• AbbVie may not be harming its Humira sales when it launches a second rheumatoid arthritis drug, upadacitinib, later this year, a Piper Jaffray survey of physicians suggests.
• Physicians believe that after upadacitinib launches, it will compete more directly with oral small molecule drugs like Eli Lilly’s Olumiant and Pfizer’s Xeljanz, rather than with injectable biologics like Humira and Amgen’s Enbrel.
• Humira is approaching the end of its patent life, and AbbVie needs to preserve all the revenue it can from the $20-billion-a-year drug, as well as expand sales of new products ahead of the 2023 U.S. entry of Humira biosimilars.

“Cannibalization” of sales is a real concern when biopharma companies launch follow-on agents to marketed drugs, as AbbVie is poised to do later this year should upadacitinib receive Food and Drug Administration approval. However, thanks to a different mechanism of action and administration method, Humira (adalimumab) may not be vulnerable to sales erosion.

Upadacitinib, along with Olumiant (baricitinib) and Xeljanz (tofacitinb), are part of a relatively new class of small-molecule drugs called Janus kinase, or JAK, inhibitors. The class works by modulating immune response, compared to the biologic Humira, an injectable antibody that blocks tumor necrosis factor.

Piper Jaffray’s survey of 101 high-volume rheumatologists asked physicians what share of patients would be taking Humira, Olumiant, Xeljanz, and several other drugs now and in six months. Humira’s share is projected to drop from 23.1% to 21.5%, while Olumiant’s rises from 1.7% to 4.2% and Xeljanz’s holds steady at 9.5%.

When asked what the share would be in six months if upadacitinib became available in that timeframe, physicians responded by saying that Olumiant’s share would only rise to 2.3% and Xeljanz would drop to 7.2%, but Humira would remain steady, rising slightly to 21.6%. In that scenario, the surveyed physicians believe they would prescribe upadacitinib to 5% of patients.

The FDA is expected to make a decision on upadacitinib by mid-August.

This is a different situation to when AbbVie launched Skyrizi (risankizumab) in psoriasis. In that case, according to a separate Piper Jaffray survey, physicians were expecting to prescribe less Humira when the new drug came on the market.

Xeljanz and Olumiant have been subject to warnings over blood clots and cardiovascular risk, with Olumiant getting a black box on its label. Of the physicians surveyed, 61% agreed that it was likely a “class effect” common to all JAK inhibitors, including upadacitinib. However, only 28% said that the warnings would have more than a “minimal impact” on day-to-day prescribing.