MARKET OUTLOOK

Conventional agents (e.g., immunosuppressants, 5-ASAs) have long been used to treat pediatric Crohn’s disease (CD). Among the TNF-α inhibitors, Janssen/Merck’s Remicade and AbbVie/Eisai’s Humira are the most commonly used biologics in moderate to severe pediatric CD. The recent launch of biosimilar infliximab (i.e., Pfizer’s Inflectra), which has labeling for pediatric CD, could possibly impact the treatment landscape, particularly during an era when payers increasingly take measures to control drug costs. The newer drugs (i.e., Takeda’s Entyvio and Janssen’s Stelara), approved for adult CD, offer alternative treatment options, especially for TNF-α refractory patients; however, these drugs are not approved in pediatric CD. Still, given the limited treatment options for pediatric CD patients who fail TNF-α inhibitors, physicians may turn to these novel therapies for some patients. Indeed, the availability of these newer agents will likely make the treatment landscape more complex.

QUESTIONS ANSWERED

  • What factors primarily influence pediatric gastroenterologists’ treatment decisions in pediatric CD?
  • What drug classes are the patient-share leaders across different lines of therapy and different disease severity levels?
  • What are the common therapies prior to the initiation of biological agents? Among biologic-treated patients, what is physicians’ preferred first-line and second-line agent? What are the common courses of action upon discontinuing the different biological agents?
  • What are the factors that drive therapy switch/discontinuation?

Table of contents

  • Crohn's Disease - Current Treatment - Detailed, Expanded Analysis: Pediatric Crohn's Disease (US)
    • Key Updates
      • November 2017
      • Introduction to Current Treatment for Pediatric CD
        • Key Findings
        • Summary Figures
          • Current Use of Pharmacological Therapies by Severity
          • Most Frequently Used Biologics by Line of Therapy
          • Influential Factors Driving Prescribing Decisions
        • Introduction to Current Treatment and Medical Practice for Pediatric CD
        • Drugs Included in This Study of Current Treatment of Pediatric CD
      • Physician Prescribing Practices
        • Key Findings
        • Patient Characteristics
          • Malnutrition and Growth Impairment Are Commonly Associated with Pediatric CD
          • Distribution of Disease Severity Among All Pediatric CD Patients
          • Distribution of Disease Severity Among Pediatric CD Patients Treated During the Past Year
          • Common Comorbidities Among Surveyed Gastroenterologists' Pediatric CD Patients
        • Physician Treatment Practices
          • Pharmacotherapy Is the Cornerstone of Pediatric CD Treatment
          • Diagnosed Pediatric CD Patients Wait up to One Year for Prescription Treatment
          • Average Length of Time Between Initial Diagnosis and Treatment Initiation by Disease Severity
          • Most Pediatric CD Patients Receive Pharmacotherapy But Nutrition Therapy Is Also Common
          • Treatment Approaches Used in Pediatric CD Patients by Severity
          • Biological Therapies Are Used Mostly in Severe Active Disease
          • Current Use of Pharmacological Therapies by Severity
          • Current Prescribing of Biologics by Agent
          • Biological Use in Combination with Other Therapies by Drug
          • Percentage of Patients Requiring Dose Escalation of Biological Therapy by Drug
          • Current Prescribing of Immunosuppressants by Agent
          • Most Common Immunosuppressant Used with Biological Therapy
          • Pediatric Dosing Compared to Adult Dosing
          • Corticosteroid Use by Route of Administration
          • On Average, Biologics Are Tried for Six Months Before Discontinuation
          • Length of Time from Initiation of Biologic to Discontinuation by Agent
          • Nutrition Therapy Is the Most Common Nonpharmacological Treatment for Pediatric CD Patients
          • Use of Nonpharmacological Approaches in the Treatment of Pediatric Crohn's Disease
          • 5-ASAs Are Preferred for Early Use While Biologics Are Reserved for Later
          • Line of Therapy Tracks with Disease Severity
          • Current Treatment Rates by Line of Therapy and Severity Levels
          • Most Patients Remain on Their First-Line Therapy One Year After Treatment Initiation
          • Line of Therapy One Year After Treatment Initiation by Severity
          • TNF-α Inhibitors Are Preferred Among Later-Line Therapies
          • Product Share by Line of Therapy
          • Most Frequently Used Biologics by Line of Therapy
          • Progression Between Lines of Biological Therapy
          • Patients Progressing to Second-Line Therapy Do So Within Seven Months
          • Treatment Duration by Line of Therapy
        • Physician Insight on Compliance and Persistency
          • Compliance Is Highest for Remicade and Lower for Biosimilar Inflectra
          • Physician-Reported Patient Compliance with Biological Therapies
          • Discontinuation Rates for Biological Therapies Within One Year of Treatment Initiation
          • Discontinuation Rates for Biological Therapies Within the Past Year
        • Sequencing of Treatment
          • Diverse Pathways Lead to Biologic Initiation
          • Treatment Prior to Initiation of Biological Therapies
          • Most Common Treatment Pathways to Initiation of Biological Therapy by Agent
          • Most Common Treatment Pathways Following Biological Discontinuation by Agent
        • Recent and Anticipated Changes in Treatment Practices
          • Biologic Class Share Growth Is Driven in Part by Inflectra, Entyvio, and to a Lesser Extent, Stelara
          • Gastroenterologists' Change in Use of Selected Drug Classes in the Past Year
          • Gastroenterologists' Change in Use of Selected Biological Agents in the Past Year
          • Current and Anticipated Patient Share for Biological Therapies
      • Physician Insight on Medical Practice
        • Factors Influencing Treatment Practice
          • Lack of Familiarity Holds Back Inflectra While Efficacy and Familiarity Drive Remicade Prescribing
          • Efficacy Is an Important Driver of Prescribing for All Therapies
          • Influential Factors Driving Prescribing Decisions
          • Influential Factors Driving Prescribing of Select Biologics by Drug
          • Both Financial and Clinical Factors Drive Brand Selection
          • Important Factors Driving Increased Use of Select Biologics by Drug
          • Important Factors Driving Decreased Use of Select Biologics by Drug
          • New Efficacy and Safety Data in Pediatric CD Instead of Adult CD Holds Value in Driving Increased Use of Biologics in Pediatric CD
          • Top Reasons Driving Increased Use of Biologics in the Past Year by Agent, for Pediatric CD versus Adult CD
          • Reimbursement and Cost-Related Issues Are an Obstacle for Both Branded and Biosimilar Biologics
          • Major Obstacles to Select Biologic Use by Drug
          • Both Primary and Secondary Failure Drive Therapy Discontinuation Among Biologics
          • Reasons for Discontinuation of Select Biological Therapies by Drug
          • Most Common Reason for Switching to Select Biologics by Drug
      • Methodology
        • Primary Market Research Methodology
        • Certifications of Surveyed Gastroenterologists
        • Geographical Distribution of Surveyed Gastroenterologists by Census Region
        • Geographical Distribution of Surveyed Gastroenterologists by State
        • Distribution of Years in Practice
        • Number of Pediatric Patients Diagnosed with Crohn's Disease Under Physician Management
        • Percentage of Gastroenterologists Prescribing Oral 5-ASAs, Corticosteroids, Immunosuppressants, and Biologics
        • Distribution of Number of Pediatric Patients Currently Treated with Biological Therapy
        • Surveyed Gastroenterologists' Practice Setting
      • Appendix
        • Abbreviations

    Author(s): Kristine Mackin, PhD

    Kristine Mackin, Ph.D., is an analyst on the immune and inflammatory disorders team at Decision Resources Group. She currently focuses on respiratory diseases, including asthma and COPD.

    She holds a doctorate in biochemistry from Brandeis University, where she studied the evolution of bacteriorhodopsin and the relationship between type I and type II rhodopsins. During her B.A. in Chemistry at Carleton College, she researched proinsulin processing. Prior to joining DRG, Dr. Mackin was involved with literature and market research for a new company pitch during an internship at Puretech Ventures in Boston, MA.


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