The market for ARTA treatment used to treat prostate cancer has been dominated by Xtandi (enzalutamide). As prescription sales of Erleada (apalutamide) rise, the market is shifting.

Astellas Pharma's Xtandi has increased its competitiveness with its indications, Janssen has started to face competition by expanding its portfolio, including Erleada, Zytiga, and Akeega.


According to the pharmaceutical market research firm UBIST, Xtandi generated the highest outpatient prescription sales in this year's first half, KRW 14.1 billion.

Analysis suggests that increased outpatient prescription sales are due to expanded reimbursement. In August 2022, Xtandi was selectively reimbursed for the treatment of patients with advanced prostate cancer accompanied by distant metastasis when used in combination with androgen deprivation therapy (ADT). Since November of last year, reimbursement has been made regardless of using other androgen synthesis inhibitors.

However, the drug price was reduced from KRW 20,882 to KRW 14,170 due to the expanded reimbursement range, affecting prescription sales. Xtandi's prescription sales for this year's Q3 was KRW 8.1 billion, then reduced to KRW 6.6 billion in Q4.

In November last year, the co-payment rate for Xtandi was adjusted from 30% to 5%, canceling out the prescription price reduction. Xtandi's sales recovered, with KRW 6.7 billion in this year's Q1 and KRW 7.4 billion in Q2.

Also, in June, Xtandi expanded its indication to non-metastatic hormone-sensitive prostate cancer (nmHSPC), which is expected to increase prescription sales in the future.

With the expanded indications, Xtandi became the only ARTA treatment that can be prescribed to treat all prostate cancer stages following biochemical recurrence, including hormone-sensitive, castration-resistant, non-metastatic, and metastatic.

An Astellas official said, "Xtandi is the only prostate cancer treatment that can be used to treat hormone-sensitive HSPC at early stages regardless of metastasis, non-metastasis, and the number of metastases." He said, "When the indication to treat nmHSPC was recently approved, the company focused on marketing to raise awareness of the importance of early ARTA combination therapy to treat HSPC."

Erleada chasing Xtandi…Janssen, "To provide patient-individualized treatment option"

Although Xtandi is the market leader, Janssen's Erleada, which has been reimbursed since last year, rapidly generates prescription sales.

Erleada generated prescription sales of KRW 3.4 billion in last year's Q4. Its sales grew with a bigger margin, with KRW 4.8 billion in this year's Q1 and KRW 7 billion in Q2. Its prescription sales in Q2 were close to Xtandi.

Analysis suggests that the close competition may be due to Xtandi's drug price reduction. Erleada appears to be established in clinical practice, as it has been a year since receiving reimbursement.

On the other hand, the prescription sales of Janssen's Zytiga (abiraterone) have decreased after the introduction of generic versions.

Last year, prescription sales for Xytiga decreased from KRW 4.9 billion in Q3 to KRW 3.5 billion in Q4. In this year's Q1 and Q2, it generated KRW 3.1 billion due to expanded prescriptions of competitor drugs and the introduction of generic products.

After Hanmi Pharm's Abiterone was approved last year, generic version of Xytiga were introduced to the market for Xytiga. Furthermore, Hanmi Pharm launched the combination drug Abiterone Duo in February, and Ace Pharmaceuticals obtained approval for Amaron. With more competitors, Xytiga's prescription sales are expected to decrease even more.

Janssen plans to focus on expanding treatment options for prostate cancer sub-types to compete against Xtandi, which has broad indications.

Janssen's prostate cancer treatment portfolio consists of Xytiga, Erleada, and Akeega. Akeega was approved in September of last year.

Akeega is a treatment for BRCA1/2 mutation-positive metastatic castration-resistant prostate cancer. It is a combination drug combining abiraterone and the PARP inhibitor ingredient niraparib.

Prescription sales of individual drugs may be lower than those of Xtandi, but the company's strategy is to face the competition by diversifying treatment options.

A Janssen official said, "For the treatment of prostate cancer in South Korea, we have been putting efforts to provide various individualized treatment options and improve treatment accessibility." "We will strive to work as a market leader to provide Korean patients with prostate cancer with optimized treatment by expanding treatment options through Erleada and Xytiga and expanding our portfolio, including Akeega.