ViewPoints: Bar set high for AbbVie, Boeheringer Ingelheim's push into psoriasis

Initial Phase III data show that risankizumab is a highly effective treatment for moderate-to-severe psoriasis, but the market is already awash with them.

There is little doubt that AbbVie and Boehringer Ingelheim's risankizumab is a more efficacious therapy than either AbbVie's Humira (a TNF inhibitor) or Johnson & Johnson's Stelara (which like risankizumab targets IL-23) and both of these established products are held in high regard.

In our recent survey of 70 dermatologists, for example, Humira and Stelara were cited as the therapies that have had the biggest impact on treatment practice in psoriasis by 30 percent and 15 percent of respondents, respectively. Indeed, nearly a quarter of dermatologists believe Humira remains the best available treatment, bar none; while other drugs have demonstrated greater efficacy, familiarity with Humira and its safety profile are compelling reasons to prescribe.

The ground is undeniably shifting, however. Whilst Stelara retains similar status among a sizeable percentage of dermatologists, a growing number of prescribers cite new IL-17 therapies – Novartis' Cosentyx and Eli Lilly's Taltz – as raising the bar in psoriasis once again. Both products are expected to be among those that achieve the biggest market share gains over the next five years, as is Tremfya, Johnson & Johnson's successor to Stelera. Only recently approved in the US, sentiment for the product among prescribers already appears high.

Although risankizumab looks to have demonstrated comparable efficacy to Tremfya, this feedback illustrates the task ahead for AbbVie and Boehringer Ingelheim, with their product not due to launch until 2019.  One potential means of differentiation, which builds on three-monthly dosing, is potential long-term disease remission from relatively few injections; a number of key opinion leaders previously interviewed by FirstWord are impressed with risankizumab's longevity of response and this could emerge as a factor that allows AbbVie and Boehringer Ingelheim to compete with incumbent players as more Phase III clinical data is released.

The establishment of older biologics and emergence of newer more effective products could make the psoriasis market "ripe for disruption by payers," suggest analysts at Credit Suisse, and there is evidence of this occurring already. Despite being identified in our physician survey as the most effectively differentiated psoriasis treatment currently available, Celgene's Otezla – an oral agent – was primarily to blame for the company's recently unveiled weaker-than-expected third-quarter performance. Management noted that Otezla sales were impacted by "a more challenging market access environment." – see ViewPoints: Still a pace-setter, but Celgene loses some sheen

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