Rheumatoid Arthritis | Unmet Need | TNF-alpha Refractory | US/EU | 2018

Rheumatoid arthritis (RA) treatment typically begins with one or more conventional DMARDs, followed by a first-line biologic, usually a TNF-α inhibitor. Patients refractory to one or more TNF-α inhibitors are then given a non-TNF-targeted therapy (biologics/Jak inhibitors). Although the RA market is generally considered to have multiple efficacious and relatively safe agents, patients refractory to TNF-α inhibitors have limited options even with the recent entry of newer agents (IL-6 inhibitors, Jak inhibitors). For the TNFi-refractory RA subpopulation, an unmet need exists for agents able to demonstrate greater efficacy in reducing signs and symptoms of disease and inducing clinical remission. In addition, the serious (although rare) safety signals associated with most targeted therapies remains a concern when physicians are making prescribing decisions. With quantitative insight into U.S. and European rheumatologist assessment of the unmet need in TNFi-refractory RA, we analyze remaining commercial opportunities and discuss how emerging therapies may capitalize on these opportunities. The emerging Jak inhibitor upadacitinib has shown promising efficacy and is analyzed against marketed agents in the same class, Xeljanz and Olumiant, with regard to physician preference and prescribing likelihood.


  • What are the treatment drivers and goals for TNFi-refractory RA?
  • What drug attributes are key influencers, which have limited impact, and which are hidden opportunities?
  • How do current therapies perform on key treatment drivers and goals for TNFi-refractory RA?
  • What are the prevailing areas of unmet need and opportunity in TNFi-refractory RA?
  • What trade-offs across different clinical attributes and price are acceptable to U.S. and European rheumatologists for a hypothetical new drug targeting TNFi-refractory RA?


Provides quantitative insight into U.S. and European physician perceptions of key treatment drivers and goals and the current level of unmet need for a specific disease. Commercial opportunities are analyzed, and the extent to which emerging therapies may capitalize on these opportunities is evaluated.

Markets covered: United States, United Kingdom, France, Germany.

Primary research: Survey of 61 U.S. and 30 European rheumatologists fielded in January 2018.

Key companies: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Pfizer, Regeneron, Roche, Sanofi.

Key drugs: Humira, Remicade, Rituxan/MabThera, Orencia, Actemra/RoActemra, Xeljanz, Olumiant

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