Rheumatoid Arthritis Market Evaluation

A Survey of 50 Board-certified or Board-eligible Rheumatologists 

Panel Intelligence, LLC

March 2007

STUDY DESCRIPTION

OBJECTIVES

Assess the current market for Rheumatoid Arthritis (RA) therapies and identify possible future treatment options.

• Examine current RA patient populations and treatment options.
• Determine practice procedures that follow the failure of an anti-TNF therapy.
• Identify the current use of and issues surrounding two newer RA treatments, Orencia and Rituxan.
• Rate the level of excitement rheumatologists have over possible future treatments for RA.

Companies and Products Mentioned in This Report 

Inclusion Criteria and Respondent Demographics

PI interpretation of data

Section 1: Current Practice

Rheumatologists currently manage an average of 575 patients who have or have had a diagnosis of Rheumatoid Arthritis.

Of the reported average of 369 patients seen per month regardless of condition, 117 patients have Rheumatoid Arthritis.

• Half of the patients with RA are described as having moderate disease.

Methotrexate is used as a primary agent for first- and second-line treatment of moderate/severe RA patients.

Corticosteroids are used third-line for more than one-third of moderate/severe RA patients. 

More than 50% of respondents indicated that efficacy is the primary reason why they choose biologic Disease Modifying Anti-Rheumatic Drugs (DMARDs). 

• 62% of rheumatologists indicated that they have been using Humira more frequently over the past 12 months than any other agent for mild RA patients.
• Physicians most commonly cited the availability of new data on RA agents as well as their personal experience with these drugs as the reasons for change in the prescriptions for milder RA patients.

Section 2: Anti-Tumor Necrosis Factor (TNF) Therapy

Participants reported that 23% of their RA patients fail anti-TNF therapy.

• It takes an average of 4 months and/or 3 therapies to identify the failure of an anti-TNF therapy.

Physicians say that they are “somewhat satisfied” with the current treatment options for moderate/severe RA patients who fail anti-TNF therapy.

Rheumatologists most commonly try Orencia after anti-TNF failure and, if the patient progresses, they try Rituxan.

A large majority of respondents report that they would use a new anti-TNF agent if it had a superior efficacy and safety profile in a head-to-head study against existing anti-TNFs.

Half of the respondents reported that they typically increase the dosage of the first-line treatment in case of first-line treatment failure.

• The action taken next most often is to switch to another anti-TNF therapy.

50% of physicians report using Orencia or Rituxan most commonly in case of failure of second-line anti-TNF therapy.

Section 3: Newer Products

More than 80% of respondents have used either Orencia or Rituxan for the treatment of RA.

Rheumatologists have treated 81% of their RA patients with Orencia after 2 or more failures of anti-TNFs.

• 19% of patients who have discontinued treatment with Orencia have done so mainly due to inefficacy of the treatment.
• About one-third of physicians report having occasionally encountered reimbursement issues with Orencia.
• 71% of respondents indicated that a 2006 Phase III study presented at ACR has had no effect on their usage of Orencia.

Rheumatologists have treated 88% of their RA patients with Rituxan after 2 or more failures of anti-TNFs.

• 20% of patients who have discontinued treatment with Rituxan have done so mainly due to inefficacy of the treatment.
• Slightly more than one-third of physicians have occasionally encountered reimbursement issues with Rituxan.
• 72% of respondents indicated that incidence of PML in lupus patients has had no effect on their usage of Rituxan.

45% of respondents are cautious about administering Rituxan in re-treatments.

74% of respondents indicated that 45% of their patients received Rituxan as a repeat course mainly because of a good initial response to this treatment.

Slightly more than half of physicians have used Orencia since its FDA approval.

Ideal Orencia patients: multiple anti-TNF failures, failure on Remicade.  

Ideal Rituxan patients: multiple anti-TNF failures, failure on Orencia, hard to accommodate for Orencia monthly infusion. 

Slightly more than half of respondents believe that Orencia and Rituxan are equivalent or superior to anti-TNFs.

47% of respondents report that concern over depleting B-cells is the most significant issue potentially limiting the use of Rituxan.

Respondents believe that neither safety concerns over increased frequency of infections nor the concerns over activated T-cells are significant issues potentially limiting the use of Orencia.

Section 4: Future RA Treatments

69% of respondents report being “excited” about Roche’s Actemra (MRA, an anti-IL6) for RA treatment.
quantitative survey detailed findings by question

Screening Question 6.

Which of the following describes your primary practice setting?

Screening Question 7.

Please describe the practice setting in which you see the majority of your MS patients.

Section 1: Current Practice

Question 1.

How many total patients, regardless of condition, do you see in a typical month?

Question 2.

Of these <insert Q.1> patients you see in a typical month, how many have Rheumatoid Arthritis (RA)?

Question 3.

Approximately what percent of your RA patients fall under the following classifications?

Question 4.

Please think only of your moderate/severe RA patients. What percent of these patients receive the following treatments?

Question 5.

Please indicate how you currently treat your moderate/severe RA patients by line of therapy.

Question 6.

When evaluating which biologic DMARD to use, what is the primary reason for choosing between treatments?

Question 7.

Please indicate how your use of each of the following treatments for milder patients has changed over the past year.

Question 8.

What has driven your change in prescribing to milder patients (if applicable)?

Section 2: Anti-Tumor Necrosis Factor (TNF) Therapy

Question 9.

What is the failure rate of patients who receive anti-TNF’s?

Question 10.

On average, how long does it usually take before a patient is deemed to have failed an anti-TNF therapy?

Question 11.

On average, how many therapies would you try before deciding that a patient is an anti-TNF failure?

Question 12.

How would you rate your current satisfaction level with the current choices for treating moderate/severe RA for patients who fail anti-TNF therapy?                                     

Question 13.

Please explain the rationale behind your response. 

Question 14.

What do you typically do when a patient fails anti-TNF therapy? (Please list each action separately)

Question 15.

If a new anti-TNF was available on the market, would you use the agent if it had a:

Question 16.

Assuming the new anti-TNF has comparable efficacy and safety in clinical studies, would you use the agent if:

Question 17.

What do you typically do when a patient fails one line of anti-TNF therapy? Please indicate what you do most often and second-most often. (Select one for each column)

Question 18.

What do you typically do when a patient fails a second-line of anti-TNF therapy? Please indicate what you do most often and second most often. (Select one for each column)

Section 3: Newer Products

Question 19.

Have you used either of these treatments for the treatment of RA? (Select one for each row)

Question 20.

Of the patients you have treated with Orencia, what percent have you treated under each of the following situations?

Question 21.

Please indicate the percent of patients treated with Orencia who have discontinued treatment.                                                                                                                             Question 22.

Please describe the leading cause(s) of discontinuation for patients treated with Orencia.                                                                                                                                        Question 23.

In your opinion, what has been the biggest barrier to early adoption of Orencia? 

Question 24.

How often have you encountered reimbursement issues with Orencia?

Question 25.

In a phase III study (results presented at 2006 ACR), Orencia was shown to effect clinical improvements (as measured by DAS28 score) out to 12 months.  How has this study impacted your use of Orencia?

Question 26.

Of the patients you have treated with Rituxan, what percent have you treated under each of the following situations?

Question 27.

Please indicate the percent of patients treated with Rituxan who have discontinued treatment.                                                                                                                        Question 28.

Please describe the leading cause(s) of discontinuation for patients treated with Rituxan. 

Question 29.

How often have you encountered reimbursement issues with Rituxan?

Question 30.

How has the incidence of PML in Lupus patients impacted your use of Rituxan?

Question 31.

How comfortable are you with the safety of administering Rituxan in repeated rounds (re-treatments)?

Question 32.

Have you re-treated any patients with Rituxan?

Question 33.

Please estimate the percentage of patients you have treated with Rituxan who receive repeat courses.                                                                                                  

Question 34.

Please describe the key factors that determine your Rituxan re-treatment prescribing. 

Question 35.

Since FDA approval and market availability, which product have you used more often?                                                                                                                                             Question 36.

Please explain the rationale behind your selection.

Question 37.

Please describe the ideal patient for Orencia compared to the ideal patient for Rituxan.  Please highlight any key differences.

Question 38.

What are your current perceptions of the efficacy (ACR Scores) of these treatments vs. current anti-TNFs?

Question 39.

How significant do you find each of the following issues in potentially limiting your use of these treatments?

Section 4: Future Treatment

Question 40.

What is your excitement level concerning the following possible future therapies for the treatment of Rheumatoid Arthritis?