The US psoriasis landscape has come a long way since the first introduction of an alternate mechanism of action agent in a previously TNF-dominant market; IL-23 inhibitors are now in the spotlight
EXTON, Pa., July 25, 2019 /PRNewswire/ — Spherix began tracking the US psoriasis market through its RealTime Dynamix™: Psoriasis (US) service in early 2016, just one year following the launch of Novartis’ Cosentyx. The 2015 FDA approval of the first IL-17 inhibitor to enter the field ushered in an era of unprecedented efficacy for the management of psoriasis. With Eli Lilly’s Taltz and Ortho Dermatologics’ Siliq launching shortly thereafter, the introduction of IL-17s would soon initiate a paradigm shift for psoriasis treatment standards. Fast forward to 2017, where the approval of Janssen’s IL-23 inhibitor, Tremfya, opened the door to Sun Pharma’s Ilumya and AbbVie’s Skyrizi and set the stage for a battle of the alternate mechanism of action (MOA) classes.
Brand share for TNF inhibitors, AbbVie’s Humira and Amgen’s Enbrel, as well as Janssen’s IL-12/23 inhibitor, Stelara, has steadily declined over the past few years as alternate MOA agents continue to flood the psoriasis market and are increasingly seen as more efficacious. The IL-17s have without a doubt made a name for themselves in the psoriasis market; the Q2 2019 update revealed that Cosentyx’s brand share among biologic-treated patients has matched that of Stelara’s for the first time. However, don’t count Janssen out, as rising share of Tremfya is not far behind and already matches that of Enbrel in the current quarter. When specifically comparing the IL-17 and IL-23 classes, dermatologists reported that the IL-23 inhibitors are perceived as performing better on a number of metrics, including dosing intervals, efficacy in skin, and sustained response, while the lack of a PsA indication results in the IL-17 inhibitors outperforming on efficacy in arthritis.
Regarding the most recent psoriasis launch, Skyrizi is off to a positive start, with nearly one-fifth of respondents already reporting use of the agent. All current users anticipate prescribing the IL-23 inhibitor to additional patients in the next three months, and every non-user intends to prescribe the agent at some point over the next year. The early success can (in part) be attributed to Skyrizi’s convenient dosing schedule, as over half of respondents agreed that it is an advantage over Tremfya. Also, given that Ilumya is the second IL-23 to market and requires administration by a healthcare professional, the excitement surrounding Skyrizi is likely going to impede on Ilumya’s growth. In fact, if limited to just one IL-23 inhibitor, surveyed dermatologists chose Skyrizi over Ilumya two to one, though the bulk still prefer Tremfya.
Spherix’s RealWorld Dynamix™: Biologic/Otezla New Starts in Psoriasis (US) is a complementary service to the quarterly market tracker and includes access to a large-scale chart audit of ~1,000 patients newly initiated on a biologic/Otezla. According to the 2019 annual audit, Tremfya was the only agent to make significant first-line gains from the prior year. This may bode well for AbbVie as they try to regain market share with Skyrizi in the new start population following the trail already blazed by earlier IL-23 entrants and as they prepare for Humira’s patent expiry in the not-so-distant future.
The study also captured opportunity (or “missed”) share for each agent, representing patients for whom the brand was the back-up choice in the event of the current brand not being available. In this case, Tremfya was the back-up brand in nearly 20% of new start patients, followed closely behind by Humira, Taltz, and Cosentyx. Interestingly, in most instances where an alternate MOA agent was the runner-up, they ultimately lost out on that share to patients being started on Humira (rather than another alternate MOA agent). So, despite these newer agents making significant strides over TNF inhibitors, Humira is still well entrenched in the first-line setting, accounting for over one-fifth of newly initiated psoriasis patients, a figure down (but not significantly) from the previous year.
Reasons for brand selection are relatively unchanged year over year, with efficacy in skin clearance remaining the top driver for brand choice in the new start population. With several key psoriasis brands also holding a psoriatic arthritis indication, and others working towards that label expansion, efficacy in both skin and joints has nearly doubled as a primary driver of brand choice over the past year, giving an edge to the IL-17 inhibitors over the IL-23s. Furthermore, when dual efficacy was a driver for brand selection, it disproportionately impacted new start share on the IL-17s and TNFs, a hurdle the IL-23 class will have to overcome.
With an ever-expanding and increasingly competitive psoriasis market, it is imperative that in-line brands and assets with near term plans to enter the space find a way to differentiate themselves. Spherix Global Insights will continue to track the launch of Skyrizi and the overall evolution of the market, with the Q3 2019 report included in RealTime Dynamix™: Psoriasis (US) fielding next month.
About RealTime Dynamix™
RealTime Dynamix™: Psoriasis (US) is an independent service providing strategic guidance through rapid and comprehensive quarterly reports, which include psoriasis market trending, launch tracking, and a fresh infusion of unique content with each wave. The 14th wave of this US study will field in August 2019 and will continue to track the launch of Skyrizi, Ilumya, and Cimzia. The second bi-annual wave included in a parallel service tracking the evolution of the European psoriasis market, RealTime Dynamix™: Psoriasis (EU), publishes next week (n=250 dermatologists per wave).
About RealWorld Dynamix™
RealWorld Dynamix™: Biologic/Otezla New Starts in Psoriasis (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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