Physicians Would Welcome Therapies Causing Lower Rate of Serious Infections than Remicade, but Will Payers View Such Agents Favorably?
Treatment for Crohn’s disease (CD)—a relapsing/remitting inflammatory bowel disease marked by abdominal pain, diarrhea, and complications including gastrointestinal fistulas—requires acute management of disease flares and chronic, long-term maintenance therapy. Moderate to severe CD is typically treated with oral corticosteroids and/or immunosuppressants to induce and maintain remission, respectively, after which patients graduate to treatment with tumor necrosis factor-alpha (TNF-α) inhibitors. The first approved TNF-α inhibitor for CD, infliximab (Janssen/Merck/Mitsubishi Tanabe’s Remicade), remains the market leader for this indication, but the second approved agent in this class, adalimumab (AbbVie/Eisai’s Humira), is experiencing increasing uptake as a first-line biologic. Emerging therapies with different mechanisms of action and/or less-burdensome delivery are in clinical development for moderate to severe CD. However, interviewed thought leaders do not expect these drugs to displace the TNF-α inhibitors as the dominant drug class for moderate to severe CD, and substantial opportunity exists for additional therapies that can improve on the efficacy and safety of marketed agents.