Surveyed U.S. Rheumatologists Report Enbrel is Their Preferred First-Line
Biologic for Peripheral Predominant Psoriatic Arthritis and Ankylosing
Spondylitis, Followed Closely By Humira
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
BURLINGTON, Mass. -- November 28, 2012
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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Christopher Comfort, 781-993-2597
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