AbbVie’s Humira was the top-selling drug in the world for many years. Now, its sales are eroding as doctors switch to biosimilars and new options enter the market.
Immunology physicians are starting to adjust to the new treatment paradigm brought on by the entry of Humira biosimilars, sending sales of AbbVie’s mega-blockbuster down precipitously. But the transition has been slow, with these emerging competitors struggling to gain market share. At the same time, care providers are simply moving on to other treatment options.
Last year, Boehringer Ingelheim bowed to the headwinds facing its biosimilar Cyltezo and laid off staff due to slow uptake. At the time, Reuters reported that customers were sticking with the branded version, which remained on pharmacy benefit managers’ reimbursement lists.
Prescribers seem to be finally coming around, according to Lynn Price, insights franchise head at Spherix Global Insights. She told BioSpace in an email that the firm’s network of rheumatologists, dermatologists and gastroenterologists are reporting an increased uptake of Humira (adalimumab) biosimilars.
“In many instances, we hear that they have resorted to simply writing ‘adalimumab’ on prescriptions and what is on formulary for that patient will get approved and filled,” Price said.
Cyltezo is one of about a dozen available Humira biosimilars. Other offerings include Amgen’s Amjevita, Pfizer’s Abrilada and Viatris’ Hulio. Many of these companies are not reporting sales for their products, save for Amgen, which recorded a YOY 22% increase in sales to $761 million for 2024, its first full year on the U.S. market. Amjevita launched in Europe in 2018 as Amgevita, bringing in $460 million in that market alone for 2022.
Sandoz recorded double-digit growth for its biosimilar portfolio thanks to adalimumab copy Hyrimoz, according to a fourth-quarter earnings report. Individual sales for the product were not disclosed, but Hyrimoz contributed to a 30% increase in sales for Sandoz’s biosimilars portfolio, which recorded $2.9 billion for 2024.
The companies have also been jockeying over pricing, which is key in the post-patent market. Sandoz signed a private label agreement with CVS subsidiary Cordavis, which works with manufacturers to commercialize biosimilars in the U.S. Hyrimoz was the first product to be included under the Cordavis private label, making its list price 80% lower than the cost of Humira at the time of the initiative’s launch in April 2023.
Then in April 2024, CVS Caremark removed branded Humira from its formularies, sending prescriptions for Hyrimoz skyrocketing.
Humira peaked in 2021 with $22 billion in sales. It became the highest grossing drug of all time, sparking investigations from Congress into AbbVie’s pricing and marketing practices.
The list price for the injectable biologic is currently around $1,800 for a box of two pens, according to Good Rx. Patients rarely pay the full retail price, however.
Boehringer Ingelheim’s Cyltezo has a similar list price to Humira, though the German pharma struck a deal with GoodRx in July 2024 to offer its copycat version at $550 per two-pack for patients who buy it from the online pharmacy. The lowest option on GoodRx is Pfizer’s Abrilada at $539 for a two pack.
Specialists Shift Preferences
The preferred biosimilar seems to vary by specialty, said Price, whose firm conducts frequent surveys of various doctors across specialties to analyze trends in biosimilars. Humira is approved for eight diseases, including rheumatoid arthritis, psoriatic arthritis, Crohn’s disease, ulcerative colitis, hidradenitis suppurativa and uveitis. The drug is primarily used for stubborn cases of these diseases, where patients do not respond to less invasive options, like topicals.
Rheumatologists surveyed by Spherix have seen the branded drug’s share of use in the more advanced form of rheumatoid arthritis decline from 22% overall in the fourth quarter of 2023 to 16% in the same period of 2024. In the same time period, biosimilar share has grown from 3% to 10% in advanced rheumatoid arthritis. Humira is expected to drop to just 12% usage by mid-year 2025. Other drugs prescribed for the condition include Amgen’s Enbrel, J&J’s Simponi and many others.
Looking at total adalimumab use in all forms of rheumatoid arthritis, AbbVie’s product has hung on to about 62% of the total pie, while biosimilars are at 38%, Price said. The overall split is expected to move toward 50/50 in the next six months.
Hyrimoz has emerged as the biosimilar of choice among rheumatologists but Price said this has more to do with payer dynamics and familiarity than a preference for one particular version over another. The specialists estimated that Hyrimoz has about one-third of the rheumatology adalimumab biosimilar prescriptions. Amgen’s Amjevita and Samsung Bioepis and Organon’s Hadlima are the other leading biosimilars.
In dermatology, Humira use for advanced systemic cases of plaque psoriasis—those that typically do not respond to topical treatments—has shrunk from 13% to 10% since the third quarter of 2023. Meanwhile, biosimilars grew from 2% to 4%, according to Spherix’s most recent analysis. Humira use is expected to drop to about 7% in this indication by mid-year as biosimilars grow to 5%.
But biosimilars are not the only reason dermatologists are ditching Humira, a tumor necrosis factor (TNF) blocker. “Dermatologists have been moving away from TNFs and Humira for the treatment of psoriasis well before the introduction of adalimumab biosimilars based on the competitive in-line advanced systemic set that offers full to near complete skin clearance,” Price said.
Biologic drugs like Johnson & Johnson’s Stelara and Remicade, AbbVie’s own Skyrizi and Novartis’ Cosentyx have become the go-to options for this disease.
For those still taking adalimumab, dermatologists are leaning toward Amjevita for psoriasis scripts, with Amgen’s option capturing about 25% of the market. Hyrimoz is second with 17%.
Over in gastroenterology, Humira use for advanced Crohn’s disease has slipped from a 19% share to 14% from the third quarter of 2023 to the same period in 2024. Meanwhile, biosimilars have grown from 3% to 6% in the same time frame. Humira is expected to erode to just 11% by mid-year, while biosimilars will remain flat at 6%. Price said the drug is simply falling out of favor for this indication as other options rise. For what’s left of the adalimumab market, the split between branded Humira and biosimiiars will likely be about 65% to 35% in six months, according to the gastroenterologists in Spherix’s network.
The American Gastroenterological Association recently revised its guidelines for treating ulcerative colitis, recommending other options like Remicade, J&J’s Simponi, Takeda’s Entyvio, Gilead and Eisai’s Jyseleca or Eli Lilly’s Omvoh and others over adalimumab. While this only applied to ulcerative colitis, Price predicts prescribing habits for Crohn’s could change as well.
Gastroenterologists prefer Amjevita with 26% of scripts, followed by unbranded adalimumab and Hyrimoz.
After much jockeying from AbbVie to maintain Humira’s market-leading position and sky-high sales, the drug seems to be taking a natural retirement as newer options emerge. During Humria’s heyday, billions of dollars flowed into inflammation and immunology in hopes of catching a snippet of the market. Spherix’s data suggests the torch is now being passed.
