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US Rheumatologists' Early Views on Eli Lilly's Olumiant for the Treatment of Rheumatoid Arthritis Show Uphill Battle, While Pfizer's Xeljanz Holds Ground as the Preferred JAK Inhibitor

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US Rheumatologists' Early Views on Eli Lilly's Olumiant for the Treatment of Rheumatoid Arthritis Show Uphill Battle, While Pfizer's Xeljanz Holds Ground as the Preferred JAK Inhibitor

The introduction of Olumiant after lengthy delays means Sanofi/Regeneron's Kevzara is no longer the "new kid on the block" and has recently boasted significant growth.

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EXTON, Pa., Aug. 20, 2018 /PRNewswire/ -- Spherix Global Insights' third quarter update of RealTime Dynamix™: Rheumatoid Arthritis (US) captured initial insights on Eli Lilly's long-awaited launch of Olumiant (baricitinib).  While three-quarters of rheumatologists (n=99) are aware of the newest JAK inhibitor's approval for the treatment of rheumatoid arthritis (RA), even fewer say they are familiar with it.  Furthermore, as of mid-July, only a small handful have actual experience prescribing the agent, and less than half of respondents plan to start prescribing it in the next three months. While lack of familiarity with Olumiant, newness to market, and lack of coverage hinder the brand's uptake, an important subset of rheumatologists express high concern in regards to safety and side effects, as well as the lack of an approved 4mg dose, due largely to the high risk of venous thromboembolic events. 

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Olumiant's potential appears more muddled when put in context with Xeljanz: rheumatologists are fairly split on the interchangeability of both JAKs, though half view Xeljanz's first-to-market status as an advantage over Olumiant. Unlike Xeljanz, Olumiant's label also carries an additional burden of required TNF-inhibitor failure, an aspect impacting the majority of respondents' willingness to prescribe Lilly's JAK in the future.

However, the brand may find some reprieve in the publicized lower price point, which is advertised at a 60% discount to leading TNF brands and thus roughly half that of Xeljanz.  Indeed, half of collaborating physicians agree that Olumiant's significant discount will lead them to prescribe it prior to Xeljanz unless the patient is contraindicated in some way; though the other half are less convinced, and with good reason.  As anyone familiar with the biologic approval process knows, a lower cost on paper does not always translate to a better access position and it will be up to Lilly to ensure their favorable ticket price translates to a beneficial status among payers.

With Olumiant now filling the "new kid" seat on the RA bus, use of Kevzara is finally experiencing an uptick in adoption.  At just over one-year post-launch, the Kevzara user-base has significantly grown to over 60%, resulting in significant share gains quarter over quarter.  Furthermore, estimates for future use reveal that approximately half of rheumatologists expect to initiate more patients on Kevzara over the next three months.

Kevzara representative recent contact rates have increased quarter over quarter throughout 2018, with over half of the respondents currently reporting contact within the past month, a figure that mirrors what is reported for Roche/Genentech's Actemra. Representative contact remains the main channel for communication between manufacturer and prescribers, and over half of rheumatologists say they currently know more about Kevzara than they did three months ago.  The connection between increased adoption and sales contact cannot be denied, as those who have been detailed by a Kevzara representative are significantly more likely to be current users of the brand compared to those who have yet to see a Sanofi/Regeneron representative.

Despite more flexible dosing options, an easy-to-use autoinjector pen, a perceived cost advantage, and a fully humanized formulation, increased Kevzara use continues to be stifled by access and cost issues, as well as a higher level of comfort with other treatment options, specifically Actemra. Despite this, more rheumatologists now consider Kevzara to be a great option for methotrexate-intolerant patients.

With exception to the slow but steady adoption of these two new market entrants, the overall RA landscape has remained relatively stable.  The introduction of biosimilars had the potential to shake up the TNF scene (which still largely dominates first-line biologic/small molecule treatment), however, only two infliximab biosimilars have been successful at launching in the US market to date: Pfizer/Celltrion's Inflectra (launched November 2016), and Samsung Bioepis/Merck's Renflexis (launched July 2017).  While these agents have continuously eroded share for Janssen's branded Remicade (with Inflectra taking much more of a bite than Renflexis), it appears their introduction has had the unintended consequence of significantly decreasing use of infliximab on the whole, with further significant declines projected over the next six months.  Though it is unlikely that additional biosimilars will be introduced as US RA treatments in the remainder of 2018, Sandoz's Erelzi (biosimilar to Amgen's branded Enbrel) will likely be the next to debut and Sandoz will be charged with ensuring growth, or at a minimum, stabilization of etanercept use for the treatment of RA.

Other aspects that will impact the US landscape include the evolving RA pipeline.  When queried specifically on what exactly a new agent could provide to disrupt the RA market, about one-third of rheumatologists mention new mechanisms of action, oral formulations, and predictive biomarkers for efficacy. Despite relatively low familiarity for phase three agents, more respondents venture to say they anticipate Merck Serono's evobrutinib and AstraZeneca's mavrilimumab will have a greater potential than what could be the possible third and fourth JAK inhibitors, AbbVie's upadacitinib and Gilead's filgotinib.

About RealTime Dynamix™: Rheumatoid Arthritis
The next wave of this study, RealTime Dynamix™ Rheumatoid Arthritis (US), will field in November 2018  and will continue to track the launch of Olumiant and Kevzara, uptake of biosimilars, as well as the overall evolving US RA market.  The second annual wave of a parallel study tracking the evolution of the European RA market will publish at the end of December 2018.

About Spherix Global Insights
Spherix Global Insights is an independent business intelligence and market research company, specializing in renal, autoimmune, neurologic and rare disease markets. Our aim is to apply our commercial experience and unique relationships within core specialty markets to translate data into insight, enabling our clients to make smarter business decisions.

All company, brand or product names in this document are trademarks of their respective holders.

For more information contact:
Lynn Price, Immunology Franchise Head
Email: info@spherixglobalinsights.com
www.spherixglobalinsights.com

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