j p全球生物制藥行業(yè)銀屑病特應(yīng)性皮膚調(diào)查要點(diǎn)2019

GlobalEquityResearch

May2019

GlobalBiopharma–Psoriasis/AtopicDermSurveyTakeaways

USMajor&SpecialtyPharmaceuticals

ChristopherSchott,CFAAC

212-622-5676

christopher.t.schott@

ChristopherNeyor

212-622-0334

christopher.z.neyor@

EkaterinaV.Knyazkova

212-622-9576

ekaterina.v.knyazkova@

CiciChen

212-622-0364

xiling.chen@

J.P.MorganSecuritiesLLC

EUPharma/Biotech

RichardVosserAC

(44-20)77426652

richard.vosser@

JamesDGordonAC

(44-20)77426654

james.d.gordon@

JamesPQuigley

(44-20)77421444

james.quigley@

SaritaKapila(MD)

(44-20)71344189

sarita.kapila@

LaerkeEngkilde

(44-20)77422917

Laerke.engkilde@

Biotechnology–LargeCap

CoryKasimovAC

212-622-5266

cory.w.kasimov@

MatthewTHolt,Ph.D.

212-622-9602

matthew.t.holt@

J.P.MorganSecuritiesLLC

J.P.MorganSecuritiesplc

Seetheendpagesofthispresentationforanalystcertificationandimportantdisclosures,includingnon-USanalystdisclosures.

J.P.Morgandoesandseekstodobusinesswithcompaniescoveredinitsresearchreports.Asaresult,investorsshouldbeawarethatthefirmmayhaveaconflictofinterestthatcouldaffecttheobjectivityofthisreport.Investorsshouldconsiderthisreportasonlyasinglefactorinmakingtheirinvestmentdecision.

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KeyTakeaways

Withanumberofmovingpiecesinthedermatologyspace,wesurveyed25physicianstobetterunderstandcurrentmarketdynamicswithafocusonbiologicuseincludingTNF,IL-17,IL-23categoriesandDupixentuseinatopicderm.

Overalloursurveysuggestscontinuedgrowthofmarketshareforbiologicsinthetreatmentofpsoriasis

OnIL-17s,physiciansseecontinuedsharegainsovertimedespitethelaunchoftheIL-23swithroughlyhalfhavingseentheseproductsproduceatleastamoderatelymeaningfulchangeintheirpsoriasistreatmentparadigm

Inoursurvey,IL-17shareisexpectedtoincreasefrom19%currentlyto24%ofbiologicsin3-yrswithphysiciansseeingbetterefficacyandlessfrequentdosingfavoringIL-17srelativetoTNFs

BetweenCosentyxandTaltz,themajorityofsurveyedphysiciansviewtheproductsassimilarandthemarketsharegapbetweenthetwodrugsisexpectedtonarrowovertime

OnIL-23s,physiciansexpressedamodestpreferenceforIL-17svsIL-23satthispoint(dueinparttofamiliarity)butseesignificantsharegainsfortheclassoverthenext3years(withshareapproachingtheIL-17sovertime)

Longertermdata,joint/PsAefficacy,andbetterinsurancecoverageshouldhelpIL-23uptake

TremfyaiscurrentlythepreferredIL-23(firstapproval)butphysiciansseenewapprovals(particularlyAbbVie’sSkyrizi/risankizumab)gainingmarketshareovertime

OnTNFs,whileoursurveysuggestscontinuedshareerosion,TNFslikelyremainthego-toagentsamongthebiologicsgivenpayercoverageandlong-termexperiencewiththeproducts

Betterinsurancecoverageandlonger-termsafetydatafortheTNFsrelativetoIL-17swerecitedbyphysicians

AmongtheTNFs,Humirarepresentsaclearfavorite(>80%physiciansshowedpreferenceforHumira)

OnDupixent,wecontinuetoseealargemarketopportunityinadultatopicdermatitisaswellasotherlate-stagetherapiesonthehorizon

Wehighlight(1)alargemoderate-to-severepatientpopulation(~60%oftheadultADpatientstreated)and(2)manypatientsuncontrolledontopicaltherapies(~28%ofmoderateand~42%ofseverepatients)

KeyCompanyTakeawaysI

ABBV:Skyrizi(risankizumab/IL-23)wellpositionedforsharegainsbutthisisoffsetbyincreasedHumirapressuresovertime

Humira:AbbViefacesacomplexdynamicinthedermspaceasweexpect(andsurveysupports)pressureonHumirainpsoriasisasphysiciansbecomeincreasinglycomfortablewithIL-17sandIL-23

Skyrizi:Atthesametime,ABBV’srecentlyapprovedrisankizumabrepresentsaveryattractivepipelineopportunityandinitialmarketaccessfortheproductistrackingwellaheadofexpectations

LLY:Taltzremainsacoregrowthdriverandsurveysupportsouraboveconsensusestimates

Taltzcontinuestoseerobustgrowthinpsoriasisaswellaslaunchesinnewindicationsincludingpsoriaticarthritis(PsA,Dec2017)andpendingankylosingspondylitisindication

Ourestimatesremainwellaboveconsensusfortheproduct,particularlyasweexpectfurtheruptakeinnewindicationsoverthenextseveralyears

JNJ:TremfyaoutlookappearsstrongwithIL-23categorygaininggreatermarketshareovertime

Tremfya’spsoriasislaunchisofftoasolidstart,outpacingtheIL-17sinNBRx.FurtherpotentialnewindicationsinpsoriaticarthritisandCrohn’srepresentsignificantopportunities

WhileSkyriziisexpectedtotakesharewithinthecategory,wecontinuetoexpecthealthyTremfyagrowthbasedoncontinuedclasssharegains

KeyCompanyTakeawaysII

NOVN:Cosentyxexpectedtoseecontinuedgrowthbythephysicians,thoughpressurein2020couldcomefrompayersdemandinghigherrebatesfollowingtheSkyrizilaunch

CosentyxisexpectedtobenefitfromcontinueduptakeoftheIL-17class,butitsshareoftheclassisexpectedtofallslightlyoverthenextthreeyears

Pressurecouldcomefromthepayersmorethanthephysicians,withpotentiallyhigherrebatesrequiredtomaintainstrongaccessfollowingtheSkyrizilaunch

REGN/SNY:Dupixentresultssuggestgreateruptakeinmoderate-to-severeadultADwithlowerpediatricuse

Dupixentsurveyresultsshowanencouragingincreaseinmoderate-to-severeadultADuse(~21%to~38%penetrationin3yrs)whileweseedecliningpediatricuseasconsistentwithprevioussurveyresults

MOR:ContinuetoseeastrongTremfyagrowthoutlook,drivenbysharegainsfortheIL-23class

PhysiciansforecastforcontinuedtransitiontoIL-23sinPsoriasisisencouraging,from12%ofBiologicscurrently,to21%inthreeyears’time

Tremfya’sstrongtrajectorylikelymaintainedevenwithSkyrizilaunch,asatleastinitially,Physiciansfavourtheoptionwheretheyhavemoreexperience,andwherethereislonger-termdata

FurtherpotentialnewindicationsinPsoriaticArthritis(PIIIdatalate2019)andCrohn’s(PhaseIII2022)representsignificantexpansionopportunities

Weseerisk-adjustedTremfyapeaksalespotentialofc.$4bn,onwhichMorphoSysisentitledtoac.5%royalty

SURVEYRESULTS

SurveyBackground:MixofPrivate/GroupPracticeinNon-HospitalSettings

SurveywaslaunchedinApril2019

Enrollmentcriteria:Respondentshad>50psoriasispatientsundertheircareandwerefamiliarwithIL-17sandIL-23sintreatingpsoriasisandDupixentintreatingatopicdermatitis

Respondentcharacteristics:Eachrespondenthadanaverageof315psoriasispatientsundertheircare

Samplesize:N=25

SurveyDemographics:62%respondentswerefromaprivatepractice,24%wereatagrouppracticeand8%werefromanacademiccenter/teachinghospital

Whichofthefollowingbestdescribeswhereyourprimarypracticesetting?

68%

24%

8%

80%

70%

60%

50%

40%

30%

20%

10%

0%

Privatepractice,non-Hospitalsetting

Grouppractice,non-Hospitalsetting(2+physicians)

Academiccenter/teachinghospital

N=25

SurveyPhysiciansSeeContinuedGrowthinBiologicsFortheTreatmentofPsoriasis

Whatpercentage,ifany,ofyourpsoriasispatientsareyoucurrentlytreatingwithbiologicsandwhatpercentage,ifany,ofpsoriasispatientsdoyouexpecttotreatwithbiologicsinthefollowingtimeperiods?%ofpatients[0-100]%

Thesurveyresultssuggestanexpansionofthemarketshareofbiologicsfrom39%currentlyto51%overthenext3years

Inaddition,thesurveyhighlightsanincreaseinbiologicsshareoverthelastyearfrom34%to39%,whichwehaveclearlyseenbasedonthegrowthofHumira,IL-17,andIL-23categories

WewouldnotethatphysiciansinoursurveyusemorebiologicscomparedtopsoriasismarketpenetrationcommentaryfromcompaniesandJPMestimates.Webelievethislikelyduetooursurveyinclusioncriteria,whichselectedforphysicianstreatingseverepsoriasis

51%

44%

39%

34%

60%

50%

40%

30%

20%

10%

0%

1yearago Currently

In1year In3years

TNFsExpectedtoLoseSharetoNewAgents(IL-17andIL-23)OverTime

Ofyourpatientsonbiologics,whatpercentage,ifany,ofpsoriasispatientsareyoucurrentlytreatingwiththefollowingtherapiesandwhatpercentage,ifany,ofpsoriasispatientsdoyouexpecttotreatwiththefollowingtherapiesin1yearandin3years?[0-100%]

SurveyresultssuggestthatTNFswillerodeovertimewithIL-17sandIL-23slikelybeingtheclearbeneficiariesofthischange

IL-23sexpectedtothelargestsharegainerwithinthecategoryfollowedbytheIL-17s

JPMView:TheseresultsreflectourviewofthecompetitivedynamicsoftheevolvingpsoriasismarketwithsignificantpotentialgrowthaheadoftheIL-17sandIL-23sandcontinuedpressureontheTNFsgiventheimprovedefficacyprofilesofthesenewercategories

40%

35%

30%

25%

36%

30%

27%

24%

22%

Current In1-year In3-years

21%

20%

15%

10%

5%

19% 18% 18%

16%

14%

12%

15%14%13%

0%

TNFs(Humira,Enbrel,Remicade,

IL-17s(Cosentyx,Taltz,Siliq)

IL-23/IL-12(Stelara) IL-23(Tremfya,

Ilumya,

Otezla(oralPDE4)

Source:JPMorganResearch Cimzia) risankizumab)

Efficacy/SafetySeenastheMostImportantDeterminantsForNewProductsUseinPsoriasis

Pleaseratethefollowingcharacteristicsonascaleofimportancefrom1to5,where1=notatallimportantand5=extremelyimportant,thatyouconsiderwhendecidingtoprescribeanewproductforthetreatmentofyourpsoriasispatients.

Notsurprisingly,surveyedphysiciansseeefficacyandsafetyasthemostimportantfactorwhenconsideringtheuseofanewdrug

Priceandclinicalexperiencewiththeproductwerealsoseentoinfluencethedecisionprocessandinterestinglyfrequencyofdosingwasseenasrelativelylessimportant

JPMView:ThissupportsourviewthattheIL-17sandIL-23sshouldcontinuetogainshareinthespacebasedontheirsuperiorefficacyassumingnoemergingsafetyissuesfortheseclasses

4.72

4.56

4.08

4.04

3.44

5.0

4.0

3.0

2.0

1.0

0.0

Efficacy Safety/tolerability

Price

Clinicalexperiencewiththeproduct

Dosingfrequency

Source:JPMorganResearch

PhysiciansMoreComfortableWiththeLongTermSafetyofTNFsButNewerAgentsGainingShareonStrongEfficacy

WhatadvantagesanddisadvantagesdoyouseefortheuseofTNFsversusIL-17sinthetreatmentofyourpsoriasispatients?

KeyadvantagesofTNFs:(1)Longersafetyandefficacydata;(2)betterforjointdisease/PsA;(3)betterinsurancecoverage;and(4)canbeusedinpatientswithIBD

KeydisadvantagesofTNFs:(1)Worseefficacyvs.IL-17s;(2)worseside-effects;and(3)Blackboxwarnings

JPMView:WithfirstapprovalofHumirainPsoriasisin2008,TNFswillalwayshavelongersafetyandefficacyfollowup.The5year+datafromCosentyxandTaltzcontinuestolookstrongandtheseassetshavepenetratedthepsoriasismarketevendespiteshorterfollowup

AdvantagesofTNFs

“Cardiacprotective”

“Tnfhasworkedwellforyearsformanypatients…Tnfhaslongersafetydataandmorejointspecificdata.Tnfcanbeusedforpatientswithibd”

“HavefoundtheTNFstobealittlemoreeffective”

“LongtermlegacyofuseandcomparableefficacyinPsA”

“TNFshaveeasieraccess,betterforjointdisease”

“TNFshavebeenonthemarketlongerandmorechanceofbeingonformulary”

“Betterforjointsandusuallypreferredbypayers”

“TNFshavebeenaroundlonger,morefamiliarwithsafetyandefficacy”

“l(fā)ongertermsafetydataandaffordability/coverage”

“Easiertoobtainbyinsasfirst-line.VerygoodPSAresponses”

“Betterinsurancecoverage”

“WoulduseTNFsforpatientswhoarebiologicnaive,thosewhohaveIBD,femalepatientsbreastfeedingorpregnant”

DisadvantagesofTNFs

"TNFsarelesseffective"

"BetteroverallefficacywIL17"

“Blackboxwarning“vs.“noblackboxwarningsfortheIL-17s”

“MuchlesseffectiveforPSO.Morepotentialside-effects"

“Sideeffectsareworst”

ReimbursementLandscapeAppearstoBeImprovingForPatients

Comparedto1-2yearsago,howdifficult,ifatall,hasobtainingreimbursementfortheuseofbiologicsforpsoriasisbeenforyouandyourpatients?

Themajorityofphysicianshaveeitherseennochange(40%)inthereimbursementlandscapeoralessdifficultenvironment(36%)withonly12%havingamoredifficulttimesecuringreimbursementforpatients

JPMView:Theoverallreimbursementlandscapeforpatientsappearstobeimproving,supportingcontinuedhealthyvolumegrowthofbiologicsinthepsoriasismarket

40%

36%

12%

8%

4%

45%

40%

35%

30%

25%

20%

15%

10%

5%

0%

Itismuchmoredifficult

Itissomewhatmoredifficult

Ihavenotseenadifference

Itissomewhatlessdifficult

Itismuchlessdifficult

HumiraRemainsthePreferredTNFinPsoriasis

AmongthedifferentTNFs,whichofthefollowing,ifany,doyoupreferandwhy?

80%oftherespondentschoseHumiraastheirTNFofchoicetotreatpsoriasispatients

Thispreferencewaslargelydrivenbyefficacy,easeofinjection,LTsafetydataandbroadinsurancecoverage

JPMView:ThissupportsourviewofHumirabeingthedominantTNFwithinthedermspaceowingtoitssafety/efficacyprofile,easeofuseaswellasitseaseofaccessandbroadinsurancecoverage

80%

8%

4%

4%

Quotesfromrespondents

"It'sbeenaroundthe2ndlongest;hasmuchbetterefficacythenEnbrelandIjust"trust"itmore."

"Decadesofusewithoverallgoodcontrolandpredictableresultsandsideeffects"

"Bestefficacy,dosingandlongtermsafety"

"Goodresponses,coversPSOandPSA,usuallywellcoveredbyins"

"Bestlongtermdataonsafetyandefficacy"

"Longhistoryandgoodefficacy"

"efficacyinskinandjoints,topnotchsupportprograms,frequentrepvisits"

"ReadilyavailablethroughgoodpriorauthorizationProgram"

"workswellformostpsoriasispatientsandtheirarthritis"

100%

80%

60%

40%

20%

0%

Humira Enbrel NoTNFpreferred

Cimzia.

IL-17sHaveMeaningfullyInfluencedtheTreatmentParadigmForMajorityofSurveyedPhysicians

Howmeaningful,ifatall,hastheavailabilityofTaltzandCosentyxbeentoyourcurrentandfuturetreatmentparadigmforpsoriasispatients?

48%ofsurveyedphysiciansseeIL-17shavingatleastamoderatelymeaningfulimpacttotheirtreatmentparadigminpsoriasis

Amajorityofsurveyedphysiciansseecurrentuseinsecond-line,TNFfailurepsoriasispatientswhileattimesdisplacingTNFsasthetreatmentofchoiceinthefrontlinesettingdependingonformularycoverage

JPMView:WeseetheIL-17scontinuingtogainshareinthespaceasphysicianfamiliaritywiththeclassgrowsandeventuallyseetheseagentsmovingearlierinthetreatmentparadigm

35%

30%

25%

20%

15%

10%

5%

0%

32%

24%

20%

12%

8%

4%

6-

Extremelymeaningfulchange

5-Verymeaningfulchange

4-

Moderatelymeaningfulchange

3-

Somewhatmeaningfulchange

2-Slightlymeaningfulchange

Quotesfromrespondents

"Itallcomesdowntoformularycoverage."

"Iusethisforpatientswithseverepsoriasisandwithpsoriatic

arthritis"

"nowfirstlineorsecondlineagents"

"initialdifficultyinprescribinghascontinuedtokeepmefrom

prescribing"

"Alternativeoptionsiffirstlinedrugisnoteffectiveorcoveredbyinsurance"

"Useaftertnffailureandsometimesfirstlineforseverediseaseandhaveinsurance"

"ifIhavenon-responderstohumira,remicaide"

"ForbiologicsnaiveorforthosewhofailTNForIL12,23inhibitors"

"Itreplacesotherbiologics"

1-No

meaningfulchange

SurveyedPhysiciansSeeCosentyxastheMostWidelyUsedIL-17

OfyourpatientsonIL-17,whatpercentage,ifany,ofyourpsoriasispatientsareyoucurrentlytreatingwiththefollowingtherapiesandwhatpercentage,ifany,ofyourpsoriasispatientsdoyouexpecttotreatwiththefollowingtherapiesin1yearandin3years[0-100]%

WhilesurveyedphysiciansexpectTaltztotakesomesharefromCosentyx,theyexpectCosentyxtocontinuetorepresent>50%IL-17marketshare

Asasecondentrant,thesurveyedphysiciansexpectTaltzsharetoexpandat~40%ofthecategory

SurveyphysiciansseeafairlymodestroleforBauschHealth’sSiliq

JPMView:ThissharesplitisconsistentwithourviewthatbothCosentyxandTaltzcontinuetohavegrowthopportunitiesaheadinpsoriasis(asIL-17sgainshare)aswellasadditionalindicationssuchaspsoriaticarthritisandAxSpA.

56%

52%

51%

42%

42%

39%

5%

6%

7%

60%

50%

40%

30%

20%

10%

0%

Currently

Cosentyx

In1-yearTaltz

Siliq

In3-years

AMajorityofSurveyedPhysiciansSeeTaltzandCosentyxasComparable

DoyouhaveapreferencebetweenTaltzandCosentyx?Pleaseelaborateonyourpreference

60%ofsurveyedphysiciansseeTaltzandCosentyxascomparable

Roughlythesame%ofphysicianshaveapreferenceforTaltzorCosentyx(20%vs.16%)

WenotethatCosentyxwasfirsttomarketintheIL-17categorywhileTaltz’slabeliscatchingupwithCosentyxafteraddingpsoriaticarthritisandwithankylosingspondylitisexpectedthisyear

JPMView:WeseethemarketsharegapbetweenTaltzandCosentyxnarrowingovertimewhileconsensusestimatesforTaltz(whichimplyflatteninggrowth)remaintoolowinourview

60%

20%

16%

4%

70%

PreferenceforCosentyx

"Longerrealworldresultsandsideeffectsknown"

"longersafetydataavailable,lessinjectionsitereactions"

"Easieraccess,patientsupportprogram"

"Bettersupportfromrepandbetterclinicalstudiesaswellasmorepreferred1stline"

PreferenceforTaltz

"Ithinkitworksfasterandrequireslessmedicineforaloadingdose"

"higherlongtermefficacy,fewerinjections"

"Ithinkitworksalittlebetter"

"BetterresultswTaltz"

60%

50%

40%

30%

20%

10%

0%

No,TaltzandCosentyxarecomparable

Yes,IpreferCosentyx.

Yes,IpreferTaltzDon’tpreferthe

IL-17classofmolecules

SurveyedPhysiciansExpressModestPreferenceForIL-17svsIL-23s

DoyouhaveapreferencebetweenTaltzandCosentyx?Pleaseelaborateonyourpreference

44%ofsurveyedphysiciansexpressnopreferencebetweenIL-17sandIL-23s

Whilealarger%ofphysicianspreferIL-17soverIL-23s(34%vs.20%)

ThispreferenceisinlargepartduetoIL-17sfirsttomarketandlongertermdata

JPMView:WeseethemarketsharegapbetweenIL-17sandIL-23snarrowingovertimealthoughIL-17sholdasignificanttimetomarketadvantage.WenotetherecentlaunchofAbbVie’sSkyrizicouldacceleratingclassmarketsharedynamics

50%

45%

40%

35%

30%

25%

20%

15%

10%

5%

0%

44%

32%

20%

4%

No,IL-17sandIL-23sarecomparable.

Yes,IpreferIL-17s.

Yes,IpreferIL-23s.

PreferIL-17s

havehadbetterresultsIL-17

Worksbetter

moreexperiencewithIl-17agents

efficacyandpersonalexperience.haveseenmoreimprovementofPsAwithil-17

IthinktheyaremoreeffectiveduetoMOA

experienceandfamiliarity

usedthemlonger

PreferIL-23s

slightlyhigherPASI100,donothavetoworryaboutIBD,betterdosingconvenience

Moreeffective

IhavesomeconcernaboutinjectionsitereactionswithTaltzandIBDwiththeIl-17s

Theefficacyanddosingfrequencyaremorefavorabletothisclass...alsotheabilitytouseintheIBDpatients.

Ithinktheyarecomparableinefficacy;IL-23sdonothavethepotentialcomplicationofGIsideeffects

No,preferanotherclassofmolecultes

SurveyedPhysiciansSeeaComparableProfileForIL-17sandIL-23s

Forthenewerbiologicagentsforpsoriasis(IL-17s,IL-23s),howwouldyourateeachproductclassbasedon(a)efficacy,(b)safetytolerability,(c)productexperienceinclinicaluse,(d)payercoverage,and(e)likelihoodtoprescribe?

MostsurveyedphysiciansseetheIL-17andIL-23categoriesascomparable

Theonlymeaningfulseparationbetweenthetwocategoriesrelatestopayercoverage(40%IL-17svs24%IL-23s)

JPMView:FurthersupportsourviewofthemarketsharegapbetweenIL-17sandIL-23snarrowingovertime

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

92%92%

88%88%

76%76%

76%72%

40%

24%

Efficacy Safety/Tolerability

Payercoverage

Likelihoodtoprescribe

PreferenceforCosentyx

"Longerrealworldresultsandsideeffectsknown"

"longersafetydataavailable,lessinjectionsitereactions"

"Easieraccess,patientsupportprogram"

"Bettersupportfromrepandbetterclinicalstudiesaswellasmorepreferred1stline"

PreferenceforTaltz

"Ithinkitworksfasterandrequireslessmedicineforaloadingdose"

"higherlongtermefficacy,fewerinjections"

"Ithinkitworksalittlebetter"

"BetterresultswTaltz"

Productexperiencein

IL-17s IL-23s clinicaluse

MixedViewsonCurrentPositionofIL-23s,HoweverThisCouldChangeasPhysiciansGainMoreExperienceWiththeClass

PleasedescribehowTremfya/Ilumya/risankizumab(IL-23s)fitintoyourcurrenttreatmentparadigmforyourpsoriasispatients?

JPMView:Thesecommentssupportthedatafromthepreviousquestionthattherearemixedfeelingsacrossphysicians;withsomereadytoprescribeimmediatelyasfirstline,whileotherswillrequiremoreexperiencewiththeclassaswellaslongertermfollowupdata

Negativequotesfromrespondents

“Donotseeasaneartermoptionforme”

“Theydon't”

“Notfamiliarenoughtofeelcomfortableprescribing”

Positivequotesfromrespondents

“Growingpartofthepractice”

“GoingforwardIexpecttoincreaseusageoftheseagentsandatanearlierpointinmytreatmentparadigm”

“Ihavejustrecentlystartedprescribingthem,butplantocontinue”

Quotesindicativeof1stline

“Theyaremyfirstlinechoice”

“Mytypicalfirstlinetherapyandmypreferredclassoftherapy”

“Ihaveincreasinglystartedusingthemasfirst-lineagents”

Quotesindicativeof2nd/3rdline

“HaveusedinpatientswithfailuretoIL17andtnf”

“Ifalltheothersstopworking”

“3rdline”

“Secondor3rdlineagent”

18

MajorityofSurveyedPhysiciansSeeTreatmentParadigmChangingWiththeIntroductionofIL-23s

Howmeaningful,ifatall,isandwilltheavailabilityofTremfya,Ilumyaandrisankizumabbetoshapingyourcurrentandfuturepsoriasistreatmentparadigm?

ThemajorityofsurveyedphysiciansbelievetheavailabilityofTremfya,Ilumyaandrisankizumabwillshapethecurrentandfuturepsoriasistreatmentparadigm

56%seesomewhat-moderatelymeaningfulchange;28%seeno-slightlymeaningfulchange;16%seevery-extremelymeaningfulchange

28%

56%

16%

32%

24%

16%

12%

12%

4%

Nomeaningfulchange

Slightlymeaningfulchange

SomewhatmeaningfulChange

Moderately Verymeaningful Extremelymeaningful change meaningfulchange change

JPMView:ThisdatasuggeststousthatphysicianswillswitchfromTNFstotheIL-23class.Thespeedoftheswitchislikelysomewhatdependentonphysicianexperienceaswellaslongertermdatapresentationsfromtheclass.Thedatabelowsuggeststhat16%mayswitchfairlyquicklytoIL-23s;whereas,56%(somewhatandmoderate)maytakesometimetoswitchtousingIL-23s

35%

30%

25%

20%

15%

10%

5%

0%

Source:JPMorganResearch

19

Note:Listofalltheanswerscanbefoundintheappendix

LongerTermData,Joint/PsAEfficacyandBetterInsuranceCoverageCouldAllDriveUptakeoftheIL-23Class

WhatwouldyouneedtoseefromIL-23agentstoswitchyourprescriptionsfromIL-17s/anti-TNFs/IL-23/12s?

WhileafewofthesurveyedphysiciansindicatedthattheyarealreadycomfortablewithprescribingIL-23sanddonotneedtoseemoredata,therewerethreekeythingsthatwerehighlighted:

Longertermefficacyandsafetydata

Goodjoint/PsAefficacy

Betterinsurancecoverageandeasieraccess

AlreadyuseTremfya

“Nothing.AlreadyuseTremfya”

“Reallynothing,IthinkitIL-23sandIL-17sarecomparableintermsofefficacyandsafety,otherthantheGIissuewithIL-17s”

Longertermefficacyandsafetydata

“Moreuseandfeedbackofresultsofuseandanysideeffects”

“Longtermefficacyandsafety”

“Justtheefficacydata,tolerability,andsafetyinformation”

“Durabilitydata”

“Highersafetyandefficacy”

“Comparableresponseratestoil-17withsamesafetyprofileasStelaraandTremfyasofar(verygood)”

Goodjoint/PsAefficacycomments

“Increasedefficacy,improvementinPSA,longtermsafety,payercoverage”

“ContinuedgoodlongtermsafetyandefficacydataandreasonabledatainPsA”

“5yearsafetydata,jointefficacycomparabletotheotherclassesofagents”

“Moreeffectiveforpsoriaticarthritis”

“Goodjointdata”

Betterinsurancecoverageandeasieraccess

“Bettercoverage”

“Easieraccesstothedrugforpatientsonmostinsuranceplans”

“Efficacyandinsurancecoverage,easieraccesstodrugwithoutthehasslesofpriorauthorization”

“Affordability/insurancecoverage”

“Greatavailabilityandcoveragealongwithsolidclinicalresults”

“Betteraccess!Mosthavetofailothertherapiesfirstbeforebeingapprovedforil23s”

20

TremfyaCurrentlyMostPreferredIL-23,PrincipallyDuetoEarlyMoverAdvantage

DoyouhaveapreferencebetweenTremfya,Ilumya,andrisankizumab?Pleaseelaborateonyourpreference.

MostsurveyedphysicianspreferTremfya,notinglongerdataandexperiencegivenfirsttomarket

40%ofsurveyedphysicianshighlightingapreferenceforTremfya,28%believingIL-23sarecomparableand16%notpreferringtheIL-23classofmolecules

The28%ofsurveyedphysicianswhobelievethatIL-23sarecomparablenotelackofevidence/experiencetofullycompareyet

JPMView:ItnotentirelysurprisingthatTremfyaismostpreferredgivenitsalmost2yearheadstartoverrisankizumab.Whileotheragents,particularlyrisankizumab,maytakeshareintheIL-23class,webelievetheclassasawholeislikelytogrowasittakessharefromtheTNFs

45%

40%

35%

30%

25%

20%

15%

10%

5%

0%

40%

28%

16%

12%

4%

PreferenceforTremfya

“Worksbetter”

“Moreexperience”

“FirsttomarketsoIhavemoreexperiencewithit”

“Quickonsetofaction”

“LongerdataoutthereandJanssenisagoodcompany”

“Havebeenusingfirstbutwillingtotrytheothers”

“Havenotseenareasontousetheothersyet”

“Ihavenotyetusedrisankizumab”

Preferenceforrisankizumab

“Moreeffective”

“MostconvenientdosingcombinedwithhighestPASI90and100numbers”

“Seemstohavethebestdataandwilllikelybemypreferredbiologicwhenavailable”

PreferenceforIlumya

“Ipreferthedosingschedule”

DonotprefertheIL-23classofmolecules

“Haven’treallystart