As IL-6 inhibitor use in second- or later-line biologic/JAK therapy in RA declines and TNF class share remains flat, the introduction and positive early readout of the third JAK to market bodes well for the JAK inhibitor class.
EXTON, Pa., December 16, 2019 /PRNewswire/ — Spherix examined the charts of 1,021 rheumatoid arthritis (RA) patients recently switched from one biologic/JAK to another agent via the 2019 annual RealWorld Dynamix™: Biologic/JAK Switching in Rheumatoid Arthritis (US) service. The patient chart analysis revealed that TNF inhibitor cycling remains the most common switch pattern among RA patients, though has leveled off over the past year after steady decreases since 2016. Nevertheless, the percent of patients being switched from one TNF inhibitor to another drops with each line of biologic/JAK therapy, as rheumatologists are more inclined to prescribe an alternate mechanism agent in the second- or later-line setting.
While the percent of patients being switched to a TNF inhibitor stands unchanged from the prior year, switches to JAK inhibitors have increased in popularity – likely at the expense of the IL-6 inhibitor class, which had been experiencing year over year gains in the switch-to segment up until the current year (reverting back to figures reported in 2016). When looking at the net change between switches to and switches from, Pfizer’s Xeljanz shows the largest net increase, followed by UCB’s Cimzia (the only TNF inhibitor to show positive net change).
Although switches to IL-6 inhibitors (Genentech’s Actemra and Regeneron/Sanofi’s Kevzara) are down, the percent of patients being switched from those agents is low, allowing for overall net growth of the class – whereas the percent of patients being switched from TNF inhibitors far outweigh the switches to these agents (with the exception of Cimzia), explaining why big name brands such as AbbVie’s Humira, Amgen’s Enbrel, and Janssen’s Remicade continue to suffer in the RA switch market.
When specifically looking at second-line share in the RA switch market, the JAK class has grown over the previous year, while the IL-6 class has decreased by nearly the same percent. The launch of AbbVie’s JAK inhibitor and most recent RA market entrant, Rinvoq (upadacitinib), will likely help boost share of the JAK inhibitor class in later lines of therapy by capturing additional switches that might have gone to a TNF or IL-6 inhibitor (while also inevitably cannibalizing share from the other JAK inhibitors).
Just prior to the launch of Rinvoq, rheumatologists were asked which of their current switched patients would have been placed on AbbVie’s JAK (among other pipeline agents) had it been available. Of those, 40% were ultimately placed on a TNF inhibitor, while less than one-third were placed on Xeljanz or Eli Lilly’s JAK inhibitor, Olumiant – indicating that the introduction of Rinvoq will, again, take share from its in-class competitors, but also increase overall share of the class by capturing a significant amount of share from the TNFs.
The latest quarterly report included in Spherix’s RealTime Dynamix™: Rheumatoid Arthritis (US) service indicates that US rheumatologists are not being shy with their uptake of the new JAK; nearly half of respondents (n=100) have trialed Rinvoq in at least one of their RA patients since its launch (data collected roughly three months post-launch). By comparison, Olumiant and Kevzara garnered a user-base of only 4% and 25%, respectively, at a similar time period post-launch.
Analysis of recent prescription share and future six-month projections reveal encouraging signals for AbbVie’s new brand, which is expected to benefit from the largest share increase over the next six months. Other brands anticipated to grow include Kevzara and Olumiant (though to a much lesser extent), while Xeljanz remains relatively flat.
With Rinvoq out of the pipeline picture, rheumatologists are more likely to prefer Gilead/Galapagos’ filgotinib (JAK) and Merck’s evobrutinib (BTK) over other developmental agents. Filgotinib is generally selected due to a higher level of familiarity and is the only agent respondents expect to become a first-line treatment; evobrutinib is most commonly preferred due to its novel mechanism of action. Participating rheumatologists also express the highest desire for a new RA agent that comes with a biomarker to predict likelihood of response. A preference for an oral formulation is down substantially from a year ago, likely the cause of the two most recent market entrants being oral JAKs and a fourth on its way.
Spherix will continue to track the launch of Rinvoq over the next year.
About RealWorld Dynamix™
RealWorld Dynamix™: Biologic/JAK Switching in Rheumatoid Arthritis (US) is an independent, data-driven service unmasking real patient management patterns through annual reports based on chart audits of ~1,000 patients switched from one biologic/JAK to another agent within the previous three months. 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. The 2019 report is the fourth edition of this study.
About RealTime Dynamix™
RealTime Dynamix™: Rheumatoid Arthritis (US) is an independent service providing strategic guidance through rapid and comprehensive quarterly reports, which include market trending, launch tracking, and a fresh infusion of unique content with each wave. The Q4 2019 report is the 17th wave of the report series included in the service.
Parallel EU5 services include RealWorld Dynamix™: Biologic/JAK Switching in Rheumatoid Arthritis (EU) (n=~1,250 EU5 patient charts) and RealTime Dynamix™: Rheumatoid Arthritis (EU) (n=~250 EU5 rheumatologists).
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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