Following the European Medicines Agency’s approvals of the PDE-4 inhibitor Otezla and the IL-17 inhibitor Cosentyx for psoriatic arthritis (PsA), treatment of this disease in the EU5 has begun to move away from its heavy reliance on TNF inhibitors. Both IL-17 inhibition and PDE-4 antagonism are new mechanisms of action for rheumatologists. Their early perceptions of these two agents can shed light on the long-term commercial prospects for the two drug classes. Also affecting the PsA therapy market in the EU5 are the launches of biosimilar etanercept and biosimilar infliximab, both of which will further reduce the uptake of the brand TNF inhibitors and may affect use of later-line therapies. These two dynamic forces are poised to reshape the treatment algorithm for PsA.

Questions Answered:

  • What are the latest trends in diagnosis and treatment rates for PsA in the EU5?
  • How do dermatologists collaborate with rheumatologists in the treatment of PsA in each EU5 country?
  • What are the current and rheumatologist-predicted future DMARD utilizations in the PsA therapy market?
  • What are rheumatologists’ rationales behind therapy switches and therapy discontinuation?
  • What are rheumatologists’ perceptions of and prescribing behaviors for Benepali and Inflectra in the EU5?
  • Where do Cosentyx and Otezla fit into European rheumatologists’ treatment algorithms?

Scope:

  • Markets covered: France, Germany, Italy, Spain, and the United Kingdom.
  • Indication coverage: Psoriatic arthritis
  • Methodology: Surveys of 250 rheumatologists (50 in France, 50 in Germany, 50 in Italy, 50 in Spain, and 50 in the United Kingdom) completed in February 2017.
  • Key drugs covered: Methotrexate, leflunomide, sulfasalazine, cyclosporine, hydroxychloroquine, Humira, , Enbrel, Benepali, , Remicade, Inflectra/Remsima/Flixabi, Simponi, Cimzia, Stelara, Cosentyx, Otezla,
  • Key companies mentioned: AbbVie, Biogen, Celgene, Janssen, Merck, Novartis, Pfizer, Sanofi, UCB​​​​​​

Table of contents

  • Psoriatic Arthritis - Current Treatment - Detailed, Expanded Analysis (EU5)
    • Key Updates
      • August 2017
      • Introduction to Current Treatment for PsA
        • Key Findings
        • Summary Figures
          • Referral Sources for PsA Patients
          • Patient Share by Product
          • Changes in DMARD Use over the Past Year
          • Anticipated Prescribing Behavior for Biosimilar Infliximab and Biosimilar Etanercept
        • Introduction to Current Treatment and Medical Practice for PsA
        • Drugs Included in This Study of Current Treatment of PsA
      • Physician Prescribing Practices
        • Key Findings
        • Patient Characteristics
          • Referrals from GPs Account for the Major Source of PsA Patients
          • Number of New Diagnoses for PsA
          • Referral Sources for PsA Patients
          • Changes in Source of Referrals from One Year Ago
          • Comorbidities Among Surveyed Rheumatologists' PsA Patients
          • Management of Comorbidities by Rheumatologists
          • Influence of Comorbidities on Rheumatologists' Prescribing Decisions
        • Treatment Practices
          • Treatment Practice for PsA Follows a Step-Up Approach
          • Time Between Diagnosis and bDMARD/tsDMARD Treatment Exceeds One Year
          • Average Length of Time to Various Stages of PsA Treatment
          • Three-Quarters of bDMARD/tsDMARD-Eligible Patients Are Treated Accordingly
          • Percentage of PsA Patients Eligible for bDMARDs/tsDMARDs
          • Treatment Rates for bDMARD/tsDMARD-Eligible Patients
          • Enbrel and Humira Lead the PsA bDMARDs' Patient Shares
          • Patient Share by Drug Class
          • Patient Share of Conventional DMARDs
          • Patient Share of bDMARDs and tsDMARDs
          • Patient Share of TNF Inhibitors
          • Patients Discontinue Any DMARD Treatment After 6-14 Months
          • Treatment Duration by Product
          • First-Line Treatment After cDMARD Failure Is Typically a TNF Inhibitor
          • Most PsA Patients Are Treated with cDMARDs
          • Later TNF Inhibitors Face Competition from New MOAs
          • Most Likely Treatment History of Patients Treated with PsA Products
          • TNF Inhibitors Dominate First and Second Lines After cDMARD Failure
          • Patient Share of Products by Line of Therapy
          • More than Half of TNF Inhibitors Are Prescribed with Methotrexate
          • Percentage of Therapies Prescribed with Methotrexate
        • Persistency and Compliance
          • High Persistency and Compliance Rates Reported with bDMARDs
          • Discontinuation Rates of PsA DMARDs
          • Compliance Rates of PsA DMARDs
        • Sequencing of Treatment
          • EU5 Rheumatologists Try Two TNF Inhibitors Before Moving to a Different MOA
          • Subsequent Line of Therapy by Prior Treatment
          • Prior Treatment in Patients by Current Treatment
        • Recent/Anticipated Changes in Brand Use/Treatment Approach
          • TNF Inhibitors Will Lose Patient Share to Newly Approved Therapies
          • Changes in DMARD Use over the Past Year
          • Current and Anticipated Patient Shares for Major Drug Classes in PsA
          • Current and Anticipated Patient Shares for bDMARDs and tsDMARDs in PsA
          • Current and Anticipated Patient Shares for TNF Inhibitors in PsA
          • Anticipated Timeline for Prescribing Biosimilar Infliximab (Currently Unavailable for Prescribing)
          • Anticipated Timeline for Prescribing Biosimilar Etanercept (Currently Unavailable for Prescribing)
          • Anticipated Prescribing Behavior for Biosimilar Infliximab and Biosimilar Etanercept
      • Physician Insight on Medical Practice
        • Key Findings
        • Drivers of Treatment Selection
          • Efficacy Is a Major Driver of Prescribing of Most PsA Brands
          • Severity of Joint Symptoms Drive Prescription Choices for PsA
          • Factors Important in Selecting First-Line bDMARD/tsDMARD
          • Factors Important in Selecting Second-Line bDMARD/tsDMARD
          • Key Reasons for Prescribing Biosimilar Infliximab and Biosimilar Etanercept
          • Key Reasons for Not Prescribing Biosimilar Infliximab
          • Key Reasons for Not Prescribing Biosimilar Etanercept
          • Strong Efficacy Is the Key Driver of TNF Inhibitors' Uptake
          • Reasons for Substantially Increased Product Utilization in the Past Year
          • Major Drivers of Humira's Use
          • Major Drivers of Enbrel's Use
          • Major Drivers of Remicade's Use
          • Major Drivers of Simponi's Use
          • Major Drivers of Cimzia's Use
          • Major Drivers of Stelara's Use
          • Major Drivers of Otezla's Use
          • Major Drivers of Cosentyx's Use
          • Obstacles to Prescribing More bDMARDs/tsDMARDs Vary by Agent
          • Reasons for Substantially Decreased Product Utilization in the Past Year
          • Reasons for Not Prescribing More Humira
          • Reasons for Not Prescribing More Enbrel
          • Reasons for Not Prescribing More Remicade
          • Reasons for Not Prescribing More Simponi
          • Reasons for Not Prescribing More Cimzia
          • Reasons for Not Prescribing More Stelara
          • Reasons for Not Prescribing More Otezla
          • Reasons for Not Prescribing More Cosentyx
          • Primary Failure Is the Main Reason for Discontinuing Later-Line DMARDs
          • Reasons for Discontinuing Humira
          • Reasons for Discontinuing Enbrel
          • Reasons for Discontinuing Remicade
          • Reasons for Discontinuing Simponi
          • Reasons for Discontinuing Cimzia
          • Reasons for Discontinuing Stelara
          • Reasons for Discontinuing Otezla
          • Reasons for Discontinuing Cosentyx
          • Safety and Tolerability Concerns Drive Deferral of cDMARDs/bDMARDs
          • Reasons for DMARD Deferral
      • Methodology
        • Primary Market Research Methodology
        • Surveyed Rheumatologists' Type of Primary Practice
        • Number of Rheumatologists in Surveyed Rheumatologists' Practice
        • Number of Years in Practice Postresidency
        • Number of PsA Patients Under Management
        • Number of PsA Patients Treated with Biologics
      • Appendix
        • Primary Market Research
          • Patients' Complaints about Skin Symptoms at Rheumatologists' Practice
          • Collaboration Between Dermatologists and Rheumatologists in Making a PsA Diagnosis
          • Collaboration Between Dermatologists and Rheumatologists in Treating Skin Symptoms of PsA
          • Product Positioning for Otezla
          • Product Positioning for Cosentyx
        • Key Abbreviations

    Author(s): Hailing Yang, PhD

    Hailing Yang, Ph.D., is an analyst on the Immune and Inflammatory research team at Decision Resources Group, focusing primarily on psoriasis and psoriatic arthritis. In this role, he conducts primary research via interviews/surveys with medical experts and write market analysis deliverables designed for key decision-makers within the biopharmaceutical industry.

    Prior to joining DRG, Dr. Yang worked at Selecta Biosciences and Bioss USA Antibodies as a consultant. He studied brain cancer and received a Ph.D. from Tufts University, where he held an executive role for Tufts New England Case Competition. Dr. Yang earned a B.S. from Wuhan University in China.


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