Highlights

Well, I think the number one [unmet need in ulcerative colitis] is that we have agents that are somewhat effective but we kind of have a ceiling of efficacy. We really can’t get much better than 30–40% remission rates, even if with Remicade or Xeljanz or any of these agents, and so what we really need is an agent that can reliably get – you know, kind of break through that ceiling and get you to that 50% to 60% to 70% remission rates that we see with psoriasis and the IL-23s. Something like that, we just don’t have anything that’s really a game changer yet. So that’s number one. Then the number two would be, we have good agents for mild disease, the 5-ASA agents, and we have really good agents for sort of moderate or moderate to severe disease, but there are this big group of people that still have active disease on 5-ASA therapy but you don’t really want to make the big leap to a biologic necessarily. It would be nice to have something that would fit into that niche as well.

Yes. I think some of the [pipeline drugs for ulcerative colitis] that are on the horizon might be an incremental improvement. There’s no game changer unfortunately, but there are definitely, I think, some incremental improvements that are coming. Anti-IL-23s look very, very good and are safe and I think will push the bar a little bit higher. And then the SP1 inhibitors also look good and they’re oral, so I think patients really prefer that. So I think we have some improvements coming down the line. I’ve yet to see anything that’s going to meet that bar of like 70% remission rates. We don’t have that yet.

When Humira has been compared to Entyvio, for instance, it’s not as effective, and I think the issue is that it’s subcutaneous and in UC particularly it’s harder to achieve a therapeutic drug level, and so the efficacy is probably a little bit less than we’d hope for.