Pso­ri­a­sis and pso­ri­at­ic arthri­tis drugs criss­cross cat­e­gories, but derm and rheum docs split on pref­er­ences

As drugs in pso­ri­a­sis and pso­ri­at­ic arthri­tis ther­a­py ar­eas nab new in­di­ca­tions that criss­cross the two cat­e­gories, der­ma­tol­o­gists and rheuma­tol­o­gists are as­sess­ing their op­tions. The twist? Emerg­ing opin­ions be­tween the two doc­tor groups are ex­act­ly the op­po­site, ac­cord­ing to Spher­ix Glob­al In­sights re­search analy­sis.

Gi­an­na Me­len­dez

Rheuma­tol­o­gists “heav­i­ly” pre­fer In­ter­leukin 17s (IL-17s) such as No­var­tis’ Cosen­tyx and Eli Lil­ly’s Taltz to treat pso­ri­at­ic arthri­tis with on­ly 25% say­ing they pre­fer the In­ter­leukin 23s (IL-23s) that in­clude Janssen’s Trem­fya, Sun’s Ilumya and Ab­b­Vie’s Skyrizi. Mean­while, der­ma­tol­o­gists much pre­fer IL-23s, and es­pe­cial­ly Skyrizi, by about the same mar­gin, Spher­ix an­a­lysts said.

Some of the dif­fer­ences come down to fa­mil­iar­i­ty and habit with IL-23s more re­cent­ly ap­proved in rheuma­tol­ogy and vice ver­sa for IL-17s in der­ma­tol­ogy. But it al­so has to do with the dif­fer­ent types of spe­cial­ists.

“Derms tend to just al­so be ear­ly adopters of new prod­uct. They re­al­ly like to try new things, more so than rheuma­tol­o­gists, so that fu­els the dif­fer­ences too,” Gi­an­na Me­len­dez, Spher­ix’s der­ma­tol­ogy fran­chise head, said.

To dive deep­er in­to why there’s a split be­tween the IL cat­e­gories, Spher­ix asked both groups of doc­tors which IL-17 or IL-23 they would choose if they could on­ly pick one. When it comes to IL-17s for rheuma­tol­o­gists, they chose Cosen­tyx over Taltz in a fair­ly close 60-40 split, but with IL-23, the arthri­tis doc­tors chose the first-to-mar­ket Trem­fya over the new­er Skyrizi much more wide­ly in an 80% to 20% split.

When they asked the der­ma­tol­o­gists about IL-23s, they went for Skyrizi in a big way, as Me­len­dez ex­plained: “Out of the gate, they be­came en­am­ored with Skyrizi and that con­tin­ues to this day.”

How­ev­er, when it comes to derms and IL-17s, Spher­ix’s five years of da­ta on the same ques­tion show a def­i­nite shift. Be­fore Skyrizi was ap­proved in 2019 — as the third-to-mar­ket IL-23 — the skin docs pre­ferred the first-to-mar­ket Cosen­tyx over Taltz. How­ev­er, Me­len­dez said, the Skyrizi ap­proval showed them that it was OK to con­sid­er drugs that may not be first to mar­ket. The re­sult is that now derms chose Taltz over Cosen­tyx for the IL-17 pref­er­ence.

That’s po­ten­tial­ly good news for up­com­ing mar­ket en­trants. UCB’s IL-17 bimek­izum­ab, for in­stance, may have a bet­ter shot with der­ma­tol­o­gists now that der­ma­tol­o­gists ac­cept that lat­er-mar­ket en­trants are worth con­sid­er­ing, Me­len­dez said.

Max­ine Yarnall

Her col­league Max­ine Yarnall, Spher­ix’s head of the rheuma­tol­ogy fran­chise, said, “Be­cause there is so much of crossover — rheums treat­ing more pa­tients with skin in­volve­ment and derms treat­ing more peo­ple with rheuma­to­log­ic con­di­tions like PsA — it’s be­com­ing more and more watched by [phar­ma] clients who are now fo­cused on both groups.”

And both ther­a­py ar­eas are on­ly get­ting more crowd­ed with new in­di­ca­tions or nov­el bi­o­log­ics for phar­ma com­peti­tors to watch. Along with the IL in­hibitor sub­set, tra­di­tion­al TNF heavy­weights Hu­mi­ra from Ab­b­Vie and En­brel from Am­gen play in both cat­e­gories as does Am­gen’s Ote­zla phos­pho­di­esterase 4 (PDE4) in­hibitor.

Oth­er drugs so far are split in­to one or the oth­er cat­e­go­ry: JAK in­hibitors such as Pfiz­er’s Xel­janz and Ab­b­Vie’s new­er Rin­voq are ap­proved for pso­ri­at­ic arthri­tis, while Bris­tol My­ers Squibb’s TYK2 in­hibitor deu­cravac­i­tinib in mod­er­ate to se­vere plaque pso­ri­a­sis is set for an FDA rul­ing this fall.

The large num­ber of crossover drugs has spurred an­oth­er ef­fect as pa­tients with both con­di­tions can po­ten­tial­ly be treat­ed by ei­ther a der­ma­tol­o­gist or rheuma­tol­o­gist.

“Most pa­tients first have pso­ri­a­sis and about 20% de­vel­op pure PsA and an­oth­er 20% get some lev­el of joint in­volve­ment,” Me­len­dez said. “Now that [der­ma­tol­o­gists] have al­most the same ex­act prod­ucts, mi­nus the JAKs, that a rheuma­tol­o­gist has, we’re see­ing pa­tients that present with mild joint dis­ease be­ing held on­to longer by der­ma­tol­o­gists.”

The same is true for rheuma­tol­o­gists with most spe­cial­ists in the cat­e­go­ry com­fort­able treat­ing pa­tients with mild to mod­er­ate pso­ri­a­sis with two-thirds us­ing their own clin­i­cal as­sess­ment when it comes to pso­ri­at­ic arthri­tis pa­tients with skin in­volve­ment.

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