Which Medications Will Succeed in the Increasingly Competitive Ulcerative Colitis Market?

Spherix Global Insights’ recently released survey of 103 US gastroenterologists reveals that practitioners project significant growth in the use vedolizumab (Entyvio), golimumab (Simponi), and Pfizer’s Inflectra (an infliximab biosimilar of Janssen’s reference drug Remicade), for the treatment of ulcerative colitis (UC) over the next 6 months.

The study suggests that, while the positive increases in Entyvio’s and Simponi’s shares of the UC market will be driven largely by increased prescriptions for current users, projected growth in the use of Inflectra is primarily driven by increases to the user base, which is anticipated to more than double over the next 6 months.

Vedolizumab, licensed to Takeda, is an intravenously infused monoclonal antibody that is indicated for use in adult patients who have moderate to severe UC or Crohn’s disease (CD). Golimumab, Janssen’s tumor necrosis factor blocker, is a subcutaneous injection indicated for use in patients who have moderate to severe rheumatoid arthritis (RA), active psoriatic arthritis (PsA), active ankylosing spondylitis (AS), and moderately to severely active UC. Inflectra (infliximab-dyyb) for injection, the second FDA-approved biosimilar, is approved for the treatment of UC, CD, pediatric CD, RA, AS, PsA, and plaque psoriasis.

The gastroenterologists surveyed were recruited for an online survey from the Spherix Network. This group of clinical gastroenterologists agree to be revisited periodically in order to share insights into strategically important issues in the gastroenterology field, including the ongoing trajectory of Entyvio, the prominence of off-label prescribing in patients with UC, key barriers across brands, and the evolution of the inflammatory bowel disease (IBD) pipeline.

The Spherix study concludes that, despite unexpected growth in the use of the infliximab biosimilar Inflectra, the current leading barrier to its adoption is the lack of insurance mandates for its use. “Only 14% of respondents report ever being contacted by a pharmacy or insurance company regarding use of Inflectra instead of Janssen’s Remicade,” the report states. Among the few gastroenterologists who have been contacted, most made no changes to the treatment plan and continued to prescribe Remicade. Remicade continues to lead the UC biologics market, yet it is expected that payers will soon increase pressure to prescribe Inflectra, helping to fuel the biosimilar’s future gains.

Off-label use of products being studied for IBD but approved for other autoimmune conditions is an additional factor potentially impacting the UC market, according to the report. Half of the survey respondents said that they would be more comfortable prescribing a newly approved drug in IBD that already has significant post-marketing experience in another indication than prescribing a drug with a completely novel mechanism of action.

When questioned about familiarity with agents in the research pipeline, gastroenterologists reported the greatest familiarity with Pfizer’s Xeljanz (tofacitinib citrate, an oral RA treatment). Their familiarity with this drug was significantly greater than their familiarity with Celgene’s investigational drugs, mongersen (for CD) and ozanimod (for CD and MS), or with Roche and Genentech’s investigational UC and CD treatment, etrolizumab.

“The key to getting market entrants in the UC space will not only be getting patients on these new therapies but augmenting current persistency rates, as the study revealed that over half of the patients spent no more than 6 months on their prior biologic brand before being switched,” the report shows. “Opportunity to improve UC outcomes abounds, as the participating gastroenterologists report that only 58% of their biologic-treated UC patients are well-managed on their current agent.”

Spherix Global Insights’ independent reports are designed and developed by Spherix, a business intelligence and market research company specializing in renal, autoimmune, neurologic, and rare disease. The latest quarterly update on UC was released in July 7, 2017.