Can Pharma Companies Expand the Current Ankylosing Spondylitis (AS) Market with a New Indication for Non-Radiographic Axial Spondyloarthropathy (nr-axSpA)? Novartis and UCB Pharma Are Just Two Companies Angling to Bring Approved Treatments to These Patients in the Near Future

According a new report from Spherix Global Insights, biologic treatment of nr-axSpA is complicated by multiple factors resulting in a significantly lower percentage of patients with nr-axSpA being treated compared to those with AS

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EXTON, Pa., Aug. 1, 2017 /PRNewswire/ — An independent study conducted by Spherix Global Insights in June with US rheumatologists (n=98) explored the use of approved biologics for the treatment of AS and off-label use for nr-axSpA. The study found that rheumatologists are generally familiar with the terminology “non-radiographic axial spondylitis” and most can describe the differences between the patient profiles for each condition. However, a large proportion of the survey respondents characterize nr-axSpA and AS as part of a spectrum of axial disease as opposed to an entirely distinct condition. Importantly, study respondents reported a high degree of similarity with regard to how they treat these conditions.

According to the surveyed physicians, biologic agents are prescribed in just over half of the AS patients under their management but in a significantly lower proportion of their nr-axSpA patients. The specific biologic brands prescribed, however, do not differ significantly in terms of share between AS and nr-axSpA, with AbbVie’s Humira and Amgen’s Enbrel defending a dominant position. Satisfaction with the TNF agents in AS and nr-axSpA overall is high and clinical response to these agents is considered very good. Indeed, far fewer patients progress to a second line biologic in either condition compared to the more established and increasingly volatile rheumatoid arthritis market, in which a much higher percent of patients are on later lines of therapy and/or being treated with non-TNF biologics or Pfizer’s Xeljanz.

The majority of rheumatologists describe the need for new therapeutic agents as high for both AS and nr-axSpA, but they report that nr-axSpa is significantly more challenging to manage. A major reason for this is grounded in the current referral patterns in which referring physicians may not recognize the symptoms, are unlikely to utilize imaging technology beyond a standard x-ray (which will not indicate inflammation) and may not be assessing biochemical parameters such as HLA-B27, CRP or ESR. As a result, patients may go undiagnosed for years, shuffling between different providers. As one rheumatologist notes, “Somebody with back pain is going to see 15 other providers before he’s ever going to get referred to a rheumatologist, if ever.”

Despite TNF inhibitor dominance in both the approved and off-label settings for AS and nr-axSpA, Novartis’ Cosentyx is making some headway as a viable alternative treatment option. At approximately eighteen months post launch, Cosentyx has captured a small niche of biologic-treated AS patients, however, significant gains are expected in both the user base and overall share in the next six months. Although Cosentyx has developed a strong reputation for efficacy in skin clearance in psoriasis and psoriatic arthritis, Humira is still preferred two to one over Cosentyx for AS patients with concomitant psoriasis and the concern about Cosentyx-associated new onset or worsening IBD is a barrier for some physicians.

Rheumatologists are the targets of a steady stream of promotion for approved biologics/JAKs across multiple indications. The highest rates of recent contact are reported for AbbVie and Amgen, along with Pfizer and Roche (for Actemra). However, Novartis and UCB Pharma (makers of Cimzia) dedicate the highest percent of time to detailing on AS compared to other companies in the space and as the two get closer to an indication for nr-axSpA, that is expected to heat up as these companies seek to increase awareness of nr-axSpA and ultimately increase treatment rates as a result.

RealTime Dynamix: Ankylosing Spondylitis and Non-Radiographic Axial Spondyloarthropathy is an independent report series published bi-annually. The series tracks the evolution of the AS and nr-axSpA market, provides a deep dive on launch effectiveness, and highlights opportunities for pipeline agents. The next wave of research will be fielded in November 2017

About Spherix Global Insights
Spherix Global Insights is a business intelligence and market research company specializing in renal, autoimmune, neurologic and rare disease markets. We provide clients with strategic insights leveraged from our independent studies conducted with healthcare providers and other stakeholders.

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