Tumor necrosis factor-alpha (TNF-α) inhibitors (AbbVie’s Humira, Amgen’s Enbrel, Janssen’s Remicade and Simponi, UCB’s Cimzia) are approved for the treatment of nonradiographic axial spondyloarthritis (nr-AxSpA) in Europe and are increasingly used off-label for the disease in the United States, where Cimzia is striving to be the first therapy to gain FDA approval for nr-AxSpA. Novartis’s IL-17 inhibitor, Cosentyx, is seeking approval for this indication in both regions and is also used off-label. In this report, the first to focus on this AxSpA subpopulation, we examine areas of unmet need in the treatment of nr-AxSpA, including inefficacy, mechanism of action, safety and tolerability, delivery, and price. Backed by quantitative insight into U.S. and European rheumatologists’ assessment of the unmet needs in nr-AxSpA, we discuss the commercial opportunities associated with treating this enigmatic indication and how emerging therapies may capitalize on these opportunities.


  • What are the treatment drivers and goals for nr-AxSpA?
  • Which drug attributes are key influencers, which have limited impact, and which are hidden opportunities?
  • How do current therapies perform on key treatment drivers and goals for nr-AxSpA?
  • What are the prevailing areas of unmet need and opportunity in nr-AxSpA?
  • What trade-offs across different clinical attributes and prices are acceptable to U.S. and European rheumatologists for a hypothetical new nr-AxSpA drug?

Markets covered: United States, France, Germany, United Kingdom

Primary research: Survey of 60 U.S. and 30 European rheumatologists fielded in January 2019

Key companies: AbbVie, Amgen, Janssen, UCB, Novartis

Key drugs: Humira, Enbrel, Remicade, Simponi, Cimzia, Cosentyx


  • Target Product Profile (TPP) simulator based on conjoint analysis methodology.
  • Stated versus derived importance of product attributes on prescribing behavior.
  • Assessment of current drug performance against treatment drivers and goals.
  • Physician perceptions of unmet needs in the indication and related indications.
  • Analysis of remaining drug development opportunities.


Unmet Need supports clinical development decisions by identifying key attributes and assessing areas of unmet need for a specific disease or subpopulation. Based on surveys with U.S. and European physicians, this report provides insight into key treatment drivers and goals, the performance of current therapies, and the remaining commercial opportunities. Two market scenarios are profiled in detail by DRG experts, and additional customized market scenarios can be evaluated with the corresponding TPP simulator.

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