Inflectra/Remsima (Germany) Wave 3 is the third in a series of syndicated reports designed to track physician perception and uptake of Hospira’s Inflectra and Mundipharma’s Remsima, two different brands of Celltrion’s infliximab biosimilar CT-P13. Unlike previous reports in this series, this report also tracks Biogen’s Benepali, the only etanercept biosimilar to launch in the EU to date.

We surveyed rheumatologists and gastroenterologists in Germany to determine their level of awareness of and experience and satisfaction with Inflectra, Remsima, and Benepali in order to identify key drivers and barriers to these biosimilars’ uptake and to gauge physicians’ level of contact with marketers of Inflectra, Remsima, Remicade, and Benepali.

Questions Answered in This Report:

  • Since Wave 1 was fielded one year ago, how have awareness and perceptions of infliximab biosimilars changed among rheumatologists and gastroenterologists in Germany, and how do their awareness and perceptions of Benepali compare with those of Inflectra/Remsima at three months’ postlaunch?
  • Among German rheumatologists and gastroenterologists, what are the key drivers of the uptake of Inflectra/Remsima and Benepali, and what proportion of patients are switched to these agents from Remicade or Enbrel?
  • What proportion of German rheumatologists and gastroenterologists have been actively encouraged to use Inflectra/Remsima or Benepali or to meet a prescribing quota for these biosimilars?
  • What benefit would another biosimilar need to offer for German rheumatologists and gastroenterologists to preferentially prescribe it in place of Inflectra/Remsima or Benepali?

Table of contents

  • Biosimilars - Emerging Biosimilars - Immunology: Inflectra/Remsima Launch Tracking (Germany) Wave 3
    • Key Findings
      • Differences Between Biosimilar Prescriber and Nonprescriber Profiles
        • Differences Between Gastroenterologist Prescribers and Nonprescribers of Inflectra/Remsima
        • Differences Between Rheumatologist Prescribers and Nonprescribers of Biosimilars
    • Market Access Analysis
      • Background on Reimbursement in Germany
      • Biosimilars Pricing in Germany
      • German Pharmacy Retail Prices for Infliximab (5 x 100 mg)
      • German Pharmacy Retail Prices for Etanercept (12 x 50 mg)
      • Key Mechanisms to Promote Biosimilar Uptake in Germany
      • Minimum Prescribing Quotas for Biosimilar Infliximab (2016)
      • German Payers' Opinion of the Market Impact of Biosimilar TNF-Alpha Inhibitors
    • Benchmarking Benepali's Launch Success vs. That of Inflectra/Remsima
      • Success of Benepali's Launch vs. That of Inflectra/Remsima
      • Benchmarking Benepali's Launch Success vs. that of Inflectra/Remsima
    • Awareness and Perceptions of Inflectra/Remsima and Benepali
      • Unaided Awareness of Biologics for Treatment of Rheumatic and Gastroenterological Indications
        • Biologics Recalled for Rheumatic and Gastroenterological Indications
        • Biologics Recalled for RA
        • Biologics Recalled for PsA
        • Biologics Recalled for AS
        • Biologics Recalled for CD
        • Biologics Recalled for UC
      • Perception of Biosimilars' Studied Indications
        • Physician Perception of Indications in Which Inflectra/Remsima and Benepali Were Studied
        • Indications in Which Physicians Believe Inflectra/Remsima Was Clinically Studied Prior to EC Approval
        • Indications in Which Rheumatologists Believe Benepali Was Clinically Studied Prior to EC Approval
      • Awareness of Biosimilars' Approved Indications
        • Physician Awareness of Inflectra/Remsima's and Benepali’s Approved Indications
        • Indications for Which Physicians Believe Inflectra/Remsima Has EC Approval
        • Indications for Which Rheumatologists Believe Benepali Has EC Approval
      • Appropriateness of Biosimilars' Approved Indications
        • Appropriateness of Inflectra/Remsima's Approval Based on Product Profile
        • Indications for Which Physicians Believe Inflectra/Remsima Should Have Been Approved
      • Familiarity with Biosimilars
        • Level of Familiarity with Biosimilars in General and with Inflectra, Remsima, and Benepali in Particular
        • Mean Level of Familiarity with Biosimilars by Wave
        • Level of Familiarity with Biosimilars in General
        • Level of Familiarity with Inflectra, Remsima, and Benepali
      • Similarity Between Biosimilars and Reference Products
        • Similarity of Inflectra/Remsima and Benepali to Their Reference Brands
        • Physician Perception of Inflectra/Remsima’s Similarity to Remicade
        • Rheumatologists' Perception of Benepali’s Similarity to Enbrel
        • Physician-Reported Clinical Differences Between Inflectra/Remsima and Remicade
    • Trial and Use of Inflectra/Remsima and Benepali
      • Prescriptions for Any Indication
        • Prescription of Inflectra, Remsima, and Benepali for Any Indication
        • Prescribers of Inflectra
        • Prescribers of Remsima
        • Prescribers of Biosimilar Infliximab
        • Prescribers of Benepali
      • Prescriptions by Indication
        • Prescription of Inflectra, Remsima, and Benepali by Indication
        • CD and UC Patients Prescribed Inflectra and Remsima
        • RA, AS, and PsA Patients Prescribed Inflectra, Remsima, and Benepali
        • Percentage of Gastroenterologists Who Have Not Prescribed Inflectra or Remsima for CD or UC
        • Percentage of Rheumatologists Who Have Not Prescribed Inflectra, Remsima, or Benepali for RA, AS, or PsA
      • Reasons for Prescribing
        • Reasons for Prescribing Inflectra, Remsima, and Benepali
        • Reasons for Choosing to Prescribe Inflectra
        • Reasons for Choosing to Prescribe Remsima
        • Reasons for Choosing to Prescribe Benepali
        • Reasons for Prescribing Biosimilars: Open-Ended Responses
      • Reasons for Not Prescribing
        • Reasons for Not Using Inflectra/Remsima or Benepali
        • Reasons for Not Using Inflectra/Remsima
        • Reasons for Not Using Benepali
      • Physician-Reported Net Cost
        • Physician-Reported Net Cost of Inflectra, Remsima, and Benepali
        • Gastroenterologist-Reported Average Net Cost of Inflectra and Remsima Below Remicade
        • Rheumatologist-Reported Average Net Cost of Inflectra, Remsima, and Benepali Below Their Reference Brands
      • Physician Satisfaction
        • Level of Satisfaction with Inflectra, Remsima, and Benepali
        • Physicians' Level of Satisfaction with Inflectra by Wave
        • Physicians' Level of Satisfaction with Remsima by Wave
        • Rheumatologists' Level of Satisfaction with Benepali
      • Prevalence of Switching
        • Prevalence of Switching and Biosimilar Use in Treatment-Naive Patients
        • Proportion of Inflectra/Remsima-Treated Patients Who Were Biologic-Naive or Switched from Another Biologic
        • Proportion of Benepali-Treated Patients Who Were Biologic-Naive or Switched from Another Biologic
      • Current and Future Patient Share
        • Current and Future Patient Share in CD and RA
        • Current and Future CD Patient Share Assuming No Further Biosimilars Launch
        • Current and Future RA Patient Share Assuming No Further Biosimilars Launch
    • External Factors Affecting Use
      • Encouraging Use of Biosimilars
        • Encouraging Use of Inflectra, Remsima, and Benepali
        • Factors That Would Encourage Use of Inflectra
        • Factors That Would Encourage Use of Remsima
        • Factors That Would Encourage Use of Benepali
      • Recommendations for Use of Inflectra/Remsima
        • Prevalence of Recommendations for the Use of Inflectra/Remsima
        • Recommendations for the Use of Inflectra/Remsima
      • Prescribing Quotas for Infliximab Biosimilars
        • Prevalence and Expectations for Biosimilar Infliximab Prescribing Quotas
        • Encouragement and Expectations to Meet a Prescribing Quota for Biosimilar Infliximab
        • Mean Prescribing Quota Reported by Physicians for Biosimilar Infliximab
      • Expectations for Reference Pricing
        • Expectations for a Reference Pricing Group Following the Launch of Inflectra/Remsima
        • Expectations for the Creation of a Reference Price Group: Gastroenterologists
        • Expectations for the Creation of a Reference Price Group: Rheumatologists
      • Physician Proposal and Patient Acceptance of Biosimilars
        • Physician Proposal and Patient Acceptance of Inflectra/Remsima and Benepali
        • Acceptance of Inflectra/Remsima Following Proposal by Gastroenterologists
        • Acceptance of Inflectra/Remsima Following Proposal by Rheumatologists
        • Acceptance of Benepali Following Proposal by Rheumatologists
    • Promotional Activity
      • Contact with Sales Representatives
        • Sales Representatives’ Last Contact
        • Timing of Sales Representatives’ Last Contact: Inflectra (Hospira)
        • Timing of Sales Representatives’ Last Contact: Remsima (Mundipharma)
        • Timing of Sales Representatives’ Last Contact: Remicade (MSD)
        • Timing of Sales Representatives’ Last Contact: Benepali (Biogen)
      • Discussions with Sales Representatives
        • Sales Representatives’ Topics of Discussion
        • Sales Representatives’ Topics of Discussion: Gastroenterologists
        • Sales Representatives’ Topics of Discussion: Rheumatologists
    • Future Use of Biosimilars
      • Timing Expectations for TNF-Alpha Inhibitor Biosimilars
        • Timing Expectations for Prescription of Inflectra, Remsima, and Benepali
        • Timing Expectations for the Prescription of Inflectra
        • Timing Expectations for the Prescription of Remsima
        • Timing Expectations for the Prescription of Benepali
      • Likelihood of Using Other Biosimilars
        • Likelihood of Using Other Biosimilars After Experience with Inflectra/Remsima
        • Likelihood of Using Other Biosimilars After Experience with Inflectra/Remsima: Gastroenterologists
        • Likelihood of Using Other Biosimilars After Experience with Inflectra/Remsima: Rheumatologists
        • Likelihood of Prescribing Another Infliximab Biosimilar After Experience with Inflectra/Remsima
        • Likelihood of Prescribing Another Infliximab Biosimilar: All Physicians
        • Likelihood of Prescribing Another Infliximab Biosimilar by Wave
    • Appendix
      • Market News and Background
        • EU TNF-Alpha Inhibitor Market News
        • Market Background: Celltrion’s Partners for Biosimilar Infliximab
        • The Celltrion Partnership Network
        • Market Background: EU Milestones and Pipeline for TNF-Alpha Inhibitor Biosimilars
        • Timeline of EU Milestones for Inflectra/Remsima
        • Timeline of EU Milestones for Other TNF-Alpha Inhibitor Biosimilars
        • Pipeline for Biosimilar TNF-Alpha Inhibitors
        • Market Background: European Assessment of Inflectra/Remsima
      • Biologics Approved for Rheumatic Diseases and/or IBD in Europe
        • Overview of Biologics Approved for Rheumatic Diseases and/or IBD in Europe
      • Overview of the Clinical Development of Inflectra/Remsima
        • Information on the Clinical Development of Inflectra/Remsima
        • Clinical Trials in Which Inflectra/Remsima Was Studied prior to EC Approval
      • Methodology and Objectives
        • Objectives
        • Physician Research Methodology
        • Significance Testing in This Study
        • Payer Research Methodology
        • German Payer Profiles
      • Respondent Demographics
        • Physician Specialty and Years in Clinical Practice
        • Breakdown of Physician Specialty
        • Physicians' Years in Clinical Practice
        • Type of Clinical Practice
        • Location of Physician Practice
        • Physicians' Regional Prescribing Associations
        • Regional Prescribing Associations Where Physicians Conduct the Majority of Their Prescribing
        • Number of Patients Currently Under Management
        • Number of Patients Currently Under Management by Gastroenterologists
        • Number of Patients Currently Under Management by Rheumatologists
        • Biologics Prescribed by Gastroenterologists and Rheumatologists
        • Available Biologics Prescribed for CD and UC by Gastroenterologists
        • Available Biologics Prescribed for RA by Rheumatologists
        • Available Biologics Prescribed for PsA by Rheumatologists
      • Abbreviations

Author(s): Marta Delgado

Marta Delgado, Ph.D. is a Business Insight Analyst in the Biosimilars Research team, responsible for the analysis of the biosimilars market across four main therapeutic areas – oncology, endocrinology, immunology and nephrology. Marta holds a Ph.D. in Molecular Neuroscience from University College of London (UCL) and a B.Sc. in Biomedicine from University Pompeu Fabra (UPF), Barcelona. Prior to joining the Biosimilars Research team, Marta worked as a Research Analyst at SKIM, specialising in advanced quantitative studies assessing the potential market opportunities to support life sciences companies in their business decision making.