Methotrexate remains a first-line choice of treatment for patients with rheumatoid arthritis (RA), with an average of 72 percent of patients receiving the agent as first-line therapy. Rheumatologists believe it is the best first-line therapy — it’s cost effective, and evidence of its efficacy is supported by three decades of clinical study.
Among biologic treatments for patients with RA, however, tumor necrosis factor (TNF) inhibitors seem to be the favored first-line treatment (82 percent), according to Datamonitor’s report “Stakeholder Insight: Rheumatoid Arthritis,” a survey of 180 rheumatologists in seven major world markets (the United States, Japan, France, Germany, Italy, Spain, and the United Kingdom).
But that position may change by 2015, when first-line use of TNF inhibitors is predicted to fall to 64 percent, in the face of higher usage of drugs with other mechanisms of action. Further, the report predicts a proportional decline in the use of TNF inhibitors from first line to fourth line.
“We also predict an overall increase in the number of biologic therapies, so even though the proportions are changing, TNF therapy still remains a growth area. We would expect sales to start falling as a result of the biosimilars coming on the market in 2014,” says Clare Davies, a lead analyst at Datamonitor.
TNF inhibitors are currently a mainstay of early biologic management of RA, whereas therapies using alternative mechanisms are used when the disease progresses or when TNF inhibitors lose their efficacy. By 2015, rheumatologists will be considering drug therapies with other mechanisms of action, such as interleukin (IL-6) and CD20. It is predicted that earlier usage of non-TNF biologics will increase more than 2.5 times from 14 percent of first-line RA patients to as much as 36 percent in 2015.
“RA is difficult to treat, so clinical executives in managed care companies are going to have a hard time setting up guidelines,” Davies says. “Physicians are worried because there are new biologics on the horizon, and managed care will be setting up different restrictions on their use.” She says the rumblings of concerned physicians may soon move from the background to the foreground.
Tina Taylor, an associate analyst at Datamonitor, says the RA arena is really changing, “and how rheumatologists approach the management of RA in 2015 should be a consideration as clinical executives make policy and decisions.”
Mean percentage of patients receiving TNF inhibitors, 2010 and 2015
Source: Datamonitor. Stakeholder Insight: Rheumatoid Arthritis — Rising competition by line and severity, 2010