Stakeholder Insight: Rheumatoid arthritis - Rising competition by line and severity

Introduction

Disease-modifying antirheumatic drugs (DMARDs) underpin the current management of rheumatoid arthritis. This will likely remain unchanged over the next decade. In spite of high costs, rheumatologists perceive there will be an increased penetration of biologic therapies in patients of all severities by 2015, with competition between biologic classes intensifying at earlier lines of therapy.

Scope

* Snapshot of the current rheumatoid arthritis market based on a survey of 183 rheumatologists, supported with views from key opinion leader interviews
* Robust epidemiology forecasts for the prevalence of rheumatoid arthritis in the seven major markets, from 2009 through to 2019
* Overview of treatment options at the class, molecule and brand level, as well as treatment trends by line of therapy and treatment outcome analysis
* Assessment of select brands used in rheumatoid arthritis treatment, including biologics and the scope for novel small molecule DMARDs

Highlights

In 2010, traditional DMARDs are the foundation of drug therapy in rheumatoid arthritis and will remain at the core of treatment going forward. Methotrexate is the most highly utilized DMARD across all disease severities and will stay as gold-standard owing to its ease of administration, manageable side-effect profile, good efficacy and low cost.

Rheumatologists predict a significant rise in the number of patients receiving biologic therapy across each severity by 2015. There will also be a greater drive from physicians to use non-TNF biologics much earlier in the treatment algorithm, with over a third of first-line patients expected to receive such therapies in the next five years

The future position in the treatment algorithm of novel, oral, small molecule DMARDs, such as tasocitinib (CP-690,550; Pfizer), will decide uptake and sales success. The majority of physicians expect to use these agents in methotrexate-failure patients and prior to a biologic, potentially delaying the move to biologics.

Reasons to Purchase

* Target rheumatologists more effectively, through an understanding of their prescribing behavior and key factors that influence decision making
* Validate new product forecasting based on diagnosis, therapy trends and the likely rate of uptake for new products utilizing physician perception
* Estimate the size of the rheumatoid arthritis population using the interactive country-specific treatment trees that incorporate patient numbers
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TABLE OF CONTENTS
Overview 1
Catalyst 1
Summary 1
About Datamonitor healthcare 2
About the Immunology & Inflammation pharmaceutical analysis team 2
About the Epidemiology team 2
EXECUTIVE SUMMARY 3
Strategic scoping and focus 3
Datamonitor insight into the disease market 3

1. Introduction and scope 9
Coverage of the Stakeholder Insight Survey 9
2. Country treatment trees 11
Introduction to treatment trees 11

3. Epidemiology 33
Key findings 33
Disease definition, classification and diagnosis criteria 34
Epidemiology of rheumatoid arthritis 34
Epidemiologic forecasting of rheumatoid arthritis 40
Epidemiological results 42
Discussion 46

4. Diagnosis and patient segmentation 48
Key findings 48
Diagnosis 49
Patient segmentation 51

5. Treatment classes and guidelines 55
Key findings 55
Rheumatoid arthritis treatment algorithms 56
Pharmacological versus non-pharmacological therapy 59
Pharmacological therapy 62
Drug classes 65

6. Treatment trends by line of therapy 77
Key findings 77
Traditional DMARDs 78
Biologic DMARD prescribing trends 83
Country trends in biologic use by line of therapy 89

7. Prescribing factors and brand assessment 100
Key findings 100
Factors influencing physician decision making 101
Brand assessment 115
Enbrel (etanercept; Amgen, Pfizer, Takeda) 121
Cimzia (certolizumab; UCB, Otsuka) 124
Humira (adalimumab; Abbott, Eisai) 129
Remicade (infliximab; Centocor Ortho Biotech, Merck & Co., Mitsubishi Tanabe) 131
Rituxan/MabThera (rituximab; Biogen Idec, Roche) 133
Actemra/RoActemra (tocilizumab; Chugai, Roche) 136
Orencia (abatacept; Bristol-Myers Squibb) 142
Simponi (golimumab; Centocor Ortho Biotech, Merck & Co., Mitsubishi Tanabe) 148
Kineret (anakinra; Biovitrum) 153
Biologic DMARD switching by brand 155
Novel small molecule DMARDs have potential in methotrexate-failure population 161
Tasocitinib (CP-690,550; Pfizer) 163
Other novel small molecule DMARDs in the pipeline 166

8. Treatment outcomes 170
Key findings 170
Introduction 171
Outcome measure definitions 171
Outcome trends 173
Compliance 177
Treatment challenges and unmet needs 181

Bibliography 185
Journal papers 185
Websites 189
Datamonitor reports 192
Appendix 193
Physician research methodology 193
The survey questionnaire 193
Contributing experts 211
About Datamonitor 211
Datamonitor consulting 212
Disclaimer 212
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