Anti-TNFs have been running the table in inflammatory bowel disease (IBD), but that’s changing. And as it does, the market’s primed for a big expansion, one analyst says.
Leerink Partners’ Geoffrey Porges expects to see the space keep expanding at its recent 20% clip—or faster, he wrote in a note to clients Wednesday. And companies with multiple late-stage IBD treatments in the pipeline—such as Celgene and AbbVie—are in line to benefit, he says.
Thanks to the arrival of new meds such as Takeda’s anti-integrin Entyvio and Johnson & Johnson’s IL-12/23 inhibitor Stelara, IBD biologics racked up about $9.2 billion in sales last year, Porges said. And other classes such as JAK inhibitors and S1P1 inhibitors are on the way.
Of course, that doesn’t mean anti-TNF meds are going anywhere. On the contrary, more are inbound, with biosimilar copies of AbbVie’s Humira, for one, speeding toward the market, and a version of Johnson & Johnson giant Remicade already out there.
But the way Porges sees it, they’ll leave room for the newcomers. Though the biosims will become “an important treatment option for first-line biological patients,” many of those patients will later require further treatment. “Literature suggests that 50%-60% of anti-TNF treated patients will have not responded or lost response within one year, which provides a large opportunity for drugs based on new mechanisms,” he said.
Without useful biomarkers to help predict responses to the up-and-comers, though, which new class will prevail remains a mystery, Porges noted. For now, he’s going off feedback from key opinion leaders who suggest IL-23s—such as AbbVie prospect risankizumab, for example—offer “the best chance for a biologic to show superior remission rates compared to the current biologics.” Oral meds in the JAK class, meanwhile, have “the best chance of being paradigm-changing by treating patients earlier in disease course than biologics,” he wrote.