Competition intensifies in 3-combo drug mkt for COPD·asthma

GSK sets out to defend market

Kolon introduces Trimbow, GSK expands its Trelegy Ellipta lineup

Whether AstraZeneca will introduce Breztri Aerosphere to the market also gains attention

GSK’s triple therapy for COPD,

Competition in the market for three-drug combinations used to treat COPD (chronic obstructive pulmonary disease) and asthma has become somewhat complicated.

 

Kolon Pharma’s Trimbow, which was introduced in January, triggered the competition, and GSK’s Trelegy Ellipta, which had enjoyed its sole lead in the market till then, strengthened its line-up in response.

 

According to industry sources on the 22nd, GSK Trelegy Ellipta will be reimbursed for the treatment of asthma in addition to COPD starting next month.

 

The Ministry of Health and Welfare issued a pre-announcement of the amendment to the revised drug reimbursement standards that Trelegy Ellipta will be reimbursed for the treatment of "severe asthma that is not adequately controlled with a combination of moderate-or high-dose inhaled corticosteroids and a long-acting inhaled beta-2 agonist,” starting on March 1st.

 

With the reimbursement, Trelegy Ellipta’s competitivity in the market will increase further as it will be available for severe asthma in addition to its existing indication for moderate-to-severe COPD in adults.

 

Trelegy Ellipta had been dominating the Korean market with its low drug price but is now facing competition with Kolon Pharm's Trimbow inhaler which was introduced in January.

 

Moreover, the new inhaler can be used for both asthma and COPD.

 

With Trelegy Ellipta’s reimbursement also extended to COPD, the two drugs will now be fully engaged in a one-on-one competition.

 

The price of Trelegy Ellipta is slightly less expensive.

 

Its price remains the same at KRW 45,602 per box even with the coverage expansion.

 

Trimbow is only KRS 1,000 more expensive, at KRW 46,669.

 

However, Trimbow seems to have scored a win by obtaining a higher price than Trelegy Ellipta.

 

Trimbow has both asthma and COPD indications, and was regarded as an alternative to Novartis’s triple therapy ‘Enerzair Breezhaler 150/50/160μg’ (upper limit price KRW 65,502) for asthma and ‘Trelegy Ellipta (upper limit price (upper limit price KRW 45,602)’ for COPD, and was priced below 90% of the weighted average price of the two drugs.

 

If Trimbow only owned an indication for COPD, its price would have been set lower than that of Trelegy Ellipta, however, owning the two indications allowed for the drug to receive a price higher than that of Trelegy Ellipta.

 

Therefore, the competition between the two drugs are likely to begin in earnest due to their similar indications and prices.

 

In addition to adding the asthma indication Trelegy Ellipta, GSK was successful in receiving reimbursement for its higher-dose Trelegy 200 Ellipta Inhaler to the list this time.

 

However, Trelegy Ellipta 200® Inhaler is only used for asthma.

 

Therefore, its alternative, ‘Enerzair Breezhaler 150/50/160μ (upper limit price KRW 74,115)’ became the basis for its pricing negotiations.

 

As a result, Trelegy Ellipta 200® Inhaler was listed at KRW 65,500 per box, after accepting a price below 90% of its alternative.

 

With the reimbursement extension for its Trelegy Ellipta and the new listing of the Trelegy Ellipta 200®, GSK will now be able to adopt a two-track strategy in Korea’s asthma inhaler market.

 

Industry analysis is that the new additions will contribute to broadening the choice for patients in Korea, with the lower-priced Trelegy Ellipta and the higher-priced, higher-dose Trelegy Ellipta 200.

 

Also, GSK voluntarily reduced the price of its 2 inhaled single-agent products to help ease the financial burden of the patients.

 

The price of Arnuity 100 Elipta (fluticasone furoate) for asthma was reduced from KRW 19,973 to KRW 17,376, and Incruse Elipta (umeclidinium bromide) for COPD was reduced from KRW 38,438 to KRW 34,978.

 

The measure is considered to have been made in strategic response to the introduction of Kolon’s triple therapy product.

 

Going forward, a key question for the triple combination market is whether AstraZeneca will introduce its Breztri Aerosphere in the market.

 

The drug received conditional approval from the Drug Reimbursement Evaluation Committee in May of last year, that its reimbursement would be adequate if it is priced below the assessed value.

 

The company has since applied for reevaluation to DREC, but no results have been disclosed since.

 

However, when listed, it would be difficult for Breztri Aerosphere, which only has an indication for COPD, to receive a price higher than that of Trelegy Ellipta, which currently has the lowest price.