EXTON, Pa., June 23, 2020 /PRNewswire/ -- Spherix recently published the inaugural report of the semiannual report series included in their RealTime Dynamix™: Psoriatic Arthritis (EU) service, which captured the responses of 246 EU5 rheumatologists surveyed last month. The market intelligence firm has been closely tracking the US psoriatic arthritis (PsA) market on a quarterly basis since 2016 and has observed a relatively stagnant treatment landscape over the past few years. However, the possible introduction of Janssen's IL-23 inhibitor, Tremfya, to both the EU and US PsA markets before the year is over will carry with it the debut of a novel class to the indication, likely causing a stir in rheumatologists' treatment algorithm.
According to the new Spherix report, TNF inhibitor use for the treatment of PsA across the EU5 remains widespread, accounting for two-thirds of all biologic/small molecule-treated patients. For adalimumab, etanercept and infliximab, use is relatively split between biosimilars and the branded reference agent (AbbVie's Humira, Amgen's Enbrel, and Janssen's Remicade, respectively), though use of Enbrel has been most eroded by generic competition.
When looking at use of alternate mechanism of action (AMOA) agents, Novartis' Cosentyx is the most penetrated brand across the EU5, showcasing the highest user base and self-reported brand share among all AMOA agents, followed by Janssen's Stelara. Eli Lilly's second-in-class IL-17 inhibitor, Taltz, has yet to reach the same heights as Cosentyx, and EU5 rheumatologists most often cite their level of experience as the key differentiator between the two agents. This, coupled with the fact that only one-quarter of respondents believe the two IL-17 inhibitors to be completely interchangeable, suggests that Taltz has ample room to grow (given more experience with the brand).
In fact, when assessing rheumatologists' six-month projected biologic/small molecule brand share in PsA, Taltz and Pfizer's Xeljanz are poised for the greatest growth. While Xeljanz is currently even-keeled with Taltz, Lilly's agent is expected to outgrow Pfizer's in the coming months, with anticipated share of Taltz expected to nearly double.
Despite the advantage of oral administration and a unique MOA in the EU PsA market, Xeljanz is struggling to surpass rheumatologists' expectations, and the majority of use is seen in second or later lines of therapy. Just shy of two years post EMA approval, respondents report long-term safety concerns as the most common primary barrier to use for the JAK inhibitor.
Interestingly, Spherix data included in a complementary service reveals EU5 rheumatologists' noticeable preference for Lilly's Olumiant over Xeljanz for the treatment of rheumatoid arthritis, and respondents perceive Olumiant's JAK 1/2 pathway to be the safest option regarding cardiovascular side effects. This is likely a contributing factor – in addition to a longer tenure and multiple EMA-approved dosing options in RA – to the slower anticipated uptake of Xeljanz in the EU5 PsA market, as prescribers may see the TNF or IL-17 inhibitors as more viable options concerning both safety and efficacy.
Nonetheless, Tremfya (guselkumab), which is in Phase 3 clinical trials for treatment in PsA, is currently under EMA review for EU approval. The introduction of the IL-23 inhibitor will be the first of its class and is expected to throw a curve in rheumatologists' current trajectories. Surveyed rheumatologists also provided six-month projected use patterns considering the commercialization of Tremfya in PsA, and respondents estimate the new entrant will capture a sizeable portion of the market.
As a result, in a post-Tremfya world, EU5 rheumatologists predict continued erosion of the TNF inhibitors and a significant reduction in the projected growth for Taltz and Xeljanz. Cosentyx share is also slated to decrease while Stelara and BMS' Orencia remain relatively stable. One-quarter of surveyed respondents consider Tremfya to be an advance over other treatments, and the majority cite "efficacy in skin/use in psoriasis" as the greatest advantage of the IL-23 class. On the other hand, perceived efficacy of the IL-23 inhibitors could also contribute to lackluster penetration of the class, as overall efficacy was also the number one disadvantage reported by rheumatologists, likely referring to unknown performance in joints for the treatment of PsA.
That is where other late-stage pipeline assets come in and set the stage for an even more dynamic future treatment landscape. Earlier this month, AbbVie announced the EMA regulatory application submission for their JAK inhibitor, Rinvoq (upadacitinib), for the treatment of PsA. While the JAK will likely come second to the Tremfya launch and will not bring with it the introduction of a novel class, early uptake and encouraging efficacy perceptions of Rinvoq for the treatment RA will likely translate to greater use in PsA (granted looming safety concerns surrounding the class do not prevail).
About RealTime Dynamix™
RealTime Dynamix™: Psoriatic Arthritis (EU) is an independent service providing strategic guidance through rapid and comprehensive semiannual reports, which include market trending, launch tracking, and a fresh infusion of unique content with each wave.
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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SOURCE Spherix Global Insights