Atopic Dermatitis (Dupixent-Refractory) (U.S.), June 2023
The MarketVue®: Dupixent-refractory atopic dermatitis market landscape report combines primary (KOL interviews and survey data) and secondary market research to empower strategic decision-making and provide a complete view of the market.
Every MarketVue® includes a disease overview, epidemiology (US and EU5), current treatment, unmet needs, pipeline and access and reimbursement chapter.
Topics covered in this report:
- Disease overview: Review the disease pathophysiology and potential druggable targets
- Epidemiology: Understand prevalence, diagnosed and drug-treated prevalence of the population and key market segments
- Current treatment: Understand the treatment decision tree and strengths and weaknesses of current on-label and off-label treatment
- Unmet needs: Identify opportunities to address treatment or disease management gaps
- Pipeline analysis: Compare current and emerging therapy clinical development strategy; their performance on efficacy, safety, and delivery metrics; and their potential to address unmet needs
- Value and access: Gain insights into the drug pricing landscape and payer controls within the disease market or analogous markets
Methodology:
Research for the MarketVue®: Dupixent-refractory atopic dermatitis report is supported by 4 qualitative interviews with key opinion leaders (U.S. Dermatologists), a quantitative survey with 27 U.S. physicians and secondary research.
Geographies covered:
United States plus epidemiology for EU5 (France, Germany, Italy, Spain, United Kingdom)
Key companies mentioned:
- Eli Lilly
- Galderma
- Amgen
- Sanofi
- Keymed Biosciences
- Kyowa Kirin
- Ichnos Sciences
- Akesobio Australia
- Jiangsu Hengrui Pharmaceuticals
- Sunshine Guojian Pharmaceutical
- Oneness Biotech Co
- Allakos Therapeutics
Key drugs mentioned:
- Topical corticosteroids
- Dupilumab (Dupixent)
- Abrocitnib (Cibinqo)
- Upadacitinib (Rinvoq)
- Tralokinumab (Adbry)
- Methotrexate
- Cyclosporine
- Azathioprine
- Mycophenolate (Cellcept)
- Ruxolitinib (Jakafi, Jakavi, Opzelura)
- Crisaborole (Eucrisa)
- Lebrikizumab (Ebglyss)
- Nemolizumab (Nemluvio)
- Rocatinlimab
- Amlitelimab
- CM310
- Telazorlimab / ISB 830
- AK120
- SHR-1819
- CM326
- FB825
- Lirentelimab / AK002
Key takeaways from the report:
Atopic dermatitis (AD) is a chronic, inflammatory skin disease characterized by skin lesions and severe itching.
Dermatologists typically begin AD treatment with topical corticosteroids (TCS), then progress to Dupixent for uncontrolled, moderate-severe cases. For patients who are refractory to Dupixent (9% of moderate cases and 16% of severe cases), physicians turn to oral JAK inhibitors despite associated black box warnings, according to REACH Market Research. Adbry, an IL-13 with a similar mechanism of action to Dupixent, was recently approved, however, interviewed dermatologists report that in their experience Adbry is not as effective as Dupixent.
These post-Dupixent AD therapy options include:
- LEO Pharma’s IL-13 inhibitor Adbry (Tralokinumab)
- Pfizer’s JAK inhibitor Cibinqo (Abrocitinib)
- AbbVie’s JAK inhibitor Rinvoq (Upadacitinib)
The AD pipeline is full of promising new biologics in development, including:
- Eli Lilly & Co.’s IL-13 inhibitor – lebrikizumab
- Keymed Biosciences Co. Ltd.’s IL-4Rα inhibitor – CM310
- Galderma’s IL-31R inhibitor – nemolizumab
- Amgen/Kyowa’s OX40 inhibitor – rocatinlimab
Most therapies in development for AD target patients with inadequate response to topicals rather than Dupixent-refractory patients, however, Eli Lilly and Co.’s lebrikizumab is one of the few investigational therapies specifically being studied in Dupixent-refractory patients.
Dermatologist, U.S.: “If a patient had suboptimal response to Dupixent, I would explain that the tralokinumab has a similar mechanism, and people might not be against injection, but it’s not their favorite thing to do, putting all those factors together. Some patients may say, ‘I’d rather try a different medication with a different mechanism,’ and also, you know, it’s a pill. It’s kind of appealing to them, but then others will say, you know, ‘No problem, I’d rather stay with a biologic because that’s what the FDA recommends.’”
1. DISEASE OVERVIEW
A chronic, inflammatory skin disease characterized by dry, inflamed skin lesions and severe itching
Table 1.1. Common triggers of AD flares
Figure 1.1. Disease comorbidities
Disease mechanism
Figure 1.2. Pathogenesis of AD
Figure 1.3. Flare prevalence and impact
2. EPIDEMIOLOGY & PATIENT POPULATIONS
Disease definition
Figure 2.1. U.S. and EU5 diagnosed prevalent cases of AD by region
Table 2.1. Prevalent cases of AD in the U.S. and EU5
Dupixent-treated AD patient population
Table 2.2. Diagnosed cases of Dupixent-treated AD in the U.S. and EU5
3. DIAGNOSIS & CURRENT TREATMENT
Overview
Figure 3.1. Dermatologist-reported agreement with the characterization of AD patients who respond poorly/suboptimally to Dupixent or are Dupixent-refractory
Physicians categorize patients by non-response and suboptimal response after 5-6 months of treatment
Figure 3.2. AD patients treated with Dupixent, those who are refractory, and those who achieve a sub-optimal response
Figure 3.3. Dupixent treatment duration before other treatment options are considered
Treatment algorithm for Dupixent-refractory AD patients
Figure 3.4. Treatment pathway for Dupixent-refractory AD patients
Treatment goals for Dupixent-refractory patients don’t change, but the approach does
Figure 3.5. Treatment goals for Dupixent-refractory AD
Figure 3.6. Current treatment patient share
Dermatologists exhaust all treatment options for Dupixent non-responders
Current Dupixent-refractory AD treatment options are moderately effective but may come with safety concerns
Table 3.1. Upsides and downsides of current treatments used in Dupixent-refractory AD patients
Current Dupixent-refractory AD treatment options have their limitations
Key treatment dynamics that shape disease management and drug use in Dupixent-refractory AD
Table 3.2. Must-know AD treatment dynamics for now and the future
Lebrikizumab is likely to be the next approved biologic, but there is competition on the way
Figure 3.7. Important dynamics of Dupixent-refractory AD market evolution
4. UNMET NEED
Overview
Figure 4.1. Dermatologist-reported percentage of patients with unsatisfactory outcomes with current treatments post-Dupixent failure
Figure 4.2. Dermatologist-reported unmet needs in Dupixent-refractory/NR/sub-optimally responsive patients
Physicians are largely satisfied with available treatment options post-Dupixent failure but unmet needs remain
Figure 4.3. Top unmet needs
5. PIPELINE ANALYSIS
Overview
Figure 5.1. Dermatologist-reported most promising mechanisms of action in the pipeline
Improvement in the extent and severity of skin lesions is the primary goal of emerging therapies
Table 5.1. Key Phase 3 trials of biologics in development for moderate-to-severe AD
Biologics and novel mechanisms are the future of AD therapeutics
Table 5.2. Ongoing key Phase 2 trials of biologics in development for moderate-to-severe AD
Lebrikizumab is poised to compete for first-line use post-Dupixent failure if approved
Figure 5.2. Select results from Phase 3 trials of lebrikizumab in moderate-to-severe AD patients (ADvocate1, ADvocate2, and ADhere trials)
6. VALUE AND ACCESS
Overview
Table 6.1. Current pricing of select systemic AD treatments
Table 6.2. Typical U.S. commercial payer coverage of post-Dupixent therapies
Dupixent access and reimbursement dynamics in AD
Figure 6.1. Dupixent-treated patients by insurance type, U.S.
Figure 6.2. Reimbursement and access considerations for emerging therapies in refractory AD
Figure 6.3. Dermatologist-reported percentage of patients who have difficulty accessing and/or staying on Dupixent due to insurance restrictions, high OOP costs, or adverse reactions
7. METHODOLOGY
Primary market research approach
Epidemiology methodology
Disease definition
Diagnosed prevalence estimates
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REACH specializes in covering diseases and subpopulations that are not addressed by traditional market research reports. As such, we focus on rare diseases and niche subpopulations of more common conditions (e.g., Dupixent-refractory atopic dermatitis). Our flexible model enables in-depth assessments across all disease types, allowing us to support research for non-rare conditions as well.
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