Decision Resources predicts TNF-alpha inhibitors to dominate rheumatoid arthritis treatment

Decision Resources, one of the world's leading research and advisory firms focusing on pharmaceutical and healthcare issues, finds that tumor necrosis factor (TNF)-alpha inhibitors will continue to dominate first- and second-line biologic therapy for the treatment of rheumatoid arthritis in the United States through 2011, but the more established branded drugs such as, Centocor Ortho Biotech's Remicade, Abbott's Humira and Amgen/Wyeth's Enbrel, in this class will face competition from newer entrants. The decline in use for these established drugs will stem from physicians increasing their use of UCB's Cimzia and Centocor Ortho Biotech's Simponi and prescribing only one TNF-alpha inhibitor before moving out of the drug class completely.

"Rheumatologists we surveyed prefer to prescribe Enbrel as a first-line biologic compared with either Humira or Remicade and they tell us that this pattern will continue through 2011," stated Cindy Fung, Ph.D., analyst at Decision Resources. "In terms of total prescriptions, approximately one-half of the rheumatologists we surveyed anticipate a decline in their use of Remicade and one-third project a decline in their total use of Enbrel and Humira, stemming in part from physicians projecting an increase in the use of new agents in the TNF-alpha inhibitor class."

The new Treatment Algorithms in Rheumatoid Arthritis report also finds that TNF-alpha inhibitors are not immune to competition from Roche's emerging IL-6 inhibitor Actemra upon its launch in 2010. Enbrel and Humira appear to be well insulated from this competition because they are well entrenched in the first two lines of therapy, but Remicade, Cimizia and/or Simponi are all at risk of losing patient share to Actemra.

By combining patient-level claims data with physician survey data, this report can be used to build patient-flow models and analyze the assumptions driving these models. Patient-level claims data show that 12.4 percent of Humira users went to it after using Enbrel, and only 1.9 percent of Humira users went to it after using Remicade. Survey findings suggest that physician perception about Enbrel's safety is a leading reason for its use ahead of Humira.