Perceptions and Prescribing Patterns of GSK’s Benlysta and Aurinia’s Lupkynis Highlight an Increasing Divide Among Nephrologists and Rheumatologists, Spherix Finds

Approaching one year on the market to treat lupus nephritis, comprehensive launch coverage reveals a widening gap in attitudes and use of the two new products

EXTON, Pa., December 14, 2021 /PRNewswire/ — The Lupus Foundation of America estimates that 1.5 million Americans, and at least five million people worldwide, have a form of lupus,^[1] and as many as half of the patients with systemic lupus will develop lupus nephritis (LN).^[2] With the approvals of GlaxoSmithKline’s Benlysta at the end of last year (December 17, 2020) and Aurinia’s Lupkynis at the beginning of this year (January 22, 2021), specialists now have valuable new treatment options to add to their armamentarium.

While it is still considerable, specialists’ perceptions of the unmet need for new products in lupus nephritis have generally dropped over the course of the year. This is especially notable given the very active pipeline for LN products, including BMS’ TYK2 inhibitor (deucravacitinib), Roche-Genentech’s Gazyva (obinutuzumab), Janssen’s Tremfya, Novartis’ Cosentyx, and AstraZeneca’s Saphnelo (which secured FDA approval for systemic lupus erythematosus [SLE] in August). Understanding where pipeline agents can expect to play will be critical as new products enter the space.

Spherix has been closely tracking Benlysta and Lupkynis in their Launch Dynamix™ service, which couples monthly performance benchmarking with quarterly deep dive reports to understand perceptions of each brand, their evolving places in the treatment paradigm, and projections for future use. The series is complemented by Spherix’s Market Dynamix™ service, focusing on how the market is likely to evolve with new pipeline products in the coming years, and their RealWorld Dynamix™ service, including access to large-scale patient chart data from over 1,000 patients evaluating actual treatment algorithms.

Given their extensive history of using the drug in SLE, six-in-ten rheumatologists now choose Benlysta as the product with the most overall benefit to treat LN patients and deem more of their patients as candidates for the drug over Lupkynis. Alternatively, six-in-ten nephrologists favor Lupkynis as the drug with the most overall benefit to LN patients (bolstered by their familiarity with the calcineurin inhibitor drug class) and see their patients as better suited for Aurinia’s brand.

Specialists’ opinions diverge on key performance metrics between the two products as well, particularly on patient adherence, tolerability, monitoring, and safety – with nephrologists favoring Lupkynis and rheumatologists favoring Benlysta. There is more controversy among specialists about which drug has superior efficacy; however, when looking across the entire sample, specialists give a slight edge to Lupkynis on efficacy performance overall.

Physicians generally feel Benlysta is ideal for addressing nephritis in more moderate patients with extra-renal manifestations, while Lupkynis is ideal for proteinuria control, often in more severe or refractory cases. In recent interviews, physicians expanded on the “ideal patient” for the brands:

• “Benlysta is good to use if the patient has a lot more extra-renal lupus, like arthritis and skin rash, then also in relation to the lupus nephritis itself.”– Nephrologist
• “For Benlysta, a patient who has other extra-renal manifestations as well, that are debilitating. Skin, joint other musculoskeletal manifestations, severe fatigue.” – Rheumatologist
• “If the patient still has significant proteinuria [with SOC] that’s usually when I add Lupkynis to the regimen. On the other hand, somebody who has a lot of active non-renal lupus in addition to nephritis, that’s typically when I use Benlysta.” – Nephrologist
• “If the patient is having significant membranous changes, in addition to proliferative changes, and have severe proteinuria, I might add Lupkynis.” – Rheumatologist

Benlysta prescribing has increased slowly but steadily since launch, with rheumatologists taking the lead on prescribing the brand to about seven LN patients, on average, compared to nephrologists who have initiated just over two LN patients. Lupkynis prescribing has also gradually increased, with rheumatologists taking a slight lead on prescribing overall, likely due to nephrologists’ cost- and risk-benefit uncertainty compared to other options like tacrolimus. Both physician-types have initiated over one patient on Lupkynis, on average, so far this year.

Out-of-pocket costs and reimbursement hassles are seen as the main barriers to use of both drugs overall – highlighting a key issue for manufacturers to address. In addition to cost and access barriers, Benlysta use is hindered by nephrologists’ lack of familiarity and rheumatologists’ efficacy concerns, while Lupkynis is perceived as less safe and less familiar overall.

Sales representatives, who are adapting to a challenging sales model during COVID-19 times, have largely increased contact with physicians over the course of the year. Unsurprisingly, most surveyed rheumatologists have seen a Benlysta representative (given their longer standing relationships) and report being most compelled by the brand’s safety messaging.

While contact rates with nephrologists have been lower (with some nephrologists feeling underserved by GSK on Benlysta), those who have been contacted feel Benlysta messaging about its likelihood of complete renal response over standard of care is most believable and compelling. One nephrologist commented, “[GSK has] little insight into nephrology rather than rheumatology practices for this indication.”

Lupkynis representatives have continued to market their product aggressively over the course of the year with physicians. One rheumatologist noted positively about Aurinia, “For a small company, they have done a good job.”

Data released days after fielding each month in Spherix’s Launch Dynamix™ service will continue to give a real-time read on uptake, perceptions, and experiences across both nephrologists and rheumatologists; the latest monthly update was released on December 10, 2021, followed by the 2021 RealWorld Dynamix™ service, which highlights data and insights from over 1,000 lupus nephritis patient charts.

About Our Services
Launch Dynamix™ is an independent service providing monthly benchmarking of newly launched products for the first eighteen months of commercial availability, augmented by a quarterly deep dive into promotional activity, barriers to uptake, and patient types gravitating to the launch brand.

Market Dynamix™ is an independent service providing analysis of markets anticipated to experience a paradigm shift within the next three to five years, highlighting market size, current treatment approaches, unmet needs, and expert opinions on the likely disruption introduced by pipeline agents.

RealWorld Dynamix™ is an independent, data-driven service unveiling real patient management patterns through rigorous analysis of large-scale patient chart audits. Insights reveal the “why” behind treatment decisions, include year over year trending to quantify key aspects of market evolution, and integrate specialists’ attitudinal & demographic data to highlight differences between stated and actual treatment patterns.

Learn more about our services here.

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 dermatology, gastroenterology, nephrology, neurology, and rheumatology markets.

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Sources:

1. https://www.lupus.org/resources/lupus-facts-and-statistics
2. https://www.mayoclinic.org/diseases-conditions/lupus-nephritis/symptoms-causes/syc-20354335