data and expertise to provide strategic guidance, so biopharma stakeholders make decisions with confidence. We specialize in select immunology, nephrology, and neurology markets.

All company, brand or product names in this document are trademarks of their respective holders.

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