Spotlight On: Pharma's key drug battlegrounds – what's the story after Q1

With first-quarter earnings season now largely over, we take a closer look at the ongoing revenue performance for notable products in some of pharma's key disease area and drug class battlegrounds.

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PD-(L)1 inhibitors - various oncology indications

Global Keytruda revenues have now outstripped those of Bristol-Myers Squibb's Opdivo for four consecutive quarters. Furthermore, Merck & Co.'s product continues to extend its lead, driven by strong uptake in first-line non-small-cell lung cancer (NSCLC).

Keytruda's position could be strengthened further - again at the expense of Opdivo - if adoption is strong in the first-line renal cell carcinoma market where US approval was recently secured.

See - KOL Views Results: Leading oncologist says ‘not so fast’ on anointing Keytruda king in RCC

Imfinzi has carved out a lucrative niche as the only approved PD-(L)1 inhibitor in Stage III NSCLC and Roche is hoping to build a similar growth strategy for Tecentriq, which is currently the only drug in class approved for small cell lung cancer and triple-negative breast cancer.

See - Physician Views Results - Tecentriq poised for rapid adoption in TNBC, suggest oncologists

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CDK4/6 inhibitors - breast cancer

In the CDK4/6 inhibitor space, the first-to-market status of Pfizer's Ibrance is the defining commercial feature; sales of the breast cancer treatment - indicated specifically for HER2-negative, HR-positive patients - have been annualising at around $4 billion for the past four quarters.

This despite the launch of two similar, but largely undifferentiated, products in the form of Novartis' Kisqali and Eli Lilly's Verzenio, which together generated sales worth approximately 20 percent of Ibrance's revenue during the first quarter.

Quarterly sales of Ibrance were flat on a sequential basis, however, which will sharpen focus on the potential of these agents in the adjuvant setting, where Pfizer will be looking to replicate the success it has enjoyed to date. Results are expected to read out next year and could double the size of the patient population eligible to receive Ibrance.

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Asthma - biologics

Supporting the argument that a new generation of agents have raised the bar for biologic asthma therapies, sales of GlaxoSmithKline's Nucala represented approximately a quarter of global Xolair revenue during Q1, despite a much more recent launch date (2015 versus 2003).

Nucala faces competition, nevertheless, from AstraZeneca's Fasenra with quarterly global revenue trends indicating that a fierce battle could play out over the coming years; not to mention from Regeneron and Sanofi’s Dupixent (Physician Views Results: Dupixent is differentiated in asthma, say prescribers)

See - ViewPoints: Novartis breathes new expectation into late-stage asthma drug

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EGFRm NSCLC   

Over the past year, AstraZeneca's Tagrisso has become clearly established as the favoured targeted therapy for EGFR-mutated NSCLC, thanks to positive data from the FLAURA study showing its impressive efficacy as a first-line therapy. Prior to this, it was primarily being used after the older tyrosine kinase inhibitors (TKIs) Iressa (also AstraZeneca) and Tarceva.

US revenues declined sequentially in the first quarter, which weighed on global performance of the brand. Downplaying the impact on full-year performance, AstraZeneca suggested staggered uptake in other markets will offset slowing growth in the US.

See - ViewPoints: AACR19 - Chi-Med data could add compelling coda to AstraZeneca's Tagrisso narrative and ViewPoints: Tagrisso, Alecensa show the impact practice-changing data has on brand health

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Multiple sclerosis

In the multiple sclerosis market it is a question of when, not if, Roche's Ocrevus becomes the best- selling global therapeutic. Approved initially in March 2017, Ocrevus has rapidly closed the gap on Tecfidera during the past 12 months and is poised to overtake Biogen's oral therapy in global revenues at some point later this year.

Described by management as the company's most successful new drug launch ever, Ocrevus is benefitting from a broad label that provides access to around 90 percent of all MS patients. Furthermore, Roche noted recently that it is seeing no evidence of treatment breaks with patients consistently being dosed every six months.

It remains to be seen what impact Novartis' Mayzent and Merck KGaA's Mavenclad can have on Ocrevus' rise to the top.

See - Physician Views snap-poll results: Neurologists cautiously optimistic about Novartis’ Mayzent and Physician Views snap poll results - US neurologists predict infrequent to occasional use for Merck KGaA’s multiple sclerosis drug Mavenclad

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HIV

The two-horse race in HIV between Gilead Sciences and ViiV Healthcare has shifted further in favour of the former since it launched Biktarvy just over a year ago. Biktarvy is poised to overtake ViiV's Triumeq as the market leading triple-combination therapy next quarter, which has sharpened the focus on ViiV's strategy to introduce two-drug treatment regimens.

The first of these - Juluca - has seen steady uptake over the past 12 months, though hopes are higher for the recently approved Dovato. ViiV is also seeking to market a once-monthly HIV therapy, though analysts expect this to be a niche product for the majority-owned GlaxoSmithKline joint venture.

See - KOL Views Results: Resistance fears will weigh on Dovato but TANGO switching study could be big boost, says leading HIV expert

With consensus forecasts for ViiV's revenue flat over the next five years, some analysts have questioned the commercial strategy of prioritising two-drug regimens given both physician inertia (despite data showing lack of disease resistance) and the need to price these cheaper to satisfy payers.

See - Physician Views snap-poll results - More patients would prefer two-drug HIV regimens but threat of resistance will slow ViiV’s strategy

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Psoriasis

Among the various non anti-TNF therapies, Johnson & Johnson's well established Stelara franchise continues to record a steady increase in growth; based on first-quarter performance, sales will annualise at around $5.6 billion. 

Sales of Novartis' IL-17 inhibitor Cosentyx declined slightly on a sequential basis, perhaps owing to uptake of Johnson & Johnson's IL-23 inhibitor Tremfya, a product that many experts predict will emerge as a favoured biologic therapy over the next few years. The catalyst to watch here is AbbVie's recently approved Skyrizi, with dermatologists snap-polled by FirstWord giving the drug's clinical profile a thumbs up.

See - Physician Views snap-poll results: Hugely encouraging feedback for AbbVie's Skyrizi

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Migraine - CGRP inhibitors

Such is the short length of time these products have been available in the US (not to mention the amount of free product circulating in the market to help drive adoption), it is challenging to read too much into early revenue trends. First-quarter results would suggest, however, that the availability of Teva's Ajovy and Eli Lilly's Emgality has reduced the first-to-market advantage of Amgen and Novartis' Aimovig in the US.

This sets up an intriguing few quarters ahead, as does the recently revealed dispute between Aimovig's commercialisation partners, the anticipated launch of Alder’s CGRP inhibitor next year and the future approval of oral CGRPs.

See - ViewPoints: New cause for concern in oral CGRP-land?

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