The rheumatoid arthritis (RA) market, although not a huge one in terms of number of patients, is becoming a crowded battlefield. Sales of the three main established anti-tumour necrosis factor (anti-TNF) drugs - Amgen/Wyeth's Enbrel (etanercept), Abbott's Humira (adalimumab), and Johnson & Johnson/Schering-Plough's Remicade (infliximab) - totalled $9.9 billion worldwide in 2006, according to IMS, representing a growth of 23% on 2005.
Makers of biologics see a huge opportunity in this market since only around 10% of the RA treated population are currently prescribed anti-TNF drugs, but these account for the great majority of all RA drug sales. The old players in this market are now being joined by newcomers like Roche, Bristol-Myers Squibb, and UCB, among several others. This fierce competition was demonstrated by some companies' conspicuous efforts to grab the attention of prescribing physicians at the Annual European Congress of Rheumatology for the European League Against Rheumatism (EULAR), which took place in Barcelona in June 2007.
TNF inhibitor sales, top five EU markets 2006
Source: IMS MIDAS Quantum
Among the medical studies presented in Barcelona, some shine light into the RA market. For example, for the first time an international map of RA has been sketched. The outline revealed that significant national differences in RA severity can be directly traced to national economics, most notably health expenditure. The map results from the QUEST-RA study, a multinational database in RA that contains data from 21 countries. QUEST-RA displays "the international variations and related economic factors that affect the progression of the disease", as explained by the lead author of the study, Dr Tuulikki Sokka of the Jyvaskyla Central Hospital in Finland. She commented that most medical literature on RA is based on randomized clinical trials but many patients do not meet trial inclusion criteria and not all European countries are sufficiently involved in such trials. The main idea behind the database was to enhance clinical rheumatology as a quantitative science and compare therapies at different countries.
The database reviewed data from 100 consecutive RA patients in three or more centres in each of the 21 participating countries: Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Serbia, Spain, Sweden, Turkey, UK, Argentina, Canada and the USA. The study collected data between January 2005 and June 2007, and measurements of patients' disease states were taken using the Disease Activity Scale 28 (DAS28), which assesses the activity of disease across the 28 joints most commonly affected by RA. The study also logged each participating country's Gross Domestic Product (GDP) and health expenditure per capita. The analysis revealed what has been empirically suspected: the disease severity is higher in poorer countries with less health spending.
Gender bias in treatment revealed
Other research results presented at EULAR also may help delineate how RA drugs are used and the potential of the market in this therapeutic area. One of them, conducted at the Karolinska Institute, Sweden, unveiled gender disparity in RA treatment. This study shows that women receive anti-TNF drugs at a higher perceived level of disease activity and when they are reporting more severe pain than their male counterparts. DAS28 scores at initiation of anti-TNF treatment were found to be significant higher for women than for men (5.53 for women and 5.04 for men) and women had higher Tender Joint Counts (9.62, compared with 8.41 for males).
Lead researcher Dr Ronald van Vollenhoven said the study does not show a gender bias as such, but indicates that physicians to some extent "discount" the subjective measures of disease activity, which were found to be higher in women, and let their decision be driven by objective markers of the disease. "Because the goal of any treatment for RA must be to relieve the patients suffering, it is not clear that this approach is the right one," he commented, calling for equal prescribing and better disease management for all.
Both studies, the QUEST-RA and the gender study, present a snapshot of the RA treatment, particularly in Europe. Professor Tore K Kvien, EULAR President, pointed out that there is a need to improve equal access to effective treatment of the disease across Europe. This is perhaps a good opportunity for anti-TNF manufacturers to redirect their marketing crusade more towards female patients and justifies extending their crowded battlefield to Europe. That explains why some pharma giants, like Wyeth, Abbott and Roche, have been deploying small armies to conferences like EULAR to perform one-on-one "attacks" on prescribing physicians.
This article was written by Johanna Kleine, Senior Editor of IMS Company Profiles. Covering more than 80 of the top pharmaceutical and biotechnology companies, the profiles offer authoritative insight into company strategy, finances, portfolio management, R&D and history and also contain top-line IMS sales data. For more information, please contact Stephanie Earle, or call +44 203 075 5757.