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Rheumatologists Cite Preferred First-Line Biologics for Psoriatic Arthritis and Ankylosing Spondylitis

Survey finds reimbursement restrictions prevent use of biologics in 30% of patients (Nov. 28)
In addition, most of the surveyed rheumatologists reported that payers require patients with peripheral or axial predominant PsA to fail treatment with conventional disease-modifying antirheumatic drugs (DMARDs) before receiving biologics. Although conventional DMARDs have a role in peripheral PsA, they are generally ineffective in treating spinal disease. The surveyed rheumatologists reported that about 30% of patients who are candidates for biologics do not receive those drugs because of reimbursement restrictions.

The surveyed rheumatologists also estimated that, irrespective of its tier position, 40% of patients who start treatment with Stelara (ustekinumab, Janssen Biotech) by the end of 2015 will have failed one or two tumor necrosis factor-alpha (TNF-alpha) inhibitors. Stelara is currently in phase III development for PsA and is FDA-approved for moderate-to-severe plaque psoriasis.

If Stelara is placed on a higher tier than the TNF-alpha inhibitors with the lowest tier position, clinicians estimate that only 20% of Stelara patients will be biologics-naïve in 2015, compared with 30% if the drug is on the same tier as the lowest-tiered TNF-alpha inhibitor. The company predicts that, based on the current coverage for Stelara on the largest commercial plans of surveyed managed care organizations (MCOs), it is most likely that Stelara will be placed on a higher tier than approved anti-TNFs.

The report also finds that if Cimzia (certolizumab pegol, UCB, Inc.) is approved for PsA, it will be the fifth TNF-alpha inhibitor to be marketed for this indication. Cimzia is currently approved for rheumatoid arthritis and Crohn’s disease.

“Over 40% of surveyed rheumatologists report the earliest line of therapy for Cimzia would be in biologics-naïve patients if it is on a similar tier to approved anti-TNFs, but the largest share of physicians (30%) expect Cimzia will most commonly occupy a similar position to Simponi [golimumab, Janssen Biotech] in their treatment algorithm — inadequate responders to one prior TNF-alpha inhibitor,” said analyst Kathryn Beane.

If Cimzia is approved for PsA and axial spondyloarthritis (SpA), surveyed MCOs said that prescribing restrictions for the drug will be similar for both indications, with approximately half of plans requiring that patients fail on one or two anti-TNFs before treatment with Cimzia –– which will likely result in the positioning of Cimzia primarily as a later-line biologic for PsA and axial SpA. In addition, since Cimzia is currently excluded from a sizeable percentage of surveyed health plans, the company predicts that some of these plans will continue to exclude Cimzia in the future, also limiting uptake of the drug in PsA and axial SpA.

Source: Decision Resources; November 28, 2012.

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