Introduction:
The launch and uptake of new biological agents in the U.S. rheumatoid arthritis (RA) market is changing physician prescribing habits. The number
of TNF-alpha inhibitors has nearly doubled from three (Amgen/Wyeth’s Enbrel
[etanercept], Centocor Ortho Biotech’s Remicade [infliximab], and Abbott’s
Humira [adalimumab]) to five with the recent approvals for UCB’s Cimzia
(certolizumab pegol) and Centocor Ortho Biotech’s Simponi (golimumab). Even
as the array of options in this leading drug class has grown, physicians are
becoming increasingly comfortable moving patients out of the TNF-alpha
inhibitor class to drugs with other mechanisms of action: Biogen
Idec/Genentech’s B-cell inhibitor Rituxan (rituximab) and Bristol-Myers
Squibb’s costimulation modulator Orencia (abatacept). Indeed, physicians
surveyed for this report typically prescribe only two biologics before starting
patients on one of these two drugs.
Using patient-level claims data, this report determines the
share of key RA drugs by line of therapy in newly diagnosed patients and assesses
how biologics are positioned relative to one another based on the previous
treatment history for patients starting a new prescription for each biologic.
In addition, we incorporate physician insight from 151 surveyed physicians—75
rheumatologists and 76 primary care physicians (PCPs)—to analyze the leading attributes
driving treatment choice among TNF-α inhibitors and in patients who fail
TNF-α inhibitor therapy, to score how each biologic performs on each
attribute, and to explain how physicians expect their prescribing to change
over the next two years as they integrate Cimzia, Simponi (including the
emerging IV formulation of this drug), and Roche/Chugai’s Actemra (tocilizumab).
Questions Answered in This Report:
*
Lines of therapy: Although interviewed
experts acknowledge that the TNF-α inhibitors offer superior efficacy
compared with conventional disease-modifying antirheumatic drugs (DMARDs),
they often wait to prescribe high-priced biologics until conventional treatments
prove ineffective.
How much patient share do Enbrel, Remicade, and Humira hold
in early lines of therapy? Do Rituxan and Orencia penetrate the treatment segment
for newly diagnosed patients? How long do patients stay on each biologic when
it is given as a first- or second-line therapy? What drugs are used in combination
DMARD treatment in newly diagnosed patients?
*
Pathways to key therapies: Rituxan and Orencia are gaining
use as third-line biological therapies.
What biological agents most commonly
precede Rituxan and Orencia, and how long does it take patients to move through
preceding therapies to each drug? How much of each TNF-α inhibitor’s use
stems from patients who have already been treated with another agent in this
class? Are there differences in how Enbrel, Remicade, and Humira are prescribed
based on patient-level claims data analysis?
*
Physician behavior: Although Cimzia and Simponi are
entering a long-established drug class in RA treatment and their clinical trial
data show rates of efficacy similar to those of Humira, Enbrel, and Remicade,
surveyed physicians rate them as performing more poorly than the established
TNF-alpha inhibitors on several important attributes.
Which attributes do
surveyed rheumatologists view as most important when considering TNF-alpha
inhibitor therapies, and how do they rate Cimzia and Simponi versus Enbrel and
Humira on these attributes? On which attributes do surveyed rheumatologists
most significantly differentiate between Enbrel, Humira, and Remicade? What
attributes do surveyed rheumatologists view as most important when considering
biological treatment in TNF-alpha nonresponders, and how do Orencia and Rituxan
perform on each of these attributes?
*
Forecast: While TNF-alpha inhibitors are expected to
remain entrenched first-line biological agents, surveyed rheumatologists report
that their use of Cimzia, Simponi (particularly the IV formulation), Orencia,
and Rituxan will continue to evolve over the next two years.
Which shifts in
biologics prescribing are most likely to take place between 2009 and 2011,
according to surveyed rheumatologists? How many surveyed physicians anticipate
prescribing Actemra, and how much of the agent’s use will be as a first-,
second-, or third-line or later biological therapy? How many surveyed
rheumatologists expect that they will use Rituxan and Orencia more frequently
in 2011 than they do now, and how many surveyed physicians anticipate a shift
for these agents to earlier lines of biological therapy? How likely are
surveyed rheumatologists to prescribe Cimzia and Simponi as a first-line versus
second-line biologic? Scope:
Includes:
Primary research: Quantitative results from our
survey of 151 physicians (75 rheumatologists and 76 PCPs):
- Physician opinion on how drug use differs by patient severity.
- Most-influential drug attributes when physicians choose between
agents.
- Anticipated changes in the line of therapy in which physicians
use key agents.
Primary patient-level data: Quantitative findings
from our analysis of data covering 61 million lives from more than 98
geographically diverse U.S. health plans:
- Quantified lines of therapy analysis showing exact share of each
agent in each line of therapy, including rate of progression between lines and
length of time patients are on each line.
- Progression flowcharts through one year of treatment for newly
diagnosed patients receiving each of the following first-line agents: NSAIDs;
narcotic analgesics; Celebrex; corticosteroids; methotrexate;
hydroxychloroquine; sulfasalazine; leflunomide; other DMARDs; Enbrel; Remicade;
Humira; Rituxan; Orencia; and Amgen/Biovitrum’s Kineret (anakinra).
- Flowcharts tracking the preceding therapy patterns for patients
taking each of the following key therapies: Enbrel, Remicade, Humira,
Rituxan, Orencia, methotrexate, hydroxychloroquine, sulfasalazine, leflunomide,
and Celebrex.