Analysis of 1,025 recently switched PsA patients reveals second- or later-line usage of IL-17, IL-23, and JAK inhibitors growing in popularity.
Exton PA, October 3, 2023 — US rheumatologists (n=204) report nearly two-thirds of their psoriatic arthritis (PsA) patients are undergoing treatment with advanced systemic therapies. What’s more, one-third of these patients have switched therapies within the past year. This results in a substantial patient population, with each physician handling an average of forty or more patients who switch their treatment on an annual basis.
Spherix Global Insights recently published its eighth annual Patient Chart Dynamix™: Triggers and Drivers in Psoriatic Arthritis, (previously RealWorld Dynamix: Switching in Psoriatic Arthritis). This comprehensive study aims to unveil the evolving patterns in treatment switches, the underlying reasons for these changes, the rationale behind the selection of new brands, and a thorough evaluation of untapped opportunities within the market landscape.
When analyzing data from 1,025 PsA patient charts provided by prescribers, it was observed that Tumor Necrosis Factor inhibitors (TNFs), largely AbbVie’s Humira and to a lesser extent Amgen’s Enbrel, continue to hold the primary position as the preferred initial advanced treatment option among rheumatologists. This preference can be attributed, in part, to payer requirements and the enduring legacy of success associated with this longstanding class of medications. Patients receiving TNFs are also provided an ample period of treatment in the first-line setting before considering a switch to an alternative therapy. In a distant second place to TNFs, Amgen’s Otezla emerges as the second-most utilized first-line treatment; however, it’s worth noting that Otezla patients tend to transition to other treatments at a pace approximately twice as fast as those on TNFs. Irrespective of the specific first-line brand/class prescribed, PsA patients predominantly undergo treatment switches primarily due to efficacy concerns, with suboptimal response for arthritis being the most common reason cited.
Just seven years ago, the process of TNF cycling constituted more than half of the recent switches analyzed in Spherix’s PsA patient chart audits; however, TNF cycling has steadily declined on an annual basis and has now reached its lowest recorded rate. Conversely, there is a rising trend in the transition to agents with alternative mechanisms of action (AMOA). This transition is occurring not only from TNFs but also increasingly from other AMOAs. Specifically, after experiencing a two-year decline, there has been a resurgence in the switch share positioning of IL-17s, with a particular focus on Novartis’ Cosentyx and, to a lesser extent, Eli Lilly’s Taltz. Notably, Cosentyx stands out as the leading brand, attracting the highest number of switched patients among all currently approved advanced systemic treatments. JAK inhibitors, with AbbVie’s Rinvoq and, to a considerably lesser extent, Pfizer’s Xeljanz, along with the IL-23 inhibitors, represented by AbbVie’s Skyrizi and Janssen/Johnson & Johnson Innovative Medicine’s Tremfya, have also achieved record-high switch shares in the 2023 assessment. It’s worth highlighting that these latter medications have not reached the same level of popularity in the second-line and beyond setting as the IL-17s.
In general, the selection of PsA brands for second-line and subsequent treatments is primarily influenced by favorable perceptions of the new agent’s efficacy, particularly in terms of joint effectiveness. Another significant factor driving these choices is the desire for a different mechanism of action, along with considerations related to perceived safety and tolerability. Patient requests for specific treatments also play a key role in PsA brand selection. In more than half of the cases where patients have requested a change in their treatment, they specifically asked for the new agent, underscoring the considerable influence of patients advocating for a medication they believe will be beneficial for their condition.
The study also captured opportunity (or “missed”) share for each agent, representing patients for whom the brand was the back-up choice in the event of the current brand not being available. This analysis revealed that while the IL-17s perform well in PsA switching, Cosentyx and Taltz also lost the most opportunity for capturing switch share. In essence, they were frequently considered but ultimately bypassed in favor of different brands.
Interestingly, most patients would have been switched to another agent within the same MOA class if their current agent hadn’t been available. This suggests highly competitive inter-class dynamics and largely solidified MOA-level treatment algorithms amongst prescribers. One exception to this phenomenon is Otezla, where if the PDE-4 inhibitor had not been available, the next likely contender was much more varied.
Patient Chart 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 and demographic data, connecting trends at the patient level to the prescribing physicians.
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