Fibrosis Emerges as Key Opportunity for TL1A Therapies in Crohn’s Disease, Spherix Global Insights Finds

Patients with fibrostenotic disease face greater disease burden and are more likely to experience delayed treatment switching, while nearly three-quarters of gastroenterologists say the lack of therapies addressing fibrotic progression limits long-term outcomes.

Exton, PA, Nov. 13, 2026 (GLOBE NEWSWIRE) -- Gastroenterologist optimism for TL1A-targeted therapies in inflammatory bowel disease (IBD) is climbing, and new research from Spherix Global Insights points to where that optimism may matter most in Crohn’s disease: patients with intestinal fibrosis or fibrostenotic strictures. Patient chart audits show these patients reach advanced therapy decisions with more severe disease and are more often switched later than their own physicians believe they should have been.  For manufacturers developing TL1A-targeted therapies, these findings highlight a significant unmet need and an opportunity to demonstrate meaningful clinical differentiation.

The findings draw on Spherix’s 2026 Patient Chart Dynamix™ audits of more than 2,100 IBD patient charts submitted by U.S. gastroenterologists: 1,008 charts from 218 physicians for patients starting their first advanced therapy and 1,098 charts from 235 physicians for patients switching between advanced therapies. These were paired with the Q3 2026 RealTime Dynamix™: Crohn’s Disease (US) survey of 99 U.S. gastroenterologists, with trend data compared against the Q3 2025 wave. Combined, they connect what is happening in individual patient records with how physicians view the next wave of therapies.

Patients with Fibrosis Face Greater Disease Burden at Key Trement Decisions

A history of intestinal fibrosis or fibrostenotic strictures was recorded in roughly one in ten audited Crohn’s patients starting their first advanced therapy and one in eight of those switching between advanced therapies. These rates describe the audited treatment populations rather than the broader Crohn’s population, but they show that fibrotic complications are present at both decision points.

These patients also arrive with a heavier disease burden. Among audited switch patients, nearly half of those with fibrosis or fibrostenotic strictures had severe disease at the time of switching, compared with 15% of those without this history. They more often presented with active flares and moderate or severe abdominal pain, and a larger share had already reached their third or later advanced therapy.

Delayed switching suggests a window for earlier intervention

Physicians’ own retrospective assessments point to missed opportunities. More than one-third of switch patients with fibrosis or fibrostenotic strictures were judged to have switched later than they should have, compared with about one in five patients without this history. For emerging therapies, this raises a commercially important question: could evidence on disease progression give physicians a clear reason to change treatment before disease burden accumulates?

Gastroenterologists see a gap current therapies do not fill

Physician attitudes underscore the need. In Spherix’s Q3 2026 Crohn’s disease survey, nearly three-quarters of gastroenterologists agreed that the lack of therapies directly addressing fibrotic progression limits their ability to improve long-term outcomes. Measurement is a second hurdle: nearly seven in ten agreed that current diagnostic tools are insufficient to consistently monitor fibrotic progression, a gap that could complicate how any antifibrotic benefit is demonstrated and recognized in practice. Nearly all agreed that the potential to prevent or reverse intestinal fibrosis would increase the long-term value of a TL1A-targeted therapy.

TL1A optimism rises, with fibrosis seen as the class’s strongest opportunity

These expectations are building alongside broader enthusiasm for the class. The share of surveyed gastroenterologists reporting high clinical optimism for TL1A therapies rose from 45% in Q3 2025 to 60% in Q3 2026. Asked where TL1As could deliver the greatest incremental benefit over existing advanced therapies, physicians most often pointed to patients with signs of progressive disease or with intestinal fibrosis and tissue remodeling.

Differentiation Among Emerging TL1A Therapies

Class enthusiasm has not yet translated into distinct roles for individual agents, though. Gastroenterologists rated roughly two in five audited Crohn’s new-start patients as good candidates for each of the three TL1A agents in Phase 3 development, Merck’s tulisokibart, Roche’s afimkibart, and Sanofi and Teva’s jointly developed duvakitug, with similarly close ratings in the switching audit. These ratings do not establish clinical equivalence, but they indicate that physicians have yet to draw meaningful distinctions between the patients they would consider for each therapy.

These findings suggest that opportunities for brand-level differentiation remain. Because fibrosis is linked to the TL1A pathway itself, the opportunity may ultimately be shared across the class; brand-level advantage is likely to depend on which sponsor generates the most convincing evidence on progression, and how that benefit is measured.

The IL-23 precedent: differentiation will take more than mechanism

Differentiation could also come from patient support or administration, a dynamic already visible in the IL-23 class. Subcutaneous (SC) induction helped distinguish Johnson & Johnson’s Tremfya within that class, offering a potential precedent for duvakitug, which is being studied with SC induction in Phase 3. However, AbbVie’s October 2026 U.S. approval of SC induction for Skyrizi in Crohn’s disease shows how quickly an administration advantage can narrow, reinforcing the importance of a broader value proposition.

“The potential of the TL1A class is compelling for physicians, especially the possibility of addressing fibrosis and changing the course of disease before damage occurs,” said Lisa Fendrick, Senior Insights Director at Spherix Global Insights. “Each manufacturer now has an opportunity to build on that enthusiasm with differentiated evidence and support that give physicians a clear reason to choose its therapy and confidence to use it earlier.”

Together, these findings highlight the importance of identifying appropriate patients, understanding when treatment intervention may be most valuable, and generating evidence that clearly demonstrates clinical differentiation. Spherix will continue to track the TL1A class as these agents advance toward approval through RealTime Dynamix™ and Patient Chart Dynamix™ and, once they reach the market, through Launch Dynamix™. To learn more about Spherix’s ongoing IBD market intelligence, contact the Spherix team.

About Patient Chart Dynamix™

Patient Chart Dynamix™ is an independent, data-driven service unveiling real patient management patterns through rigorous analysis of large-scale patient chart audits. Insights reveal the “why” behind treatment decisions, include year over year trending to quantify key aspects of market evolution, and integrate specialists’ attitudinal & demographic data to highlight differences between stated and actual treatment patterns.

About RealTime Dynamix™

RealTime Dynamix™ is an independent service providing strategic guidance through quarterly or semiannual reports, which include market trending and a fresh infusion of event-driven and variable content with each wave. The reports provide an unbiased view of the competitive landscape within rapidly evolving specialty markets, fueled by robust HCP primary research and our in-house team of experts.

About Launch Dynamix™

Launch Dynamix™ is an independent service providing monthly benchmarking of newly launched products for the first eighteen months of commercial availability, augmented by a quarterly deep dive into promotional activity, barriers to uptake, and patient types gravitating to the launch brand.

About Spherix Global Insights

Spherix Global Insights is a leading independent provider of market intelligence and advisory services for specialty pharmaceutical and biotech markets. By combining physician, patient, and payer perspectives into a single integrated view, Spherix helps brand teams, market access stakeholders, and investors understand how a specialty market actually behaves, not how any one stakeholder describes it. The firm operates ten dedicated therapeutic franchises – Dermatology, Gastroenterology, Hematology, Nephrology, Neuroscience, Obesity, Oncology, Ophthalmology, Respiratory and Rheumatology – alongside a fully dedicated Market Access team. Each franchise is led by hyper-focused analysts and researchers who track these specialty areas full-time, drawing on independently curated communities of vetted practicing specialists, KOLs, patients recruited through treating physicians and advocacy partners, and medical and pharmacy directors at commercial and government payers. Spherix delivers quarterly trending, launch tracking, chart audits, KOL synthesis, patient experience research, and payer and market access intelligence that support confident, strategic decision-making across the pharma lifecycle. Trusted by 19 of the top 20 pharmaceutical and biotech organizations, Spherix has been a go-to resource for more than a decade for leading brands, market access stakeholders, industry media outlets, financial analysts, professional organizations, and patient advocacy groups seeking an unbiased, holistic view of specialty markets.

To learn more, visit spherixglobalinsights.com or connect on LinkedIn.

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NOTICE: All company, brand, or product names in this press release are trademarks of their respective holders. The findings and opinions expressed within are based on Spherix Global Insights’ analysis and do not imply a relationship with or endorsement of the companies or brands mentioned in this press release.

Lisa Fendrick
Spherix Global Insights
484-879-4284
Lisa.Fendrick@spherixglobalinsights.com