US Rheumatologists Teed Up for Rapid Adoption of BMS' Orencia in Psoriatic Arthritis, Though the Real Game Changer Could Come with the Approval of Pfizer's Xeljanz

EXTON, Pa., Oct. 20, 2017 /PRNewswire/ -- At approximately three months post-launch, one-third of sampled rheumatologists (n=102) report use of Orencia for the treatment of psoriatic arthritis (PsA), a figure that is expected to climb to nearly 90% over the next six months.  Rapid adoption of Orencia can be attributed to rheumatologists' substantial post-marketing experience with the brand in rheumatoid arthritis (RA), flexible subcutaneous and intravenous dosing options, proven safety, and unique t-cell co-stimulation modulating mechanism of action (MOA).  Though Orencia's joint efficacy is well understood based on ample experience in RA, rheumatologists are a little more skeptical about how Orencia will perform with regard to skin clearance, and also comment that the brand tends to be "slow to action" for initiating a response.  Despite these concerns, future six month projections estimate that Orencia could capture as much as 7% of the PsA biologics market in 2018. 

Though rheumatologists now have more alternative MOA options for the treatment of PsA than ever before, in the form of Novartis' Cosentyx and now Orencia, they are still eagerly awaiting the likely addition of Xeljanz. Indeed, nearly all rheumatologists view Xeljanz as an advance in PsA, while one-quarter report that they even have PsA patients that are "waiting in the wings" for the JAK to gain FDA approval.  Akin to Orencia, Xeljanz will reap the same benefit of existing physician familiarity and comfort with the brand based on experience and use in RA. Furthermore, rheumatologists are increasingly more comfortable with Xeljanz's risk-benefit ratio and most report that access for Xeljanz in RA has improved over the past year.

The introduction of a second oral small molecule could spell trouble for Celgene's Otezla, a brand that after over three years on the market, continues to struggle with access and insurance coverage, as well as securing – and then maintaining -  a strong position in the PsA treatment algorithm.  Insurance coverage is consistently cited as a leading barrier to Otezla use and half of the surveyed rheumatologists believe that payer policies discourage their use of the oral PDE4 inhibitor.  Furthermore, less than one-quarter agree that access for Otezla has improved over the past year.  Otezla also grapples with perceptions of inferior efficacy compared to biologic agents, with less than half of the patients currently on the drug considered "well-managed" by their rheumatologist.  This pool of patients presents low-hanging fruit for Xeljanz given that a large percentage of the patients on Otezla were placed on the drug due to patient request and preference for its oral formulation.  A parallel study in RA confirms that Xeljanz is the most requested brand and rheumatologists report Pfizer's DTC campaign is the most influential.

Another game-changing event potentially on the PsA horizon is the likely introduction of a second IL-17 inhibitor.  Eli Lilly recently reported that they anticipate an FDA decision on their Supplemental Biologics License Application for Taltz by the end of the year. As the only approved IL-17 inhibitor in PsA, Novartis' Cosentyx has enjoyed strong uptake in PsA with 95% of rheumatologists now prescribing the drug and a steady share gain over the past several quarters.  Though over one-third of the rheumatologists believe Cosentyx's status as the first IL-17 to the PsA market gives the brand a significant advantage over Taltz, it remains to be seen whether Taltz will help expand the IL-17 pool, whether it will split the IL-17 spoils with Cosentyx or whether Cosentyx can maintain its position as a growth brand in PsA.

RealTime Dynamix™: Psoriatic Arthritis, is an independent report series published on a quarterly basis.  The series tracks the evolution of the PsA market, provides a deep dive on launch effectiveness, and highlights opportunities for pipeline agents.  The next wave of research will be fielded in November 2017.

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