AstraZeneca’s Fasenra puts more pressure on GSK’s Nucala with expanded NICE backing

Back in mid-2018, AstraZeneca’s Fasenra hit a speed bump as England’s drug cost watchdog recommended it only when GlaxoSmithKline’s rival asthma drug Nucala wasn’t appropriate. But now, the AZ drug is in the fast lane thanks to an expanded recommendation.

In renewed draft guidance, the National Institute for Health and Care Excellence (NICE) removed the previous restriction on Fasenra, allowing it to be funded for an expanded pool of patients in England and Wales with severe eosinophilic asthma.

Unsurprisingly, AZ agreed to take a confidential discount off its £1,955-per-syringe list price to win NICE backing; after all, the agency had previously said the drug was not cost-effective compared with Nucala. But this time, the agency went so far as painting Fasenra as a possibly better option than Nucala and Teva Pharmaceutial’s Cinqair, both of which have NICE nods.

Fasenra is given every four weeks for the first three doses and then every eight weeks. Compared with Nucala and Cinqair’s schedules of every four weeks throughout treatment, Fasenra is "potentially more convenient," NICE noted in a statement.

Approved by the FDA in November 2017 and in the EU in early 2018, Fasenra headed into a fierce competition with Nucala, which enjoyed a two-year head start, and was followed closely with Sanofi’s Dupixent, which in October earned a severe asthma nod that analysts predict will add $2.5 billion to its peak sales.

In the third quarter, AZ recorded $86 million with Fasenra, while growth for Nucala was flat at £145 million ($183 million) after the second quarter's £141 million performance. And according to GSK Chief Financial Officer Simon Dingemans, GSK is expecting growth for the next few quarters "to be a bit more challenging" as competition picks up, he said on the company’s Q3 earnings call.

On the call, pharma chief Luke Miels—a former AZ executive—tried to inspire investor confidence, saying the company's Nucala had "very much held [Fasenra] in place in Japan and Europe." Miels did acknowledge the threat from Fasenra and Dupixent, but he stressed that it wasn't necessarily about the products themselves, but "about execution." With that in mind, GSK has changed out some key members of the Nucala team in the U.S. and has bumped up financial backing behind the drug.

Doctors seem to like the AZ drug’s quickness to action and its convenience, which is why GSK is planning to launch an auto-injector version of Nucala for at-home use in 2019. But in AZ’s Q3 call a few days later in November, CEO Pascal Soriot played down the importance of its very own home-use program.

"What we have from physicians is in severe asthma … being able to bring the patient every couple of months to the office to inject Fasenra is also good from a compliance viewpoint and follow-up," Soriot said.