The Future of Plaque Psoriasis Treatment: A Shift Towards Oral Medication

Plaque Psoriasis© Iri-s from Getty Images / Canva

With psoriasis impacting over 8 million Americans, the continual search for improved treatments is essential. Fortunately, a recent study from Spherix Global Insights, the Chester County-based market research company for the global life sciences industry, examines what US dermatologists report of the current and future landscape in regard to the treatment of plaque psoriasis with injectable biologics or oral agents.

The findings suggest that despite ongoing therapeutic opportunities in psoriasis, there is very little remaining unmet need for injectables due to their lack of efficacy and patient burden. Dermatologists have reported that they are instead interested in additional oral agents bringing enhanced safety and efficacy profiles compared to existing options such as Amgen’s Otezla or Bristol Myers Squibb’s Sotyktu.

In the realm of autoimmune disorders, recent advancements in the biologic treatment of plaque psoriasis have been nothing short of remarkable. With each new generation of biologics, the standards of care and performance expectations have continually risen. However, despite these advancements, the role of approved oral small molecules in treating moderate to severe psoriasis remains substantial.

Historically, tumor necrosis factor (TNF) inhibitors like Amgen’s Enbrel, Janssen’s Remicade, and AbbVie’s Humira, along with a host of biosimilars, have been the go-to treatments in large immunology markets. But the psoriasis landscape has seen a shift towards more selective and targeted biologic options, improving efficacy, safety, and convenience for patients.

Market newcomers such as Janssen’s Stelara, the IL-17 class (including Novartis’ Cosentyx, Eli Lilly’s Taltz and Ortho Dermatologics’s Siliq), and most recently, the IL-23’s (Janssen’s Tremfya, Sun Pharma’s Ilumya, and AbbVie’s Skyrizi) have each revolutionized the treatment landscape, offering the possibility of total skin clearance for many psoriasis patients.

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Despite this, Amgen’s Otezla, an oral agent, has held its own since 2014, providing an option for patients who are needle-phobic or prefer the convenience of a pill. While US dermatologists report that Otezla does not meet the high standards set by the newer IL-17 and IL-23 options, it is primarily used in the pre-biologic setting, before initiating patients on an injectable biologic.

In 2022, BMS’ Sotyktu, a TKY2 inhibitor, joined Otezla as another oral option. Despite boasting increased efficacy over Otezla according to BMS’ clinical trial data, Otezla has successfully maintained its market share, with patient share for the legacy oral asset nearly double that of Sotyktu, according to a Q3 update from Spherix Global Insights’ RealTime Dynamix™: Plaque Psoriasis.

Interestingly, while Sotyktu is projected to make incremental gains in market share over the next six months, it’s likely to come at the expense of injectable biologics rather than Otezla. When dermatologists compared Sotyktu and Otezla across several attributes including overall efficacy, clinical data, mechanism of action, overall tolerability, and dosing frequency, a higher percentage felt Sotyktu outperformed Otezla, except in terms of safety and tolerability.

However, dermatologists report a very low unmet need for additional plaque psoriasis treatments, with leading IL-17 and IL-23 agents ranking highest in all inquired efficacy, safety, and non-clinical metrics. Nonetheless, the future seems to be leaning towards oral treatments, with prescribers expressing a desire for a safe and efficacious oral option with comparable efficacy to biologics.

Recognizing this need, the psoriasis pipeline is brimming with oral assets trying to match biologic efficacy. In July, Janssen announced positive results for JNJ-2113, an oral IL-23 inhibitor licensed from Protagonist. Nearly 40% of moderate-to-severe psoriasis patients would be considered a candidate for the developmental drug, with most reporting a high potential of prescribing if approved, according to Spherix.

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With a shifting focus towards oral medication, the future of plaque psoriasis treatment could potentially see a significant change, marking a new era in autoimmune disorder treatment.

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