July 02, 2020
Massive Shift in Practice Patterns in Psoriatic Arthritis as Rheumatologists Lean Toward Increased Use of JAK inhibitors and Novel Biologics
Spherix Global Insights releases fifth annual patient chart study focused exclusively on biologic and small molecule switching patterns among US rheumatologists
EXTON, Pa., July 2, 2020 /PRNewswire/ – Over the past four years, multiple new agents have been FDA approved for the treatment of psoriatic arthritis (PsA), including Pfizer’s Xeljanz, Eli Lilly’s Taltz, BMS’ Orencia, and Janssen’s Simponi Aria. In addition, the development pipeline is ripe with many new agents offering novel mechanism approaches, including UCB’s bimekizumab and BMS’ TYK2 inhibitor (BMS-986165), that will join likely PsA line extensions of Janssen’s Tremfya, Sun Pharma’s Ilumya, and AbbVie’s Rinvoq and Skyrizi.
Each year, Spherix Global Insights collaborates with approximately 200 rheumatologists to conduct large scale, retrospective patient chart audits, exclusively focusing on recent trends in PsA switching patterns. The 2020 audit, which was released last week, highlights recent switching patterns for 1,008 patients with PsA who are being treated with a biologic, JAK inhibitor, or Amgen’s Otezla. Notably, this is the first year that Otezla is under Amgen’s domain, after being divested by Celgene in accordance with the acquisition by BMS.
At the end of 2015, switching patterns in PsA were still largely driven by TNF inhibitor sequencing, with more than one-half of the recent switches occurring within the class. In each sequential year, TNF cycling eroded, with the most recent results indicating that approximately one-in-four patients are now treated with two consecutive TNFs. Collectively, the IL-17s (Novartis’ Cosentyx and Eli Lilly’s Taltz) grew switching share from virtually nothing in late 2015 to approximately one-quarter of switches in the present audit. The approval of Xeljanz for PsA in December 2017 also caused some disruption, introducing an oral challenger to Otezla. Switches both from and to oral agents increased substantially since the first edition of this study several years ago.
Rheumatologists have consistently reported that among their PsA patients being treated with biologics or advanced small molecules, slightly more than one-quarter are switched in any given year, making the competition for second-line agents fierce. There is less opportunity for later-line switching, making it critical to be positioned as the first-line or first-switch brand. An evaluation of first-line treatment among patients who ultimately switched indicates dwindling first-line use of Amgen’s Enbrel over the past three years, but an uptick in Otezla – keeping the company’s portfolio largely net neutral in first-line use.
However, since late 2015, Enbrel and Otezla have collectively forfeited second-line share, dropping from 38% to 21% over the four-year period. Furthermore, Enbrel was poised to capture an incremental 9% of the recent switches, ultimately losing out to AbbVie’s Humira most frequently, but also losing to Amgen’s own Otezla in more than 10% of the cases. Market access seems to be helping Enbrel stay in the game – in more than half of the cases where patients were switched to Enbrel, the rheumatologist would have selected a different agent if market access were not a factor.
As expected, most switching is based on the desire for improved efficacy in joints, but often the decision is multi-factorial, with rheumatologists reporting that patients themselves are often the drivers in more than one-quarter of the cases. The reasons for selection of the new agent vary by mechanism of action and brand, with Xeljanz and Otezla benefitting from patient requests and a desire for the oral formulation. Humira and Enbrel are often selected based on habit, while others stake a claim on specific patient types: Orencia for patients with multiple co-morbidities; Taltz when skin efficacy is desired; and Cimzia when family planning considerations are at play.
The market will soon be crowded with even more treatment options. Rheumatologists report the greatest familiarity with AbbVie’s Rinvoq for PsA, which was approved last August and has had a meteoric rise in rheumatoid arthritis (see RealTime Dynamix: Rheumatoid Arthritis (US)). Comparably, there is less familiarity with bimekizumab, Tremfya, Skyrizi, Ilumya, and BMS-986165. Rinvoq looks to pose the greatest threat to Xeljanz; bimekizumab to the IL-17s; and Tremfya to Cosentyx and Janssen’s own Stelara.
Being positioned clinically (with strong joint efficacy data) and from a market access perspective to compete in the first- or second-line position is critical to optimizing performance in the PsA market. Secondary strategies include being able to carve out a sizable patient profile niche and/or driving patient requests through DTC and the development of patient-preferred formulations.
About RealWorld Dynamix™
RealWorld Dynamix™: Biologic/Small Molecule Switching in PsA (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.
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