As AbbVie seeks a matching subcutaneous option for Skyrizi, J&J’s response to a narrowing advantage previews the differentiation challenge facing TL1A manufacturers entering Crohn’s disease.
By: Lisa Fendrick, Insights Director II, Gastroenterology and Jim Hickey, Franchise Head, Gastroenterology and Obesity
Interleukin-23 (IL-23) inhibitors have established a strong class identity in Crohn’s disease around efficacy and safety, but individual brands still need a distinct reason to be selected. In Spherix Global Insights’ RealTime Dynamix™: Crohn’s Disease Q3 2026 research, most surveyed gastroenterologists did not view Skyrizi, Tremfya, and Omvoh as clinically equivalent. For manufacturers, the commercial challenge is to establish a meaningful point of difference and sustain it as competitors expand their evidence and treatment options.
Skyrizi (risankizumab, AbbVie) entered the Crohn’s disease market first in 2022, with its position reinforced by SEQUENCE data, AbbVie’s established inflammatory bowel disease (IBD) presence, and a strong sales force. Lilly’s Omvoh (mirikizumab) and Johnson & Johnson’s (J&J’s) Tremfya (guselkumab) followed in early 2025 – Omvoh in January, Tremfya in March. Omvoh’s emphasis on bowel urgency brought Lilly into a new therapeutic space against established IBD competitors. Gastroenterologists also report less frequent contact with Lilly representatives than with those from AbbVie and J&J, adding a commercial challenge to establishing the brand. Tremfya has gained use and preference share through subcutaneous (SC) induction and substantial patient-access investment. With AbbVie seeking approval for SC Skyrizi induction (filed with the FDA in April 2026), however, Tremfya’s clearest distinction may become less exclusive. J&J’s need to prepare for that possibility offers a relevant lesson for TL1A (TNF-like ligand 1A) manufacturers approaching the market.
Subcutaneous induction supports early Tremfya adoption
Tremfya’s growth demonstrates the value of a clear brand distinction. Its share of biologic- and JAK-treated Crohn’s patients in the Spherix study has increased substantially from one year earlier. The brand also accounts for a meaningful share of recent advanced-therapy prescriptions and has emerged as the most preferred first-line option among surveyed gastroenterologists.
SC induction was the leading reason physicians would choose Tremfya over Skyrizi, ahead of efficacy expectations and access considerations. This finding identifies the main source of Tremfya’s early differentiation while highlighting J&J’s exposure if a competitor offers the same administration option.
A matched administration option changes the basis of competition
An SC Skyrizi induction option would not necessarily reverse Tremfya’s progress. Physician responses were divided between greater likelihood of choosing Skyrizi and no expected change. Tremfya therefore appears to have established value beyond administration, but the findings also indicate that matching this option could influence treatment selection for a substantial group of physicians.
J&J’s immediate commercial need is to sustain Tremfya’s momentum while establishing an additional reason to choose the brand. Administration should remain part of its positioning, particularly for patients and practices that value rapid initiation and self-administration. A broader proposition will become more important if the available options converge.
Fistula evidence creates an opportunity for physician education
Tremfya’s Phase 3 FUZION data – combined fistula remission in roughly one-quarter of treated patients at Week 24, versus about one in ten on placebo, a statistically significant difference – offer a potential point of clinical distinction in a population where physicians identify substantial unmet need. Most surveyed gastroenterologists were familiar with the findings presented at Digestive Disease Week in May 2026, indicating that the evidence has reached its intended clinical audience.
Awareness has not yet translated into a change in the preferred treatment. Infliximab remained the clear first choice for perianal fistulizing Crohn’s disease, with substantially fewer physicians selecting Tremfya. This gap defines J&J’s unmet commercial need. Physician education, sequencing guidance, and continued evidence development could help gastroenterologists understand how the findings may inform treatment selection. The opportunity is to connect awareness of the evidence with confidence in choosing Tremfya for appropriate patients.
Commercial infrastructure reinforces clinical differentiation
The IL-23 experience shows that clinical messaging is one part of differentiation, alongside first-to-market advantages and IBD-specific commercial infrastructure. Skyrizi benefits from AbbVie’s established presence, while Tremfya’s administration profile is supported by J&J’s field execution and patient-access services. These include one-day access for qualified patients through TremfyaWithMe, illustrating how practical support can reinforce the treatment proposition.
AbbVie and J&J representatives each reached a substantial majority of surveyed gastroenterologists during the previous month. Recent prescribing for Skyrizi and Tremfya was higher among physicians contacted by a representative, although this association does not establish causation. For manufacturers, the implication is that clinical evidence, administration, field-force quality, access services, and patient support need to reinforce one another. A distinct clinical message alone may be insufficient to establish sustained preference and use.
TL1A manufacturers face a similar differentiation challenge
These findings are relevant to late-stage TL1A manufacturers as fibrosis and disease modification emerge as potential defining attributes of the class. An overwhelming majority of surveyed gastroenterologists said the potential to prevent or reverse intestinal fibrosis would increase the long-term value of a TL1A-targeted therapy. Physicians identified the greatest incremental opportunity in progressive or fibrotic Crohn’s disease and in patients refractory to multiple biologics.
Strong interest in these outcomes may support the class without distinguishing individual assets. If tulisokibart (Merck), afimkibart (Roche), and duvakitug (Sanofi and Teva) develop similar fibrosis profiles, each manufacturer will need to establish additional reasons to select its therapy. Duvakitug’s SC administration may offer an initial distinction, but the Tremfya experience illustrates why an administration advantage needs support from broader evidence and commercial capabilities.
TL1A manufacturers will need to connect class-level interest with evidence specific to their therapies. Outcomes in defined patient populations, the strength and durability of fibrosis data, administration, and long-term safety could each influence positioning. Physician education, access, and patient services will also shape how that positioning translates into practice. Addressing these questions before launch can help manufacturers establish a clearer role for their assets as the class develops.
Planning for the next point of difference starts early
For J&J, the priority is to translate perianal fistula evidence into a clearer clinical role for Tremfya while maintaining the administration and access support contributing to adoption. For TL1A manufacturers, the priority is to identify which evidence and capabilities will distinguish individual therapies if fibrosis becomes a shared class attribute.
Spherix’s findings underscore the need to evaluate differentiation over time. Manufacturers should track whether physicians recognize a brand’s distinction, whether that distinction influences prescribing, and how readily competitors could match it. Those insights can guide evidence development, physician education, and commercial investment before an early advantage narrows.
Source: Spherix Global Insights, RealTime Dynamix™: Crohn’s Disease (US), Q3 2026. Findings are based on an online survey of 98 U.S. gastroenterologists fielded July 27 through August 5, 2026.