Physician and Payer Perspectives on Biologic Use and Novel Therapeutic Targets in the Treatment of Psoriatic Arthritis, Ankylosing Spondylitis, and Nonradiographic Axial Spondyloarthritis
Spondyloarthritis (SpA) is a family of chronic inflammatory rheumatic diseases primarily affecting the spine, including joints and entheses, where ligaments and tendons attach to the bone. The umbrella indication covers both axial SpA (Ax SpA), which includes ankylosing spondylitis (AS) and nonradiographic Ax SpA, and peripheral SpA, which includes psoriatic arthritis (PsA) and undifferentiated peripheral SpA. Over the past decade, SpA, and more specifically Ax SpA and PsA, have seen significant advances in terms of diagnosis and treatment, including updates to international guidelines that recommend use of TNF-α inhibitors in patients with nonradiographic Ax SpA refractory to conventional agents. Five TNF-α inhibitors currently approved for the treatment of Ax SpA and PsA are the mainstay treatment for moderate-to-severe PsA/Ax SpA patients who fail conventional therapies. While the PsA market is becoming increasingly crowded with the availability of the IL-12/23 inhibitor, Stelara, and an oral agent, Otezla, as alternative treatment options to TNFs, unmet need exists for efficacious, safer, and more cost-effective drugs. Unlike the situation in PsA, in Ax SpA, the lack of targeted immune therapies other than TNF-α inhibitors signals a clear opportunity for drug developers to bring agents to market that offer alternative treatment options.
Drawing on insights from 255 European rheumatologists and 15 payers with influence at national or regional levels, this report analyzes European physicians’ and payers’ attitudes with respect to the changing PsA/Ax SpA market. In addition, we focus on physicians’ and payers’ view of the marketed biologics, recently launched Otezla, biosimilars, and emerging therapies.