USA —Bristol Myers Squibb (BMS) and AbbVie are shaking up the U.S. inflammatory bowel disease (IBD) market with their newer-to-market drugs Zeposia and Skyrizi, according to Spherix Global Insights, a healthcare data consultancy.

According to the report, doctors appear to prefer the most recently approved drugs from companies like Bristol Myers Squibb and AbbVie over older Tumor Necrosis Factor (TNF) therapies and now the two drugs have made significant gains in first-line prescriptions since 2021.

Anti-TNF drugs for inflammatory bowel disease (IBD) conditions such as Crohn’s disease (CD) and ulcerative colitis (UC) have been on the market for nearly three decades and include multibillion-dollar blockbusters such as AbbVie’s US$20 billion-a-year Humira, Johnson & Johnson’s Remicade and Simponi, and UCB’s Cimzia.

TNF inhibitors have long been the go-to drugs for patients who have failed methotrexate, and they can also be used as a first-line treatment at the discretion of a doctor.

While newer drugs such as Takeda’s Entyvio and Johnson & Johnson’s Stelara have taken market share from TNFs in the years since their approval, Spherix’s latest analysis shows that even newer drugs are increasing their prescription share.

Spherix came to this conclusion after tracking and analyzing 1,013 charts of IBD patients in the United States who were starting medication for the first time this year.

TNFs are now “substantially less likely to be used first-line compared to prior years,” while newer brands with alternative mechanisms of action (AMOAs) are now “increasingly popular,” the consultancy Spherix said in a release.

Spherix discovered that over the last 18 months in the United States, drugs with different mechanisms of action from anti-TNFs, specifically BMS’ Zeposia and AbbVie’s Rinvoq for the treatment of UC and AbbVie’s Skyrizi for treatment of CD, “have had material changes to new start IBD treatment patterns,” according to the report.

Spherix attributed the majority of the oral Zeposia gains to AbbVie’s older TNF-blocker Humira. With Humira facing a slew of biosimilar market entrants for the first time in January, prescription writing has already begun to decline.

According to Lynn Price, Spherix’s VP of immunology insights, Zeposia is also gaining favor as a non-biologic option for patients who have never taken one, as well as the only advanced systemic oral that does not require a TNF failure.

This makes Zeposia a more appealing option when compared to competitor orals such as AbbVie’s Rinvoq and Pfizer’s Xeljanz, which not only require TNF failure but also now have FDA black box warnings for increased risks of heart-related events, cancer, blood clots, and death.

BMS has also stepped up its sales force efforts, increasing detailing rates and in-person visits to doctors and, as a result, notching greatly improved ratings from gastroenterologists regarding its reps, Price said.

Meanwhile, in the second IBD therapy area, Crohn’s disease, the IL-23 inhibitor Skyrizi has risen to first-line status, with doctors telling Spherix that they prefer it for perceived efficacy and targeted mechanism of action.

Spherix attributed the Crohn’s drug gains to Humira’s losses, emphasizing the importance of AbbVie’s next-generation med Skyrizi’s success.

Both drugs, along with AbbVie’s Rinvoq, are adding fuel to the fire in the already crowded IBD market, and it’s far from over.

Line extensions from current players are expected to crisscross the conditions, even as novel drugs such as Eli Lilly’s mirikizumab and Pfizer’s etrasimod are set to hit the market in 2023.

However, as Price noted, there is still opportunity in the market because of still large unmet needs in IBD.

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