Rheumatoid Arthritis – Unmet Need – Detailed, Expanded Analysis: TNF-Alpha Refractory Rheumatoid Arthritis (US/EU)

Rheumatoid arthritis (RA) patients who are refractory to one or more tumor necrosis factor-alpha (TNF-α) inhibitors are generally prescribed a non-TNF-targeted therapy (e.g., Bristol Myers Squibb’s Orencia, Roche’s Actemra / RoActemra, Roche’s Rituxan / MabThera, AbbVie’s Rinvoq, Pfizer’s Xeljanz, Eli Lilly / Incyte’s Olumiant). The launch of noninvasive targeted therapies like JAK inhibitors offers more treatment options, but recent safety data are raising new concerns about JAK inhibitors, highlighting an unmet need for less risk of serious infections, cardiovascular events, and/or malignancy and restricting the use of JAK inhibitors in older patients with comorbidities. Although the RA therapy market offers multiple efficacious and relatively safe agents, patients refractory to TNF-α inhibitors have limited options; therefore, substantial unmet need remains in the treatment of TNFi-refractory RA.


  • What are the treatment drivers and goals for TNFi-refractory RA?
  • Which drug attributes are key influencers, which have limited impact, and which are hidden opportunities?
  • How do current therapies perform on key clinical and nonclinical attributes 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 TNFi-refractory RA drug?


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 April 2023

Key companies: Amgen, Pfizer, Roche, Biogen, Bristol Myers Squibb, Eli Lilly, AbbVie

Key drugs: Enbrel, Rituxan / MabThera, Orencia, Actemra / RoActemra, Xeljanz, Olumiant, Rinvoq

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