The post-marketing data in the treatment refractory population of the COSMOS Phase IIIb study could allow J&J the opportunity to position interleukin (IL)-23 inhibitor Tremfya early in the PsA treatment algorithm, ahead of the older IL-17 drug class, according to GlobalData. If this happens, and J&J is able to contract aggressively with payers, the leading data and analytics company predicts that Tremfya will still be able to stake a claim to the market. By 2028, Tremfya is expected to net sales of $361m in the US and $577m globally in for PsA.

Tiffany Chan, Immunology Analyst at GlobalData comments: “The results from the COSMOS trial will help to solidify Tremfya’s position in a rapidly saturating biologics market. Tremfya’s demonstration of symptom improvement in a significantly higher proportion of patients; complete skin clearance versus placebo at Week 24; and superior efficacy versus placebo in terms of patient quality of life measures will pack a serious punch against some stiff competition. This is especially so considering that the drug is expected to meet the needs of patients that do not respond to TNF inhibitors – something that key opinion leaders (KOLs) interviewed by GlobalData notes was a major clinical unmet need.”

Despite promising long-term data, Tremfya still faces strong competition in the field, notably from AbbVie’s IL-23 inhibitor, Skyrizi (risankizumab). While it is currently pending FDA approval for PsA, Skyrizi has already been well received by dermatologists for plaque psoriasis (PsO).

Chan added: “KOLs attribute Skyrizi’s success to the fact that AbbVie has competitively contracted with payors to ensure that Skyrizi is easy for physicians to prescribe, which accounts for its stronger sales compared to Tremfya. Therefore, improving contracting relationships with payers is a key component in ensuring Tremfya’s future commercial success.”

If the COSMOS clinical trial results lead to guidelines recommending earlier use of Tremfya after TNF inhibitor failure, J&J could see a sales boost.

Chan notes: “Over the next decade, Tremfya is expected to have strong uptake in the PsA market, based on J&J’s previous experience marketing Stelara in this disease space. Although Stelara’s patent is set to expire in 2023 in the US and Japan – and in 2024 in the five major European markets (5EU*) – J&J will likely be able to preserve its position in the PsA space with Tremfya’s sales.”

The current annual cost of therapy (ACOT) for Tremfya is $76,189, which is a slight premium over other available biologics but slightly cheaper than Skyrizi’s ACOT of $90,740 per year.

5EU = France, Germany, Italy, Spain and the UK