Positive Growth of Eli Lilly's Taltz and Stabilization of Novartis' Cosentyx in Psoriasis May be an Indicator for Future Psoriatic Arthritis Market Shift
Cosentyx's first-to-market status in psoriasis, psoriatic arthritis, and ankylosing spondylitis has historically provided the brand with a competitive edge over in-class rival, Taltz, though recent studies conducted by Spherix Global Insights indicate changes are afoot
EXTON, Pa., Oct. 10, 2019 /PRNewswire/ -- Novartis' Cosentyx was first approved by the FDA for the treatment of psoriasis in January 2015, followed by a label extension for both psoriatic arthritis (PsA) and ankylosing spondylitis (AS) a year later – snagging the first-to-market IL-17 inhibitor status in all three markets. With Eli Lilly's IL-17 competitor, Taltz, entering the psoriasis market in March 2016 and the PsA landscape nearly two years later, it became clear that Cosentyx's first-in-class status provided the brand with a competitive edge over the later-market entrant.
However, according to the Q3 2019 report included in Spherix's RealTime Dynamix™: Psoriasis (US) service, biologic brand share for Cosentyx has remained relatively flat over the past three quarters of trending, likely a result of the plethora of agents flooding the psoriasis market over the past few years, namely Janssen's Tremfya, AbbVie's Skyrizi, and Sun Pharma's Ilumya (though Ilumya's contribution has been minimal). An impressive nod to Lilly, Taltz is still managing to boast quarter-over-quarter growth while Cosentyx plateaus in the wake of a rapidly expanding IL-23 class.
Will rheumatologists follow the path being paved by their dermatology counterparts? Taltz is coming up on the two-year anniversary of its PsA approval and rheumatologists are reporting an uptick in use, according to the most recent quarterly report covered in Spherix's RealTime Dynamix™: Psoriatic Arthritis (US) service. Indeed, more rheumatologists surveyed plan to increase their use of Taltz than they do any other agent, including Cosentyx and Pfizer's Xeljanz (which launched in PsA alongside Taltz).
Additionally, future six-month share projections show a significant increase for both Lilly's and Novartis' agents (though the extent of Cosentyx growth pales in comparison to Taltz), while Xeljanz will remain comparatively flat. Amongst this change, flagship TNF-inhibitor brands will continue to dwindle. This shift is particularly interesting as the PsA market readies itself for further disruption with the potential introduction of IL-23 inhibitors in the not-so-distant future. Following a similar timeline of alternate mechanism agent entrance as the psoriasis market, it is quite possible that the same pattern of increased use in Taltz and a flatlining of Cosentyx will be observed in rheumatologists' prescribing behavior for PsA.
Despite these favorable metrics for Taltz, one cannot discount the high level of comfortability that still exists with Novartis' brand and the lack of differentiation that Lilly brings to the table with Taltz. In fact, nearly 45% of surveyed rheumatologists believe Cosentyx possesses an advantage over Taltz from being the first to market, and just over one-third believe both Taltz and Cosentyx to be interchangeable (a figure that has remained relatively stable since launch). Additionally, respondents report 'comfort with other agents' as the second-highest barrier to increased Taltz use, following insurance and cost issues.
Furthermore, only one-fifth of rheumatologists agree they have current Cosentyx patients that they plan to switch to Taltz, indicating a low propensity to cycle brands within the IL-17 inhibitor class and further reinforcing brand loyalty to a treatment with a longer track record in PsA. These self-reported findings are corroborated in Spherix's RealWorld Dynamix™: Biologic/Small Molecule Switching in PsA (US) patient chart audit, which examined 994 PsA patients who were switched from one biologic/small molecule brand to another. Of all patients in the study previously treated with Novartis' IL-17 inhibitor, nearly half were switched to a TNF inhibitor brand, while roughly one-third were switched to Xeljanz or Janssen's Stelara – placing Taltz towards the bottom of the totem pole.
The availability of Xeljanz in PsA and lack thereof in psoriasis will also play a role in the shifting landscape of the PsA market, especially as the IL-23 inhibitors make their way down the pipeline. Pfizer's JAK has had slightly more success in capturing brand share in PsA than Taltz, though (as mentioned above), is not poised for the same magnitude of growth as Lilly's brand. The stunt in Xeljanz growth that has been reported in recent waves of research is partially the result of increased discontinuations – which is not all that surprising as Xeljanz is viewed by rheumatologists as one of the lowest performing brands in overall skin efficacy, a top-rated attribute when prescribers are choosing an agent in PsA.
Indeed, when Xeljanz was under investigation by the FDA for the psoriasis indication, the now black-boxed 10mg BID dose was the leading candidate for use in the skin disease. Pfizer received a Complete Response Letter in 2015 and did not end up pursuing the indication. Luckily for the company, looming safety concerns associated with the 10mg BID dose do not carry over to the approved PsA dose (5mg BID), according to nearly two-thirds of surveyed rheumatologists. In addition, the JAK inhibitor is still touted for its ease of (oral) administration, though, unfortunately for the brand, the influence of this attribute falls far down on the list of importance in agent selection.
In late August, Lilly announced the FDA approval of Taltz for the treatment of adults with active AS, a whopping three and a half years after the introduction of Cosentyx. One aspect that could prove to be an immediate advantage for Taltz is in the approved dosing. While the FDA has approved Taltz for AS at the same maintenance dose as psoriasis and PsA, the approved dosing for Cosentyx in AS is half that of the predecessor indications – an aspect that has proven troublesome for rheumatologists, according to the Q2 2019 report included in Spherix's RealTime Dynamix™: AS and nr-axSpA (US) service. Respondents reported that close to two-thirds of their AS patients prescribed Cosentyx are currently receiving a non-approved 300mg dose, with the majority stating that the 150mg dose was not effective.
Considering positive outcomes for Cosentyx and Taltz in their respective nr-axSpA clinical trials, surveyed rheumatologists anticipate nearly doubling their current off-label use of Cosentyx and increasing their use of Taltz tenfold should they receive the FDA approval; though projected use of Cosentyx still trumps that of Taltz. At the moment, these two agents are largely undifferentiated in terms of clinical measures; however, obtaining the first-in-class position in nr-axSpA with preferential managed care coverage could be the impetus that breaks the tie. In fact, the majority of physicians agree they will prescribe the IL-17 with the best coverage and that the first-to-market agent will have an advantage over the second entrant. Taltz stands the chance to finally beat Cosentyx to market, but it does beg the question, will it be too little, too late?
About RealTime Dynamix™ RealTime Dynamix™: Psoriatic Arthritis (US) is an independent service providing strategic guidance through rapid and comprehensive quarterly reports, which include market trending, launch tracking, and a fresh infusion of unique content with each wave (n=100 US rheumatologists). Parallel services include RealTime Dynamix™: Psoriasis (US), which tracks the evolution of the psoriasis market on a quarterly basis (n=100 US dermatologists) and RealTime Dynamix™: AS and nr-axSpA (US), which tracks the evolving AS landscape on a twice-yearly basis (n=100 US rheumatologists).
About RealWorld Dynamix™ RealWorld Dynamix™: Biologic/Small Molecule Switching in PsA (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.
Spherix was recently recognized by Philadelphia Business Journal as a 2019 Soaring 76 Recipient for the fastest growing companies in the Greater Philadelphia area and by The Philadelphia Inquirer as an Entrepreneurs' Forum 2019 Philadelphia 100® Winner for the fastest growing privately-held companies in the Greater Philadelphia area.