Spherix Global Insights

December 04, 2018

In Rheumatoid Arthritis, TNF Cycling Continues to Be Highly Prevalent, Though Alternate Mechanism Agents Are Capturing a Greater Percentage of the Switching Population Compared to the Prior Year

According to the latest patient audit analysis from Spherix Global Insights, biosimilars have gained ground, but the overall infliximab pie in the rheumatoid arthritis switching segment is beginning to shrink

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Exton, PA., December 4, 2018 /PRNewswire/ — In Spherix Global Insight’s third annual RealWorld Dynamix: Biologic/JAK Switching in Rheumatoid Arthritis (US) study, 211 U.S. rheumatologists collaborated to provide detailed patient chart reviews on 1,074 patients with rheumatoid arthritis (RA) that were recently switched from one biologic/JAK to a different brand.  The study, which published last week, analyzed clinical and non-clinical factors to trigger switching and probed into the rationale for choice of the new brand.

Rheumatologists have reported increased switching rates over the prior two years, with more than one-quarter of currently treated patients switched in the past year.  Less than half of the recently switched patients were on their prior agent for more than six months.  Although patient requests are not typically the primary driver behind brand switches, rheumatologists indicated that in the majority of cases, patients had significant input into the decision to switch.

For the second year in a row, the practice of TNF cycling has declined, though still represents the predominant switching pattern, particularly for patients switching for the first time.  JAK inhibitors captured the second greatest switching share, fueled by switching gains from Pfizer’s Xeljanz over the prior year and, to a lesser extent, the introduction of Eli Lilly’s Olumiant.

In Spherix’s quarterly publication, RealTime Dynamix: Rheumatoid Arthritis (US), monotherapy continues to be highlighted as a key message for brands like Xeljanz, Roche-Genentech’s Actemra, and Sanofi-Regeneron’s Kevzara; indeed, audited patient level data revealed higher rates of monotherapy with these agents.  In about one in five of the switches, the desire for monotherapy was a factor that influenced the choice of the new brand, and in these cases, an IL-6 or JAK inhibitor was chosen approximately half of the time.  However, the rheumatology jury may still be out on this topic, according to Lynn Price, Immunology Franchise Head at Spherix, “The concept of monotherapy may be more of an industry goal than a rheumatology goal.  Although 75% of the rheumatologists collaborating in this study agree that they are getting more comfortable with using biologics/JAKs without concomitant tDMARDs, 64% indicate that they prefer to prescribe them in combination whenever possible and a similar percentage agree that methotrexate is the backbone of RA treatment.”

While biosimilar adoption in the U.S. autoimmune space has not been an overwhelming success, the year over year findings in this audit indicate favorable momentum.  Overall, infliximab’s share of the switching pool declined significantly from the prior year.  However, biosimilars captured a greater percentage of the infliximab share; from 26% in 2017 to 37% in 2018.  Furthermore, biosimilar brands derived a greater percentage of their switches from Janssen’s Remicade; 21% in 2017 versus 29% in the current year.  Though it should be noted that a lack of payer pressure mandating use is still the most common reason branded Remicade is prescribed instead of a biosimilar infliximab brand in the U.S.

The audit also evaluated missed opportunities, finding that brands like Actemra and BMS’ Orencia may be leaving a lot on the table.  While both brands captured approximately 10% of the recent switches, rheumatologists indicated each was the back-up brand in an additional 13-14% of the cases (nearly 10% of switches from each agent went to the alternative formulation of the same brand).  Actemra primarily lost to Xeljanz and Orencia, while Orencia was leap-frogged by a wide range of products, including Xeljanz, Actemra, AbbVie’s Humira, Amgen’s Enbrel, and Roche-Genentech’s Rituxan.  Overall, the IL-6 inhibitors captured a greater percentage of the switch market compared to the prior year, and in-class cannibalization is less than anticipated. In just 9% of the missed share cases for Actemra, Kevzara was the winner, and in only about one-quarter of the Kevzara losses did Actemra gain, indicating the brands are doing a good job positioning against other mechanisms of action.

About RealWorld Dynamix™
RealWorld Dynamix™: Biologic/JAK Switching in RA (US) is a robust and deep patient chart analysis of 1,074 RA patients who were switched from one biologic or JAK to a different brand in the past three months. The 2018 audit (n=211 rheumatologists) is the third annual wave of this report and includes trending back to 2016. A similar audit analyzing RA switch patients in the EU5 (France, Italy, Germany, Spain, and the UK; n=1,312 patients; n=320 rheumatologists) will also publish this month.

RealWorld Dynamix™ captures the clinician’s perspective on why the switch was made and the new brand chosen, as well as future intentions should the response be suboptimal. In addition to patient demographics and treatment history, clinical assessments, diagnostic tests and laboratory values are included to provide insight into the clinical course of the disease.

About Spherix Global Insights
Spherix Global Insights is an independent business intelligence and market research company, specializing in renal, autoimmune, neurologic and rare disease markets. Our aim is to apply our commercial experience and unique relationships within core specialty markets to translate data into insight, enabling our clients to make smarter business decisions.

All company, brand or product names in this document are trademarks of their respective holders.

For more information contact:
Lynn Price, Immunology Franchise Head
Email: [email protected]

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