The Majority of Surveyed Rheumatologists Report That Payers Require Patients with Peripheral or Axial Predominant Psoriatic Arthritis Fail Treatment with Conventional DMARDs and/or NSAIDs Prior to Receiving Biologics
November 28, 2012-Burlington, Mass. –Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that surveyed U.S. rheumatologists report that Amgen/Pfizer/Takeda’s Enbrel is their preferred first-line biologic for peripheral predominant psoriatic arthritis (PsA), and ankylosing spondylitis (AS), followed closely by Abbott/Eisai’s Humira, while only a small minority (15 percent) of surveyed rheumatologists cite Janssen Biotech/Merck/Mitsubishi Tanabe’s Remicade as their preferred first-line biologic for peripheral predominant PsA and AS. Additionally, the majority of surveyed rheumatologists report payers require patients with peripheral or axial predominant PsA fail treatment with conventional disease-modifying antirheumatic drugs (DMARDs) prior to receiving biologics. Although conventional DMARDs serve a role in peripheral PsA, these drugs are generally ineffective in treating spinal disease. However, drug coverage is a limitation for treatment as surveyed rheumatologists report that, of patients who are candidates for biologics, approximately 30 percent do not receive biologics due to reimbursement restrictions.
The new U.S. Physician & Payer Forum report entitled How Will U.S. Payers and Prescribers Determine the Success of New Biologics and Oral Entrants and Currently Marketed Biologics in Psoriatic Arthritis and Axial Spondyloarthritis?
also finds that surveyed rheumatologists estimate that irrespective of its tier position, 40 percent of patients who will start Janssen Biotech/Janssen-Cilag’s Stelara, in Phase III for PsA and currently approved for psoriasis, by year-end 2015 will have failed one or two TNF-alpha inhibitors. If the drug is placed on a higher tier than the TNF-alpha inhibitors with the lowest tier position, clinicians estimate that only 20 percent of Stelara patients will be biologics-naive in 2015, compared with 30 percent if the drug is on the same tier as the lowest-tiered TNF-alpha inhibitor. Based on Stelara’s current coverage on surveyed managed care organizations’ (MCOs) largest commercial plans, it is most likely that Stelara will be placed on a higher tier than approved anti-TNFs.
The report also finds that, if approved for PsA, UCB/Astellas’s Cimzia will be the fifth TNF-alpha inhibitor to be marketed for this indication.
“Over 40 percent of surveyed rheumatologists report the earliest line of therapy for Cimzia would be in biologics-naive patients if it is on a similar tier to approved anti-TNFs, but the largest share of physicians, 30 percent, expect Cimzia will most commonly occupy a similar position to Simponi in their treatment algorithm—inadequate responders to one prior TNF-alpha inhibitor,” said Decision Resources Analyst Kathryn Beane.
If Cimzia is approved for PsA and axial spondyloarthritis (SpA), surveyed MCOs report prescribing restrictions for the agent will be similar for both indications, with approximately half of plans requiring patients fail one or two anti-TNFs prior to treatment with Cimzia, which will likely result in Cimzia’s positioning primarily as a later-line biologic for PsA and axial SpA. Additionally, considering that Cimzia is currently excluded from a sizeable percentage of surveyed health plans, it is likely that some of these plans will continue to exclude Cimzia in the future, also limiting uptake of Cimzia in PsA and axial SpA.
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