Bristol Myers Squibb is the surprise winner in an emerging rheumatoid arthritis (RA) market dynamic as doctors eschew new JAK inhibitors amid safety concerns.
That’s the analysis of a new first-quarter 2022 report by Spherix, which surveyed 102 U.S. rheumatologists on their recent prescribing habits. The survey found a “potential paradigm shift” away from JAK inhibitors despite these drugs being on the market for only a few years.
TNF inhibitors dominate the market and are the most used drug class in the first- and second-line patient settings. AbbVie's Humira, a $20 billion-a-year blockbuster that's used in multiple immunology diseases, is still the market leader.
But while used early on, many patients will need a new therapy option if anti-TNFs aren’t working for them, and Spherix says it has seen a hankering from U.S. doctors for drugs with new mechanisms of action to fill up this setting.
And here's where JAK inhibitors come into the picture. These drugs work by putting a wrench in the process of cytokines getting released (and causing inflammation), which in turn helps calm down the immune system and ease RA symptoms.
Pfizer's Xeljanz and AbbVie’s Rinvoq were, according to Spherix, the two JAK inhibitors set to make the biggest stir. Yet, at the start of last year, serious safety questions about Xeljanz and later the whole class arose, hitting confidence in the pair.
Trials showed that the use of JAKs could raise the risk of heart conditions including heart and stroke.
Rinvoq “recently recognized a minor decline in physician-reported brand share for the first time following its introduction, while Xeljanz share has slowly trickled throughout the last year,” Spherix said in its report.
“When querying respondents on the last five prescriptions written for their RA patients (and trending those responses over time), the notable impact of safety concerns surrounding JAKs on both perceptions and use of the brands is clear. New prescription shares for Xeljanz and Rinvoq have sharply declined over the past year.”
That might be as expected, but in this gap comes a curious new contender in Orencia. Spherix specifically probed rheumatologists on their preferred alternate drug class when switching from a TNF inhibitor.
“Interestingly, preference for Bristol’s Orencia post-TNF use has been increasing at nearly the same rate that preference for the JAKs has been decreasing,” the report found. It noted that two-fifths of respondents selected Orencia as their “preferred agent to prescribe” when discontinuing a TNF agent.
The drug has been on the U.S. market for more than a decade and works by binding to two proteins, CD80 and CD86, found on the surface of certain immune cells. These proteins activate T cells, which help the immune system to fight infection. Orencia stops the T cell from being activated, which disrupts harmful signals from being sent to your joints. The drug made Bristol Myers Squibb $3.3 billion last year, up 5%, and is its fifth biggest-selling drug.
Looking again at the last five prescriptions written, Orencia “has seen a significant jump,” Spherix said, doubling its recent prescription share since the second half of last year. In addition, there has been a slight uptick in later-line share for the Bristol Myers Squibb brand year over year.
As for the other challengers, the IL-6 inhibitors' overall brand share “has remained flat” for both Genentech's Actemra and Sanofi/Regeneron's Kevzara, the report noted. There’s still life in the old Orencia dog yet, it seems.