9. Tremfya

Johnson & Johnson’s Tremfya, the first selective IL-23 inhibitor approved by the FDA, collected $416 million in its first four full quarters of sales. (Tremfya)

9. Tremfya
Company: Johnson & Johnson
Disease: plaque psoriasis
Approved: July 13, 2017
First four full quarters sales: $416 million

Johnson & Johnson’s Tremfya was the first selective IL-23 inhibitor to land on the scene. But as Credit Suisse analyst Vamil Divan wrote in an investor note before Tremfya’s approval, the immunology market was already crowded with numerous options working in different mechanisms of actions, and experts told him “they did not feel there was a need for many newer agents.”

J&J itself has anti-TNF med Remicade and IL-12/23 inhibitor Stelara, which is still growing with new indications. And there are the IL-17 meds, namely Novartis’ Cosentyx, Eli Lilly’s Taltz and Bausch Health’s Siliq. Nevertheless, Tremfya still earned a place on our top launch report, reflecting just how big the inflammatory space is.

Tremfya doesn’t even look like the best option out there. It did outperform AbbVie's best-selling Humira at clearing patients’ skin and induced great improvements in patients who had inadequate response to Stelara. But what next-gen drugs haven’t topped those two older meds on the way to approval? To snatch a meaningful piece of the psoriasis market, you generally need to show better efficacy than some newer meds.

RELATED: Johnson & Johnson's Tremfya backs psoriatic arthritis play with newest data

In a head-to-head phase 3 that pitted Tremfya against Cosentyx, about 85% of patients on the J&J med achieved at least 90% improvement in skin clearance at the 48-week mark, better than the 70% in the Cosentyx cohort. However, Tremya failed to show statistically significant superiority when it came to the study’s secondary endpoints of at least 75% reduction after 12 weeks and 48 weeks.

Results from that showdown came toward the end of 2018, and therefore didn’t contribute much to Tremfya’s first four full quarters’ haul of $416 million.

Bad news came for Tremfya last year. It was beaten by Eli Lilly’s Taltz in a phase 4 study measuring the percentage of patients who achieved complete skin clearance at 12 weeks. On the bright side, the drug recently hit study goals in psoriatic arthritis, and it's now expecting FDA and EMA decisions on the new use soon.

9. Tremfya