After several years on the market, the majority of US dermatologists report that Cosentyx has lost its advantage over Taltz as the first IL-17 inhibitor on the market; with increased penetration of Taltz for the treatment of psoriatic arthritis, will rheumatologists follow suit?
EXTON, Pa., April 17, 2019 /PRNewswire/ — Spherix Global Insights has been tracking the evolution of the US psoriatic arthritis (PsA) market on a quarterly basis since 2015 via the RealTime Dynamix™: Psoriatic Arthritis (US) report series. The PsA landscape has been experiencing large-scale change as rheumatologists continue to adopt alternate mechanism of action (MOA) agents for the treatment of the disease. The most recent wave of the report series, which included responses from 98 US rheumatologists, revealed that overall brand share of the established TNF inhibitors (AbbVie’s Humira, Amgen’s Enbrel, Janssen’s Remicade, etc.) has trended downwards over the past year, a trend that is projected to continue. This has been the case in multiple autoimmune disease areas, but particularly in psoriasis, where there has been an influx of advanced systemic therapies entering the market and opening the door to a shift in the prescribing paradigm. The question is no longer whether the alternate MOA agents will disrupt these TNF inhibitor-dominant markets, but how they will differentiate themselves within each class to capture patients who are candidates for these newer treatment modalities.
For instance, Novartis’ Cosentyx was the first IL-17 inhibitor approved by the FDA to treat moderate-to-severe PsA, giving it an obvious first-to-market advantage and allowing it almost two years of market exclusivity before the next IL-17 inhibitor (Eli Lilly’s Taltz) was approved. When looking at the performance of the two brands approximately one year following their respective launches, substantially more rheumatologists had adopted Cosentyx into their armamentarium than they had Taltz, further demonstrating the advantage of being a first-in-class agent. Indeed, Cosentyx is currently the top preferred alternate MOA agent for the treatment of PsA by a landslide, far outpacing not only Taltz, but agents with other mechanisms of action, including Janssen’s Stelara and Pfizer’s Xeljanz. In addition, Taltz brand share among biologic/small molecule-treated patients is markedly lower than Cosentyx and even falls below Xeljanz, a JAK inhibitor that was introduced to the market just weeks after Eli Lilly’s IL-17 inhibitor.
Though comparisons between the IL-17 inhibitors are unavoidable, one-third of rheumatologists consider both agents to be clinically interchangeable, and the vast majority of respondents do not view either brand as superior on a host of attributes. Regardless, two-fifths of respondents consider Cosentyx’s status as the first IL-17 to market as an advantage over Taltz, a factor that may lead to reserved use of Eli Lilly’s drug. The biggest barrier for Taltz continues to be related to coverage and cost issues, which is indicative of the difficulties of a second-in-class agent in obtaining adequate formulary coverage with payers.
In psoriasis, where Cosentyx was similarly introduced into the market prior to Taltz and has reaped the same benefits, the gap between the IL-17 inhibitors has since levelled off, according to the Q1 2019 update of RealTime Dynamix™: Psoriasis (US). With both brands now having several years of post-marketing experience in psoriasis and each IL-17 inhibitor having over a year of additional time on the psoriasis market compared to PsA, less than half of dermatologists continue to report that Cosentyx’s first-to-market status still holds an advantage over Taltz. Indeed, dermatologists now seem to be divided into two camps: Cosentyx vs. Taltz loyalists – with favorable brand share and performance ratings of the two aligning to which camp respondents belong to. Furthermore, when dermatologists were queried about which IL-17 inhibitor is most likely to become the standard of care for psoriasis, Taltz edges out the competition. This leads Spherix experts to believe these patterns may carry over into the PsA market, expecting Cosentyx’s edge over Taltz to wane as the newer brand continues to penetrate the rheumatology market.
Having said that, where both brands benefit is in their dual indication for PsA and psoriasis. In fact, nearly three-quarters of rheumatologists surveyed agree that they prefer to use biologics and small molecules with a dual indication in psoriasis, and a comparable figure of dermatologists prefer brands with a dual indication in PsA. Regarding the performance of other agents with dual indications, two-thirds of rheumatologists perceive Janssen’s Stelara, an IL-12/23 inhibitor, as performing substantially better in psoriasis, which is of particular interest given the more targeted, sister molecules—the selective IL-23 inhibitors, have begun to disrupt the psoriasis market with plans to make their way into rheumatology offices over the next couple years. Indeed, Janssen’s Tremfya has had a substantial impact on the US psoriasis market and is quickly being viewed as a leading treatment, introducing superior efficacy over existing brands, as well as a positive safety profile. The pending approval of AbbVie’s Skyrizi (risankizumab) will likely continue this trend, adding a more favorable dosing profile.
With the IL-23 inhibitors expected to make their way to the PsA market in the coming years, it remains to be seen if their legacy amongst dermatologists will carry over to rheumatologists, or if they will continue the trend set by Stelara—an agent with great skin clearance but less efficacy when joint disease is involved. Regardless, 40% of collaborating rheumatologists would prefer an IL-23 inhibitor to gain approval and are most familiar with Janssen’s Tremfya. Additionally, half of respondents indicate they plan to prescribe Tremfya routinely, with intentions of first-line use, and nearly one in ten rheumatologists currently report that they already have experience prescribing Janssen’s IL-23 inhibitor off-label to their PsA patients.
About RealTime Dynamix™
The RealTime Dynamix™: Psoriatic Arthritis (US) report series provides a quarterly detailed and timely look at current and future trends in the psoriatic arthritis market and the effects of the future shifting landscape. The series tracks the evolution of the market, provides a deep dive on launch effectiveness, and highlights opportunities for pipeline agents. A similar report, RealTime Dynamix™: Psoriasis (US), tracks the US psoriasis market on a quarterly basis.
About Spherix Global Insights
Spherix Global Insights is an independent business intelligence and market research company, specializing in renal, autoimmune, neurologic and rare disease markets. Our aim is to apply our commercial experience and unique relationships within core specialty markets to translate data into insight, enabling our clients to make smarter business decisions.
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