Physician and Payer Perspectives on Biologic Use and Novel Therapeutic Targets in the Treatment of Psoriatic Arthritis, Ankylosing Spondylitis, and Nonradiographic Axial Spondyloarthritis

Spondyloarthritis (SpA) is a family of chronic inflammatory rheumatic diseases primarily affecting the spine, including joints and entheses, where ligaments and tendons attach to the bone. The umbrella indication covers both axial SpA (Ax SpA), which includes ankylosing spondylitis (AS) and nonradiographic Ax SpA, and peripheral SpA, which includes psoriatic arthritis (PsA) and undifferentiated peripheral SpA. Over the past decade, SpA, and more specifically Ax SpA and PsA, have seen significant advances in terms of diagnosis and treatment, including updates to international guidelines that recommend use of TNF-α inhibitors in patients with nonradiographic Ax SpA refractory to conventional agents. Five TNF-α inhibitors currently approved for the treatment of Ax SpA and PsA are the mainstay treatment for moderate-to-severe PsA/Ax SpA patients who fail conventional therapies. While the PsA market is becoming increasingly crowded with the availability of the IL-12/23 inhibitor, Stelara, and an oral agent, Otezla, as alternative treatment options to TNFs, unmet need exists for efficacious, safer, and more cost-effective drugs. Unlike the situation in PsA, in Ax SpA, the lack of targeted immune therapies other than TNF-α inhibitors signals a clear opportunity for drug developers to bring agents to market that offer alternative treatment options.


Drawing on insights from 255 European rheumatologists and 15 payers with influence at national or regional levels, this report analyzes European physicians’ and payers’ attitudes with respect to the changing PsA/Ax SpA market. In addition, we focus on physicians’ and payers’ view of the marketed biologics, recently launched Otezla, biosimilars, and emerging therapies.

Questions Answered in This Report:

  • Impact of reimbursement and payer policies on use of current SpA key agents, including biologics and oral therapies: What do the prescribing patterns for biologics tell us about the impact of reimbursement policies for these therapies in PsA/Ax SpA? What reimbursement factors impact rheumatologists’ prescribing the most? How do healthcare authorities monitor prescribing? How could regional discounts and risk-sharing agreements improve market penetration of the current SpA biologics/oral agents?

  • Payer and physician perspectives on emerging agents for SpA: How might evolving healthcare reforms and cost-containment strategies affect reimbursement and uptake of novel agents for PsA/AS? What are the key market access challenges in each country? What are payers’ opinions on the importance of conducting head-to-head studies? How will use of recently launched and emerging agents impact prescribing of TNF-α inhibitors by the end of 2018?

  • The effect on market dynamics of the launch of infliximab biosimilars and biosimilars of other TNF inhibitors: Will payers require use of the biosimilars in newly treated patients? Will they encourage switching? What are physicians’ attitudes toward biosimilars for SpA? What are physicians’ expectations for biosimilar uptake by year-end 2018?


Markets covered: France, Germany, Italy, Spain, and the United Kingdom.

Primary research: surveys of 255 rheumatologists and 15 payers, all of whom with influence at a national or regional level. Interviewed payers include the following:

- France: Former HAS (Commission de la Transparence) member; hospital formulary committee member, Lyon; hospital formulary committee member, Strasbourg.

- Germany: Honorary chair of a regional physicians’ association/ex-chairman of a regional association of physicians/G-BA advisory role; member of a physicians’ association; head of drugs of sickness fund.

- Italy: Prontuario terapeutico ospedaliero (PTO) and prontuario terapeutico ospedaliero regionale (PTOR) member/chief hospital pharmacist, Rome; PTO/PTOR advisor/hospital/regional pharmacy director, Palermo; PTO/PTOR member/hospital/regional formulary committee member/hospital/regional pharmacy directors, Trieste-North Italy.

- Spain: Hospital/regional formulary committee member/hospital pharmacy director, Valencia; hospital/regional formulary committee member/hospital pharmacy director, Barcelona; hospital/regional formulary committee member/hospital/regional pharmacy director, Madrid.

- United Kingdom: CCG member/hospital formulary committee member, London; CCG member/hospital formulary committee member, Sunderland; CCG member/hospital formulary committee member, Brighton.

Author(s): Sangha Mitra, Ph.D., M.B.A.