Disease Modification in Rheumatoid Arthritis - Anti-TNFs defend first-line biologic position despite competition

Datamonitor forecasts that total sales for the seven major rheumatoid arthritis markets will grow from $7 billion in 2007 to over $12 billion in 2017. The sustained uptake of anti-TNFs combined with the launch of several new biologic products will drive growth in the short-and mid-term. However, biosimilar entry will cause a small contraction in market value at the end of the forecast period.

Simponi (golimumab) exemplifies a brand adopting both follow-on and dual formulation strategies, but positioning with Remicade will be challenging. Careful brand management, sales and marketing efforts and a well executed switching strategy will see Simponi achieve blockbuster status in the seven major markets.

The TNF-failure pool will increase considerably as patients cycle through a maximum of 2-3 TNF therapies. Currently, Orencia and Rituxan/MabThera compete in this sub-population, which will become increasingly crowded. With its well-perceived safety profile and Actemra's US approval delay, Orencia will cement its first-line position in TNF-failures.

Although some novel biologic products, have amassed convincing efficacy data against anti-TNFs, their use will be limited to the anti-TNF failure patient population, at least in the mid-term. To progress up the treatment algorithm, new agents need to demonstrate superiority to anti-TNFs and show cost-effectiveness.

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