Takeda's Entyvio, Janssen's Stelara, and AbbVie's Humira leave the most on the table when first-line biologic or small molecule agents are prescribed in inflammatory bowel disease
EXTON, Pa., Nov. 30, 2022 /PRNewswire/ -- US gastroenterologists estimate that just under 60% of their ulcerative colitis (UC) and 55% of their Crohn's disease (CD) patients treated with a biologic or small molecule are on their first-line advanced systemic therapy. Over the past eighteen months, the US inflammatory bowel disease (IBD) market has become increasingly competitive with the market entry of BMS' Zeposia and AbbVie's Rinvoq for the treatment of UC and AbbVie's Skyrizi in CD, which have had material changes to new start IBD treatment patterns.
Spherix Global Insights ("Spherix") has been tracking the newly initiated IBD patient segment for the past five years via their RealWorld Dynamix™ service. Data from the 2022 update, which includes analysis of 1,013 charts of IBD patients initiated on a biologic or small molecule therapy for the first time, reveals that TNF inhibitors are substantially less likely to be used first-line compared to prior years, while newer brands with alternative mechanisms of action (AMOA) have become increasingly popular.
When specifically examining UC new starts, Zeposia, a first-in-class S1P receptor modulator, has made substantial inroads as a pre-biologic option, capturing a sizeable portion of first-line patients. Unsurprisingly, the most prominent driver behind Zeposia use is the brand's oral administration, followed by the perceived efficacy and unique MOA.
Uptake of BMS' drug has most directly impacted AbbVie's Humira prescriptions, likely pushing the legacy TNF further back in the treatment algorithm. Of note, however, Zeposia's UC opportunity may be limited to the pre-biologic setting, as patients on the brand have overall less severe disease than those started on biologics, and only 3% of all audited UC patients are slated to receive Zeposia in a second-line switch scenario if their current treatment is ultimately unsuccessful.
First-line use of Takeda's Entyvio and Janssen's Stelara in UC have stabilized after prior year-over-year gains, though Entyvio is now the most widely prescribed first-line brand (due to notable TNF declines). Despite the ability to hold their ground in the face of increasing competition, both AMOA brands are also leaving the most on the table.
Indeed, Spherix's missed opportunity analysis – representing patients for whom the brand was the back-up choice in the event of the current brand not being available – reveals that both agents were in consideration to garner an additional one-fifth of the new start patients but were ultimately passed over. Humira falls third in terms of missed opportunities, though these patients were most commonly placed on an infliximab brand.
Crohn's disease new start patterns have also been altered by the newest CD market entrant, Skyrizi.
With just a few short months on the market, the IL-23 inhibitor has made significant advances in the first-line CD treatment algorithm, with prescribers stating the perceived efficacy and targeted MOA as the top drivers behind use.
Unlike UC, however, Stelara has managed to continue making incremental gains in the first-line Crohn's setting, ultimately surpassing Entyvio use – which is generally flat compared to 2021. Once again, the TNFs, and namely Humira, are bearing the brunt of the increased competition. As such, success of Skyrizi will be paramount for AbbVie's continued gastroenterology strategy as they attempt to brace for the impacts of an already declining Humira share, an FDA label mandating use of Rinvoq in the post-TNF setting, and the entry of adalimumab biosimilars in the not-so-distant future.
Missed opportunities in Crohn's disease mirror those in UC, with Entyvio, Stelara, and Humira being passed over the most frequently. Of note, Skyrizi had the potential to capture nearly 10% more of first-line share, but the vast majority of these patients were ultimately prescribed Stelara.
The IBD patient landscape is poised for future shifts in the new year, as 2023 is likely to bring several additional assets and line extensions into the mix, with Eli Lilly's mirikizumab and Pfizer's etrasimod the most likely novel brands expected to launch.
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.
Spherix Global Insights is a leading provider of market intelligence and advisory services to the global life sciences industry.
The company's unique service offerings are powered by deep therapeutic knowledge, the Spherix Network specialty physician panel, and commercially relevant analyses to enable strategic decision-making by our valued customers.
A trusted advisor and industry thought leader, Spherix Global Insights provides specialized market expertise in six (6) focused therapeutic areas including: dermatology, gastroenterology, nephrology, neurology, rheumatology, and ophthalmology.
Spherix Global Insights Contacts:
Geoff Red, Gastroenterology Franchise Head
Scott Upham, Corporate Communications
SOURCE Spherix Global Insights