Pfizer's Xeljanz Begins to Shift the Treatment Paradigm in Ulcerative Colitis (UC) With Early Launch Metrics Largely Favorable for the Brand

The majority of patients started on Xeljanz have failed multiple biologics, but some gastroenterologists see the brand securing a role in the pre-biologic space in the near future, according to the latest quarterly report from Spherix Global Insights

Based on the latest Spherix Global Insights survey of US gastroenterologists (n=100) conducted in mid-July, the excitement surrounding the introduction of the first oral JAK inhibitor to treat UC is high, with 98% of the physicians calling the product an advance over other treatment options in UC. Overwhelmingly, and not surprisingly, the oral formulation is noted as the product’s leading advantage, but the Q3 edition of RealTime Dynamix: Inflammatory Bowel Disease (IBD) also found that GI specialists also have high expectations for the drug’s efficacy.

About one-third of the survey respondents report having at least one patient on Xeljanz, a figure lower in comparison to Janssen’s Stelara in Crohn’s disease at the same point post-launch, although users report a higher number of patient initiations per user for Xeljanz. This could be related to the payer landscape as 22% of the respondents noted that early approvals for Stelara were “quick and easy” while, by comparison, one-third of the Xeljanz users classified the approvals as being “slow and difficult.”

The majority of gastroenterologists expect to increase their use of Xeljanz in the next three months, and while they largely expect the decreased use of AbbVie's Humira and Janssen's Remicade as a result, the impact to Takeda’s Entyvio cannot be ignored. Prior to the launch of Xeljanz, 85% of the gastroenterologists would have chosen Entyvio as one of their brand choices if limited to only two for the treatment of UC; this dropped significantly with the introduction of Xeljanz, underscoring the heated competition to be the first non-TNF used in the treatment cycle. Furthermore, when asked which agent would have been used if Xeljanz had not been available, Entyvio was the most frequently noted. 

Longer term Pfizer will likely aim to parlay the oral formulation, strong efficacy, and an increasingly payer-neutral landscape into a pre-biologic role for Xeljanz. For now, pre-biologic use is limited with only 15% of the recent starts falling into this category, and Pfizer has its work cut out to secure this positioning. Less than one-quarter of the gastroenterologists currently agree that “The ideal Xeljanz patient is an earlier patient than a typical biologic patient” (33% disagree), and nearly half agree that the ideal Xeljanz patient is the same as a biologic-ready patient. On the plus side, the patient type most frequently selected for Xeljanz is described as “younger, active lifestyle” – a patient type representing one of the largest segments and largely dominated by preference for Humira.

Aside from the typical new drug barriers of limited familiarity and market access issues, Xeljanz representatives will have to address concerns about serious adverse events with gastroenterologists as these are noted as a barrier for one-third of the respondents. Indeed, 62 percent of the respondents indicate that more safety data would lead to a significant increase in Xeljanz prescribing. Leveraging the extensive post-marketing experience of Xeljanz in rheumatoid arthritis as well as establishing Pfizer as a partner in the field of gastroenterology will be critical. Although early in the launch, more than 40% of the respondents still have not seen a representative, and a clear correlation exists between contact rates and new patient initiations. 

The next wave of this study will be fielded in mid-October.

RealTime Dynamix™: Inflammatory Bowel Disease is an independent report series published on a quarterly basis. The series provides a close-quarters analysis of key performance metrics, focusing on brand gains and losses, industry contact rates, familiarity and adoption rates of recently launched products and awareness of products in development. The next wave of the study will field in November and will continue to track emerging trends, with a focus on the Xeljanz launch in UC.

About Spherix Global Insights
Spherix Global Insights is an independent business intelligence agency 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.

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Lynn Price, Immunology Franchise Head

Source: Spherix Global Insights