IL-23 inhibitors stage fierce competition in psoriasis, arthritis treatment market

Competition is intensifying between the two Interleukin (IL)-23 inhibitors in the treatment market for psoriasis and psoriatic arthritis, as latecomer Skyrizi (risankizumab) of AbbVie closely chases frontrunner Tremfya (guselkumab) of Janssen.

According to data at market surveyor IQVIA, Tremfya’s sales jumped 33.2 percent from 18.25 billion won ($13.89 million) in 2021 to 24.25 billion won last year.

Skyrizi’s sales even showed a far steeper rise of 96.2 percent, from 8.42 billion won to 16.52 billion won.

Beginning with adult plaque psoriasis in September 2018, Tremfya expanded its indication entitled to insurance benefits to palmoplantar pustulosis in May 2019 and to patients with active or progressive psoriatic arthritis who have stopped treatment due to insufficient response, side effects, or prohibition to one or more tumor necrosis factor alpha inhibitors (TNF-α inhibitor) or IL-17 inhibitors.

Tremfya is also the first IL-23 inhibitor that won insurance benefits as the treatment for adult active psoriatic arthritis and was prescribed for psoriasis patients accompanied by psoriatic arthritis.

On the other hand, Skyrizi won approval as a treatment for mild-to-moderate plaque psoriasis in 2019 and for adult patients with active psoriatic arthritis who have not previously shown proper response or no tolerance to disease-modifying anti-rheumatic drugs (DMARDs) in January of last year.

It also won reimbursement for treating adult patients with chronic severe plaque psoriasis from June 1, 2020, and has received the same reimbursement as Tremfya for progressive psoriatic arthritis patients from March.

In other words, Skyrizi narrowed the gap with Tremfya over a year without reimbursement for psoriatic arthritis. In 2021, Tremfya’s sales exceeded Skirizi’s by 53 percent, but the gap narrowed to 31 percent last year.

Their quarterly sales records also showed that the difference between the two treatments rapidly decreased from 2.3 billion won in the first quarter to 2.7 billion won, 2 billion won, and 700 million won in the following quarters.

In addition, Skyrizi’s registration on insurance benefits will speed up its sales growth even further.

Skyrizi is also expanding treatment options through diversifying formulations. Starting this month, Skirizi 150 mg was registered on the reimbursement as a treatment for mild-to-moderate adult plague psoriasis and adult active or progressive psoriatic arthritis.

The additional registration will cover the existing 75mg prefilled pen and the new 150 mg pen, enabling patients to reduce their annual administration numbers to half.

“Skyrizi has proven its efficacy in plaque psoriasis and psoriatic arthritis through many clinical trials and long-term safety to an extent, according to data so far,” said Professor Choi Yong-beom of the Dermatology Department at Konkuk University Hospital. “In addition to the convenience of four yearly administrations, the insurance benefits for 150mg prefilled pen will reduce the number of administrations to half, further enhancing options and convenience for patients and medical workers.”

The upper limit of Skyrizi 150mg’s drug cost was 2,343,000 won per shot, and it is administered four times a year in terms of maintenance therapy. Patients subject to special calculation cases pay 10 percent of the cost or about 230,000 won per shot.