In the most recent quarterly update of RealTime Dynamix Psoriatic Arthritis, a growing population of US rheumatologists (n=101) are reporting use of Novartis’ (NOVN: VX) Cosentyx (secukinumab) to treat their patients with psoriatic arthritis (PsA).
Nonetheless, according to the report from market intelligence agency Spherix, this increasing user base has not translated into overall increases in biologic share. Furthermore, in second-quarter 2016, rheumatologists anticipated doubling their Cosentyx share over the subsequent six month period, a projection that panned out and was fully realized in practice. However, since the end of 2016, rheumatologists have continued to forecast positive Cosentyx growth, but have failed to see those projections through.
The majority of rheumatologists indicate that “ideal” Cosentyx patients have previously failed at least one TNF agent, a group representing nearly half of all biologic-treated PsA patients, so what is at the source of Cosentyx’ apparent plateau? Just under one-third of rheumatologists report high satisfaction with the interleukin (IL)-17 inhibitor, a lower percent compared to the leading TNF agents and Johnson & Johnson’s (NYSE: JNJ) Stelara (ustekinumab). Furthermore, despite Cosentyx’ association with strong efficacy in skin clearance, more rheumatologists prefer AbbVie’s (NYSE: ABBV) Humira (adalimumab) over Cosentyx for patients with severe psoriasis. Finally, use of Cosentyx continues to be hampered by rheumatologists’ perceptions of inferior market access compared to more established biologic brands.
Pressure ahead from PsA agents in pipeline
Additional pressure on Cosentyx is ahead in the form of pipeline PsA agents which will offer even more options for non-TNF treatment. Among those is the second IL-17 inhibitor, Eli Lilly’s Taltz (ixekizumab). Although nearly one-third of respondents see Cosentyx’ first-to-market status as a significant advantage over Taltz, over the past year there has been a significant increase in Taltz familiarity and a growing percentage of rheumatologists anticipate routine use of Taltz once approved.
Taltz is expected to have a competitive position in the PsA treatment paradigm if available, however, most rheumatologists agree that there is a higher unmet need for new, oral, small molecule agents for PsA than for any additional alternate MOA biologics. Indeed, when asked directly which agent they would most like to see gain the PsA indication, 61% selected a JAK inhibitor, such as Pfizer’s (NYSE: PFE) Xeljanz(tofacitinib citrate), whereas the remaining respondents were split between Bristol-Myers Squibb’s (NYSE: BMY) Orencia (abatacept) , an additional IL-17 such as Taltz, and an IL-23 inhibitor.
According to RealWorld Dynamix: Biologic and Otezla Switching in PsA, which evaluated over 1,000 PsA patients recently switched from one biologic or Otezla to a different brand, Xeljanz has already captured 2% of the switch population and one in five recently switched patients are considered by the treating rheumatologist to be good candidates for future treatment with Xeljanz.