As the user base of Regeneron’s Kevzara and Eli Lilly’s Olumiant continue to expand, US rheumatologists gear up for AbbVie’s JAK inhibitor to enter the market – with Pfizer’s Xeljanz most at risk for displacement
EXTON, Pa., July 18, 2019 /PRNewswire/ — The latest report included in Spherix’s RealTime Dynamix™ Rheumatoid Arthritis (US) independent service comprises the responses of 101 US rheumatologists and captures the impact of new product launches and market events on prescribing behavior and product perceptions. In the US rheumatoid arthritis (RA) market, it is clear that TNF inhibitors have historically dominated, with AbbVie’s Humira and Amgen’s Enbrel accounting for the lion’s share of biologic/JAK-treated patients. However, as share for these agents are starting to dwindle, use of alternative mechanism of action (MOA) brands is anticipated to grow. Indeed, rheumatologists expect their share of Humira, Enbrel, and infliximab to drop significantly in the next six months while share of Regeneron’s Kevzara and Eli Lilly’s Olumiant are expected to do the opposite.
JAK inhibitors, namely Olumiant and Pfizer’s Xeljanz, garner just under one-tenth of first-line advanced systemic treatment in RA, with use skyrocketing in consecutive lines of therapy. In fact, over one-fifth of the biologic/JAK-treated RA population is on their third- or later-line of therapy, and JAK inhibitors account for 26% of use in that patient population, a figure higher than any other MOA class. For the nearly one in ten patients on a JAK inhibitor in the pre-biologic setting, two-fifths stopped treatment due to primary efficacy failure. At this point, JAK cycling is still uncommon, but the propensity to cycle may increase as more selective JAK pathways hit the market in the near future.
AbbVie’s pipeline JAK1 selective inhibitor, upadacitinib, is expected to become available for the treatment of RA in the next few months, and rheumatologists’ reported familiarity with the late-stage agent has increased two-fold in the past year. Indeed, nearly two-fifths of respondents expect a substantial number of patients to benefit from upadacitinib and plan to use it routinely. It is estimated that the release of AbbVie’s JAK will have an immediate impact on the RA treatment landscape and could capture a significant amount of share within the first six months of launch.
When projecting future brand share in a scenario where upadacitinib is readily available, rheumatologists expect Xeljanz to take the greatest hit; with significant estimated declines in share, a phenomenon never before recorded for Pfizer’s JAK since Spherix’s coverage began in 2015. Conversely, Olumiant is still projected to grow in an upadacitinib world, albeit not to as great an extent as if the third-to-market JAK were not available. It should be noted, however, that Pfizer’s JAK has more to lose, and projected share of AbbVie’s brand is estimated to trump that of Olumiant’s within the first six months on the market. When rheumatologists were probed about what upadacitinib could bring to the market to make it more appealing than Xeljanz, “better efficacy” was the overarching answer, tying back to the leading reason for JAK discontinuations (efficacy failure). On the other hand, respondents were not so clear about what could differentiate upadacitinib from Olumiant, other than slightly more rheumatologists stating “better safety,” an aspect likely conceived about the entire JAK class and not solely Olumiant. The lack of an outright differentiator between AbbVie and Lilly’s JAKs could explain why Xeljanz is projected to lose share and Olumiant is not, were upadacitinib to become available.
Pfizer’s announcement of an ongoing post-marketing requirement study investigating the risk of cardiovascular (CV) events in RA appears to have little impact on share for the two JAKs currently approved in RA. Indeed, the majority of respondents do agree that CV risks are more likely a function of the JAK inhibitor class rather than isolated just to Xeljanz. However, when it comes to JAK and TNF inhibitor comparisons, though they are seen as equally efficacious, JAKs are perceived as far less safe. With other JAKs in the pipeline, including Gilead’s filgotinib, it will be imperative for manufacturers to differentiate their brands in this increasingly competitive market.
About RealTime Dynamix™
The RealTime Dynamix™ Rheumatoid Arthritis (US) is an independent service providing strategic guidance through rapid and comprehensive quarterly reports, which include RA market trending, launch tracking, and a fresh infusion of unique content with each wave. The sixteenth wave of this US study will field in August 2019 and will continue to track the launch of Olumiant, uptake of biosimilars, as well as the overall evolving US RA market. The fifth bi-annual wave included in a parallel service tracking the evolution of the European RA market, RealTime Dynamix™ Rheumatoid Arthritis (EU), published in July 2019 (n=250 rheumatologists per wave).
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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