A simpler GLP-1, plus big-market launches

Competitive environment

Treatment for plaque psoriasis includes topical creams or ointments, light therapy, and systemic therapies. Systemic drugs travel through the bloodstream, reaching and affecting cells all over the body.

Systemic drugs include injectable biologics (including other IL-23 antagonists) and oral disease-modifying therapies like Sotyktu® and Otezla®. They are generally used in patients with higher disease activity or when topical therapy is challenging. 

Icotrokinra would be the first orally administered IL-23 antagonist. In head-to-head studies vs. Sotyktu, an orally administered tyrosine kinase 2 (TYK2) inhibitor, icotrokinra demonstrated a statistically significant improvement in the primary endpoints. The studies looked at both PASI90 and IGA responses, commonly used measures of psoriasis severity and improvement. PASI90 responses were about 55% to 57% with icotrokinra vs. 30% to 34% with Sotyktu and the IGA response was about 70% for icotrokinra vs. 50% to 54% with Sotyktu. These results not only demonstrate the superiority of icotrokinra vs. Sotyktu, but when compared indirectly, show that icotrokinra provided the highest response rates of any oral disease modifying therapy approved for plaque psoriasis. It was also generally well tolerated in the clinical trials with no major safety concerns.

Compared indirectly, icotrokinra provides similar efficacy to Stelara® (ustekinumab), an injectable IL-12/23 inhibitor with available biosimilars. Johnson & Johnson is hopeful that icotrokinra will provide similar or better response rates than Stelara and is conducting a head-to-head trial which is expected to complete in March 2026. 

When compared indirectly to other injectable biologics, such as Tremfya, icotrokinra provides lower response rates. For healthcare providers and patients who prefer the drug with the highest likelihood of treatment success, biologic injectables will likely still be selected. As with other drugs in this category, icotrokinra is being studied for additional indications, with psoriatic arthritis likely to follow the initial psoriasis approval.

For reference, the wholesale acquisition cost (WAC) for Tremfya, Johnson & Johnson’s injectable IL-23 antagonist, is approximately $87,000 per year. This cost estimate is more than six times that of the alternative Humira and Stelara biosimilars.

Competitive environment

If approved, orforglipron would be the direct competitor to Novo Nordisk’s oral Wegovy and the second oral GLP-1 drug for weight loss. Across different studies, the weight reductions are similar for orforglipron compared to oral Wegovy. Overall, oral drugs for weight loss, including Wegovy, do not provide the amount of weight loss seen with injectable GLP-1 drugs like injectable Wegovy or Zepbound.

The primary differentiator for orforglipron is that it’s designed to be taken orally, without restrictions on food or liquid intake. Oral Wegovy must be taken in the morning on an empty stomach 30 minutes prior to food or any liquids except water.

Like other GLP-1 drugs, including semaglutide, orforglipron has been evaluated to treat type 2 diabetes. The trial results were positive, including in a head-to-head study demonstrating superiority for A1C reduction vs. oral semaglutide. Eli Lilly is expecting to apply for approval for a new indication for type 2 diabetes this year, with potential approval in late 2026.

For reference, the wholesale acquisition cost for Zepbound, Eli Lilly’s injectable GLP-1 drug for weight loss, is approximately $13,000 per year.

Competitive environment

Xocova would be the first preventive treatment for COVID-19 infection that would be effective after exposure. It would potentially have a similar place in therapy for COVID as antivirals like Tamiflu® have for influenza. In addition to this initial preventive indication, Xocova is approved to treat COVID-19 outside of the U.S. That could become a potential future use here in the U.S.

The key clinical study found a 67% reduction in the risk of developing symptoms of COVID-19. Nearly all the study participants had antibodies to COVID-19 before this exposure. It’s difficult to know if Xocova can provide protection against severe COVID-19 outcomes because there were no hospitalizations nor deaths in either the treatment nor placebo group. The study also required household contacts to be treated within 72 hours of exposure to a person with COVID-19, so Xocova’s ability to protect will likely be time sensitive.

The prevention indication for Xocova per the label is expected to be broad. However, its common use in practice is likely to be more concentrated in patients at high risk for severe COVID-19 outcomes (e.g., elderly patients, immunocompromised, smokers). 

For reference, the wholesale acquisition cost for Paxlovid, an antiviral approved to treat COVID-19, is approximately $1,500 per treatment course.