MrgprX2 antagonists(Haipaitec)

Novartis has reignited its competitive streak, targeting the reign of Dupixent (dupilumab), the newly crowned “autoimmune drug king” from Sanofi. The company has initiated a head-to-head Phase III trial for its investigational BTK inhibitor remibrutinib against Dupixent, aiming to disrupt the dominance of this top-tier therapeutic. This is not Novartis’ first strike at market leaders. In the past, its blockbuster Cosentyx (secukinumab) outperformed AbbVie's Humira and Johnson & Johnson’s Stelara in direct head-to-head trials, cementing its position as a key player in psoriasis treatment. However, despite these wins, Novartis’ 2024 autoimmune business revenue of $9.293 billion left it short of the $10 billion milestone and outside the top three in the field. Industry giants such as AbbVie, Johnson & Johnson, and Sanofi dominate the autoimmune space with super blockbuster drugs. AbbVie leads with a commanding $11.7 billion in Skyrizi sales and strong growth from Rinvoq, while Johnson & Johnson relies on products like Stelara and Tremfya. Sanofi, with Dupixent achieving $14.2 billion in sales, has solidified its position as the third-largest player in the sector. Novartis, though just shy of the $10 billion mark, is not backing down. Cosentyx, its flagship IL-17A inhibitor, has driven significant revenue growth, reaching $6.141 billion in 2024 sales, thanks to approvals for multiple indications like plaque psoriasis and psoriatic arthritis. Expansion into conditions such as polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), with Phase III trial results expected in 2025, could further elevate its market potential to $8 billion in peak sales. Yet, its other autoimmune drugs lag behind. Xolair (omalizumab), co-developed with Roche, generated $1.643 billion outside the US, but faces increasing pressure from Dupixent, which is now approved for chronic spontaneous urticaria (CSU) in Japan and awaiting FDA approval. Additionally, Chinese competitors are advancing innovative IgE-targeting therapies, challenging Xolair’s dominance. To counter these threats, Novartis has taken bold steps. It became the first company to file for remibrutinib’s approval in CSU treatment in China and has begun the RECLAIM Phase III trial, comparing remibrutinib directly with Dupixent. As a highly selective, oral, and irreversible BTK inhibitor, remibrutinib offers convenience over injectable biologics, with Novartis projecting $3 billion in peak sales. Additionally, Novartis secured an $830 million deal with Kyorin Pharmaceutical to develop MRGPRX2 antagonists like KRP-M223, targeting allergic and inflammatory mast cell diseases such as CSU. This emerging class of drugs represents a blue ocean market, with few competitors currently in clinical trials. Novartis is also advancing a robust autoimmune pipeline, with 15 early-stage and 8 late-stage clinical programs exploring diverse mechanisms, including NLRP3 inhibitors, CD19 CAR-T therapies, and BAFF-R monoclonal antibodies. Analysts suggest that Novartis’ strategy of head-to-head trials, pipeline diversification, and strategic licensing could help secure its place in the $100 billion autoimmune market. While challenges remain, including strong competition from Sanofi and Johnson & Johnson, Novartis’ aggressive moves could reshape the landscape, positioning it as a leading force in the autoimmune sector.