Spherix Global Insights' Annual Update of the Psoriasis Switching Market Reveals Significant Gains for Janssen's Tremfya, Much to the Detriment of Sister-Brand Stelara
EXTON, Pa., Nov. 20, 2018
EXTON, Pa. , Nov. 20, 2018 /PRNewswire/ -- Biologic agents with alternate mechanisms of action (MOA) for the treatment of psoriasis are becoming increasingly popular, according to the second annual edition of Spherix Global Insights' biologic/Otezla switching patient chart audit (n=1,006). The majority of collaborating US dermatologists (n=186) agree that they foresee alternative MOA biologic brands moving up as preferred first-line agents to treat psoriasis, anticipate decreasing their use of TNF-inhibitors in favor of alternative MOA brands in the near future, and would prescribe TNF inhibitors less often if managed care were not an issue. Furthermore, the vast majority also report that they have increased their use of biologics overall when treating psoriasis and most commonly attribute this increase to new agents with novel MOAs entering the market. With dermatologists now having excess (and far more efficacious) options for the treatment of psoriasis, it is not surprising the reported annual rate of psoriasis patients switched from one biologic brand or Otezla to another brand is up significantly over the prior year.
Efficacy is the most common trigger for a switch, though the switch patterns differ dramatically depending on whether it was a primary vs. secondary efficacy issue, with other factors, such as patient and payer influence also playing a role. Reasons for new brand choice also vary between classes of treatment. When efficacy in skin clearance is the leading driver behind new brand selection, Tremfya and the IL-17 inhibitors (Novartis' Cosentyx and Eli Lilly's Taltz) benefit the greatest, whereas TNF inhibitors gain when insurance mandates are the primary reason behind new agent selection. The degree to which psoriatic arthritis is present also influences the switch pattern and whether or not a rheumatologist is involved in co-management.
While the established TNF-inhibitors, AbbVie's Humira and Amgen's Enbrel, continue to maintain strong positions as first-line biologic/small molecule psoriasis treatments, the overall rate of patients switching from the TNF class is significantly down from 2017, while switches from IL-17 inhibitors is significantly up. With the majority of switches captured in the audit from a first- to second-line agent, an increase in switches away from IL-17s suggests that Cosentyx and Taltz have made substantial year over year strides in the first-line setting. Conversely, specific agents that patients have switchedto in the current audit have largely remained consistent over 2017, apart from Tremfya capturing significantly more switches than the prior year – much to the detriment of sister brand Stelara (which captured significantly fewer switches than in 2017). In fact, Tremfya now boasts one of the strongest second- and later-line positions regarding psoriasis management, and analysis of 2018 switch patterns reveals that Tremfya has the greatest net gains when switching occurs. The question remains, however, if Tremfya will be able to maintain this edge over the course of the next year with increased in-class competition from Sun Pharma's Ilumya and potentially AbbVie's investigational IL-23 inhibitor, risankizumab.
Celgene's oral PDE4 inhibitor, in line with company reports of increased pre-biologic access to commercially insured patients, has in fact made gains in the first-line setting among audited patients. Specifically, use of Otezla as a first-line/pre-biologic treatment is significantly up over the prior year. Furthermore, the rate of pre-biologic Otezla use substantially grew for patients initiated on their first advanced psoriasis treatment within the past year compared to those initiated one to two years ago, and more than two years ago, underscoring increased pre-biologic brand momentum. Despite these earlier line of therapy gains, it should be noted that Otezla continues to leave a lot on the table, as a clear majority of patients leap-frogged the oral option and went straight to biologic therapy. Additionally, Otezla was only in the running for an incremental 2% of switches, and only 3% of patients are expected to be switched to the PDE4-inhibitor next if their current treatment is unsuccessful, highlighting limited future opportunity and the criticality of capturing patients before they begin biologics for any further brand growth in this increasingly competitive market.
RealWorld Dynamix™: Biologic and Otezla Switching in Psoriasis is an independent report derived from a robust patient audit focused on drivers of treatment switches in the highly dynamic psoriasis market. Unlike claims data, the analysis includes physician assessment, rationale for treatment decisions, and future intended use of drugs, including candidacy for leading pipeline agents. In addition, key variables such as patient engagement level, the influence of the payer, socioeconomic and HR-QOL metrics, co-morbidities, concomitant medications, and test results are also included to provide a comprehensive analysis of the patient journey.
About Spherix Global Insights
Spherix Global Insights is an independent business intelligence and market research company, specializing in renal, autoimmune, neurologic and rare disease markets. Our aim is to apply our commercial experience and unique relationships within core specialty markets to translate data into insight, enabling our clients to make smarter business decisions.
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