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Treatment Algorithms: Rheumatoid Arthritis 2nd Edition - DMARDs Move to Front of PackPublished by: Datamonitor Published: Nov. 29, 2002 - 227 Pages Table of ContentsOverview Introduction Rheumatoid arthritis is a debilitating disease that involves the inflammation of the lining of the joints. While no cure exists, physicians can utilize a number of strategies and products in an attempt to control the disesase, and the accompanying pain and swelling. Based on 245 physician interviews, this analysis examines current treatment trends in the ongoing fight against rheumatoid arthritis. Scope This analysis covers the seven major pharmaceutical markets, US, Japan, France, Germany, Italy, Spain, and the UK The drug classes covered include DMARDs, biologics, traditional NSAIDs, COX-II inhibitors, immunosuppressants, and oral and injectable steroids Treatment strategies vary from country to country in terms of use of biologics and DMARDs, particularly with regard to mild and moderate RA cases Report Highlights Rheumatoid arthritis is an uncurable disease. However, the availability of DMARDs and biologics have allowed physicians the opportunity to slow progression of the disease, and improve the patient's condition from an early stage. Across all markets, physicians are using DMARDs, and combinations of DMARDs, to treat mild and moderate RA patients in an attempt to control the arthritis from diagnosis. Despite the highly specialized nature of rheumatoid arthritis treatment, the majority of patients in all markets except Japan initially present their RA symptoms to primary care physicians. As a result, these physicians play a vital role in the treatment and referral of rheumatoid arthritis patients; companies must continue to encourage awareness and understanding of the disease at a primary care level, to ensure maximum diagnosis. The battle between Enbrel and Remicade for sales within the biologic DMARD drug class has become the focus of the RA market in the past year. A number of factors have influenced physician choice during this period, including availability and method of administration, and as a result the success of each product has varied significantly from market to market. Reasons to Purchase Understand treatment trends across seven markets, by disease severity, to evaluate potential for current and pipeline products. Assess the current and perceived role of biologic DMARDs in the treatment of RA, amidst varied market challenges. Evaluate markets where the patient population, or the use of a drug class in particular, is underpenetrated, to best position your products. Identify the leading products in each market, to build an understanding of the factors that contribute to success on the RA market in each country. DRIVERS AND TRENDS Overview of the factors shaping rheumatoid arthritis treatment trends across the globe, and individual markets around the world. Understand the key factors that have determined the relative successes of arthritis drug classes and individual products competing in the arthritis market today: Which products are at the forefront of rheumatologists treatment regimens, whether generic or branded? How have the recommendations of early, aggressive DMARD use impacted treatment trends? Which unmet needs provide the biggest opportunity for pharmaceutical companies, according to primary care physicians and rheumatologists? PATIENT POTENTIAL Understand the demographics and diagnosis rates that shape the potential drug-treated population: Evaluate the prevalence of RA in each market Identify markets with low diagnosis rates Predict future RA populations DIAGNOSIS Diagnosis methods, co-morbidities, and RA prevalence by disease severity (mild, moderate, severe) is presented in this chapter: Who makes the initial RA diagnosis in each market? What diagnosis methods are most commonly used? What are the most common symptoms presented by patients, by disease severity? MANAGEMENT OF RHEUMATOID ARTHRITIS An in-depth look at current treatment trends in rheumatoid arthritis, to the level of individual drugs prescribed to manage the disease at each disease severity in the seven major markets: Prescription by drug class: Traditional NSAIDs, COX-II inhibitors, DMARDs, biologic DMARDs, oral and injectable steroids Overview of the leading drugs in RA Individual country trends Treatment Guidelines ACR sets the bar Presentation and Management How important are PCPs? Non-pharmacological therapy Budget savings through inaction Drug classes prescribed DMARDs- early and often Drug use by class Numerous choices; more on the way PATIENT OUTCOMES Examines the outcomes that physicians seek when treating rheumatoid arthritis, the level of patient compliance, and unmet needs in the current treatment of RA: What factors are influencing compliance, and how can compliance be improved? What are physician goals in the treatment of RA? What are the greatest unmet needs from the average rheumatologist’s perspective? RHEUMATOID ARTHRITIS TREATMENT TREES Detailed treatment trees identifying the percentage and total patient numbers treated with specific drug classes, and individual drugs within those classes, based on treatment algorithm survey responses: Identify drug-treated patient populations by severity for each market Understand perceived compliance rates, and the rate desired outcomes reported by physicians ACTION POINTS Recent trends emphasize aggressive and early use of DMARDs to slow the progression of rheumatoid arthritis. While the magnitude of this trend’s impact varies across markets, an opportunity clearly exists for companies that market DMARDs to increase penetration among rheumatologists treating mild and moderate RA, as many treatment regimens remain focused on treating pain, rather than modifying the disease. Despite the highly specialized nature of rheumatoid arthritis treatment, the majority of patients in all markets except Japan initially present their RA symptoms to primary care physicians. As a result, these physicians play a vital role in the treatment and referral of rheumatoid arthritis patients; companies must continue to encourage awareness and understanding of the disease at a primary care level, to ensure maximum diagnosis. DATASETS Table of tables Table 1: Prevalence of rheumatoid arthritis in the seven major markets, 2002 Table 2: Rheumatoid Arthritis Prevalence by Country, (million), 2000-10e Table 3: Tests and strategies used in the diagnosis of rheumatoid arthritis in the seven major markets, 2002 Table 4: Co-Morbidities associated with rheumatoid arthritis Table 5: American College of Rheumatology guidelines for baseline evaluation of RA disease activity and damage Table 6: Proportion of initial presentation and initial treatment of RA, seven major markets, by specialty Table 7: Percentage of diagnosed RA patients receiving non-drug therapy alone in the seven major markets, 2002 Table 8: Non-pharmacological treatments utilized by physicians for RA in seven major markets, 2002 Table 9: Breakdown (%) in the pharmacotherapy prescribed to RA patients among diagnosed, drug-treated patients in the seven major markets, 2002 Table 10: Composite breakdown (%) in the pharmacotherapy prescribed to RA patients, among diagnosed, drug-treated patients across the seven major markets, 2002 Table 11: Leading factors influencing prescribing behavior in the management of rheumatoid arthritis Table 12: Percentage of diagnosed, drug-treated RA patients receiving DMARD therapy in the seven major markets, by disease severity, 2002 Table 13: Percentage of diagnosed, drug-treated RA patients receiving biologics therapy in the seven major markets, by disease severity, 2002 Table 14: Percentage of diagnosed, drug-treated RA patients receiving traditional NSAIDs therapy in the seven major markets, by disease severity, 2002 Table 15: Percentage of diagnosed, drug-treated RA patients receiving traditional COX-II inhibitor therapy in the seven major markets, by disease severity, 2002 Table 16: Percentage of diagnosed, drug-treated patients receiving oral steroid therapy in the seven major markets, 2002 Table 17: Percentage of diagnosed, drug-treated patients receiving injectable steroid therapy in the seven major markets, 2002 Table 18: Percentage (%) of diagnosed, drug-treated RA patients receiving combination therapy in the seven major markets, 2002 Table 19: Breakdown (%) of traditional NSAID therapy for rheumatoid arthritis in the US, 2002 Table 20: Breakdown (%) of traditional NSAID therapy for rheumatoid arthritis in Japan, 2002 Table 21: Breakdown (%) of traditional NSAID therapy for rheumatoid arthritis in Europe, 2002 Table 22: Breakdown (%) of traditional NSAID therapy for rheumatoid arthritis in Europe, by severity, 2002 Table 23: Breakdown (%) of COX-II inhibitor therapy for rheumatoid arthritis in the US, 2002 Table 24: Breakdown (%) of COX-II inhibitor therapy for rheumatoid arthritis in Europe, by severity, 2002 Table 25: Breakdown (%) of DMARD therapy for rheumatoid arthritis in the US, 2002 Table 26: Breakdown (%) of DMARD therapy for rheumatoid arthritis in Japan, 2002 Table 27: Breakdown (%) of DMARD therapy for rheumatoid arthritis in Europe, 2002 Table 28: Breakdown (%) of DMARD therapy for rheumatoid arthritis in Europe, by severity, 2002 Table 29: Breakdown (%) of biologic therapy for rheumatoid arthritis in the US, 2002 Table 30: Breakdown (%) of biologic therapy for rheumatoid arthritis in Europe, by severity, 2002 Table 31: Breakdown (%) of oral steroid therapy for rheumatoid arthritis in the US, 2002 Table 32: Breakdown (%) of oral steroid therapy for rheumatoid arthritis in Europe, 2002 Table 33: Breakdown (%) of injectable steroid therapy for rheumatoid arthritis in the US, 2002 Table 34: Breakdown (%) of injectable steroid therapy for rheumatoid arthritis in Japan, 2002 Table 35: Breakdown (%) of injectable steroid therapy for rheumatoid arthritis in Europe, 2002 Table 36: Breakdown (%) of immunosuppressant therapy for rheumatoid arthritis in the US, 2002 Table 37: Breakdown (%) of immunosuppressant therapy for rheumatoid arthritis in Japan, 2002 Table 38: Breakdown (%) of immunosuppressant therapy for rheumatoid arthritis in Europe, 2002 Table 39: Breakdown (%) of immunosuppressant therapy for rheumatoid arthritis in Europe, by severity, 2002 Table 40: Yearly cost per patient of leading RA drugs in the UK, 2002 Table 41: Estimated costs of the leading RA drug regimens per patient per year in the UK, 2002 Table 42: Yearly cost per patient of leading RA drugs in France, 2002 Table 43: Estimated costs of the leading RA drug regimens per patient per year in France, 2002 Table 44: Yearly cost per patient of leading RA drugs in the US, 2002 Table 45: Estimated costs of the leading RA drug regimens per patient per year in the US, 2002 Table 46: Desired outcomes cited by physicians by disease severity, in seven major markets Table 47: Criteria used by physicians to measure treatment efficacy Table 48: Rate of compliance in seven major markets, by disease severity Table 49: Breakdown (%) of DMARD therapy for RA in the US, 2002 Table 50: Breakdown (%) of biologic therapy for RA in the US, 2002 Table 51: Breakdown (%) of traditional NSAID therapy for RA in the US, 2002 Table 52: Breakdown (%) of COX-II inhibitor therapy for RA in the US, 2002 Table 53: Breakdown (%) of oral steroid therapy for RA in the US, 2002 Table 54: Breakdown (%) of injectable steroid therapy for RA in the US, 2002 Table 55: Breakdown (%) of DMARD therapy for RA in Japan, 2002 Table 56: Breakdown (%) of traditional NSAID therapy for RA in Japan, 2002 Table 57: Breakdown (%) of injectable steroid therapy for RA in Japan, 2002 Table 58: Breakdown (%) of DMARD therapy for RA in France, 2002 Table 59: Breakdown (%) of biologic therapy for RA in France, 2002 Table 60: Breakdown (%) of NSAID therapy for RA in France, 2002 Table 61: Breakdown (%) of COX-II inhibitor therapy for RA in France, 2002 Table 62: Breakdown (%) of oral steroid therapy for RA in France, 2002 Table 63: Breakdown (%) of injectable steroid therapy for RA in France, 2002 Table 64: Breakdown (%) of DMARD therapy for RA in Germany, 2002 Table 65: Breakdown (%) of biologic therapy for RA in Germany, 2002 Table 66: Breakdown (%) of traditional NSAID therapy for RA in Germany, 2002 Table 67: Breakdown (%) of COX-II inhibitor therapy for RA in Germany, 2002 Table 68: Breakdown (%) of oral steroid therapy for RA in Germany, 2002 Table 69: Breakdown (%) of injectable steroid therapy for RA in Germany, 2002 Table 70: Breakdown (%) of DMARD therapy for RA in Italy, 2002 Table 71: Breakdown (%) of biologic therapy for RA in Italy, 2002 Table 72: Breakdown (%) of traditional NSAID therapy for RA in Italy, 2002 Table 73: Breakdown (%) of COX-II inhibitor therapy for RA in Italy, 2002 Table 74: Breakdown (%) of oral steroids therapy for RA in Italy, 2002 Table 75: Breakdown (%) of injectable steroids therapy for RA in Italy, 2002 Table 76: Breakdown (%) of DMARD therapy for RA in Spain, 2002 Table 77: Breakdown (%) of biologic therapy for RA in Spain, 2002 Table 78: Breakdown (%) of traditional NSAID therapy for RA in Spain, 2002 Table 79: Breakdown (%) of COX-II inhibitor therapy for RA in Spain, 2002 Table 80: Breakdown (%) of oral steroid therapy for RA in Spain, 2002 Table 81: Breakdown (%) of injectable steroid therapy for RA in Spain, 2002 Table 82: Breakdown (%) of DMARD therapy for RA in UK, 2002 Table 83: Breakdown (%) of biologic therapy for RA in the UK, 2002 Table 84: Breakdown (%) of traditional NSAID therapy for RA in UK, 2002 Table 85: Breakdown (%) of COX-II inhibitor therapy for RA in UK, 2002 Table 86: Breakdown (%) of injectable steroid therapy for RA in UK, 2002 Table 87: US physician sample breakdown Table 88: Japan physician sample breakdown Table 89: France physician sample breakdown Table 90: Germany physician sample breakdown Table 91: Italy physician sample breakdown Table 92: Spain physician sample breakdown Table 93: UK physician sample breakdown List of figures Figure 1: Prevalence of rheumatoid arthritis in the seven major markets, 2002 Figure 2: Rheumatoid arthritis diagnosis rates in the seven major markets, 2002 Figure 3: Diagnosed RA patient populations in seven major markets, 2002 Figure 4: Proportion of RA patients diagnosed by type of physician in seven major markets, 2002 Figure 5: Diagnosed RA patient population in seven major markets, by severity, 2002 Figure 6: Symptoms associated with RA, by severity Figure 7: ACR guidelines for the management of rheumatoid arthritis Figure 8: Proportion of initial treatment of RA, seven major markets, by specialty Figure 9: Percentage of mild and moderate RA patients treated with pharmacological, non-pharmacological, and combination therapy in the seven major markets Figure 10: Total RA drug treated population in seven major markets, based on diagnosis rates and drug treatment rates Figure 11: Proportion of RA patients receiving DMARDs in the seven major markets, 2002 Figure 12: Proportion of RA patients receiving biologics in the seven major markets, 2002 Figure 13: Proportion of RA patients receiving traditional and biologic DMARDs in the seven major markets, 2002 Figure 14: Proportion of RA patients receiving traditional NSAIDs in the seven major markets, 2002 Figure 15: Proportion of RA patients receiving COX-II inhibitors in the seven major markets, 2002 Figure 16: Proportion of RA patients prescribed oral and injectable steroids in the seven major markets, 2002 Figure 17: Breakdown of traditional NSAID therapy for rheumatoid arthritis in the US, 2002 Figure 18: Breakdown of traditional NSAID therapy for rheumatoid arthritis in Europe, 2002 Figure 19: Breakdown of COX-II inhibitor therapy for rheumatoid arthritis in the US, 2002 Figure 20: Breakdown of COX-II inhibitor therapy for rheumatoid arthritis in Europe, 2002 Figure 21: Breakdown of DMARD therapy for rheumatoid arthritis in the US, 2002 Figure 22: Breakdown of DMARD therapy for rheumatoid arthritis in Europe, 2002 Figure 23: Breakdown of biologic therapy for rheumatoid arthritis in the US, 2002 Figure 24: Breakdown of biologic therapy for rheumatoid arthritis in Europe, 2002 Figure 25: Breakdown of oral steroid therapy for rheumatoid arthritis in Europe, 2002 Figure 26: Breakdown of injectable steroid therapy for rheumatoid arthritis in the US, 2002 Figure 27: Breakdown of injectable steroid therapy for rheumatoid arthritis in Europe, 2002 Figure 28: Breakdown of immunosuppressant therapy for rheumatoid arthritis in the US, 2002 Figure 29: Breakdown of immunosuppressant therapy for rheumatoid arthritis in Europe, 2002 Figure 30: Compliance rates in seven major markets, by disease severity Figure 31: Unmet needs in the treatment of rheumatoid arthritis Figure 32: Breakdown of the rheumatoid arthritis population by disease severity and overall treatment modality in the US, 2002 Figure 33: Segmentation of the overall drug treated rheumatoid arthritis population by drug class in the US, 2002 Figure 34: Segmentation of the drug treated mild rheumatoid arthritis population by drug class in the US, 2002 Figure 35: Segmentation of the drug treated moderate rheumatoid arthritis population by drug class in the US, 2002 Figure 36: Segmentation of the drug treated severe rheumatoid arthritis population by drug class in the US, 2002 Figure 37: Breakdown of the rheumatoid arthritis population by disease severity and overall treatment modality in Japan, 2002 Figure 38: Segmentation of the overall drug treated rheumatoid arthritis population by drug class in Japan, 2002 Figure 39: Segmentation of the drug treated mild rheumatoid arthritis population by drug class in Japan 2002 Figure 40: Segmentation of the drug treated moderate rheumatoid arthritis population by drug class in Japan, 2002 Figure 41: Segmentation of the drug treated severe rheumatoid arthritis population by drug class in Japan, 2002 Figure 42: Breakdown of the rheumatoid arthritis population by disease severity and overall treatment modality in France, 2002 Figure 43: Segmentation of the overall drug treated rheumatoid arthritis population by drug class in France, 2002 Figure 44: Segmentation of the drug treated mild rheumatoid arthritis population by drug class in France, 2002 Figure 45: Segmentation of the drug treated moderate rheumatoid arthritis population by drug class in France, 2002 Figure 46: Segmentation of the drug treated severe rheumatoid arthritis population by drug class in France, 2002 Figure 47: Breakdown of the rheumatoid arthritis population by disease severity and overall treatment modality in Germany, 2002 Figure 48: Segmentation of the overall drug treated rheumatoid arthritis population by drug class in Germany, 2002 Figure 49: Segmentation of the drug treated mild rheumatoid arthritis population by drug class in Germany, 2002 Figure 50: Segmentation of the drug treated moderate rheumatoid arthritis population by drug class in Germany, 2002 Figure 51: Segmentation of the drug treated severe rheumatoid arthritis population by drug class in Germany, 2002 Figure 52: Breakdown of the rheumatoid arthritis population by disease severity and overall treatment modality in Italy, 2002 Figure 53: Segmentation of the overall drug treated rheumatoid arthritis population by drug class in Italy, 2002 Figure 54: Segmentation of the drug treated mild rheumatoid arthritis population by drug class in Italy, 2002 Figure 55: Segmentation of the drug treated moderate rheumatoid arthritis population by drug class in Italy, 2002 Figure 56: Segmentation of the drug treated severe rheumatoid arthritis population by drug class in Italy, 2002 Figure 57: Breakdown of the rheumatoid arthritis population by disease severity and overall treatment modality in Spain, 2002 Figure 58: Segmentation of the overall drug treated rheumatoid arthritis population by drug class in Spain, 2002 Figure 59: Segmentation of the drug treated mild rheumatoid arthritis population by drug class in Spain, 2002 Figure 60: Segmentation of the drug treated moderate rheumatoid arthritis population by drug class in Spain, 2002 Figure 61: Segmentation of the drug treated severe rheumatoid arthritis population by drug class in Spain, 2002 Figure 62: Breakdown of the rheumatoid arthritis population by disease severity and overall treatment modality in the UK, 2002 Figure 63: Segmentation of the overall drug treated rheumatoid arthritis population by drug class in the UK, 2002 Figure 64: Segmentation of the drug treated mild rheumatoid arthritis population by drug class in the UK, 2002 Figure 65: Segmentation of the drug treated moderate rheumatoid arthritis population by drug class in the UK, 2002 Figure 66: Segmentation of the drug treated severe rheumatoid arthritis population by drug class in the UK, 2002 Figure 47: Datamonitor Healthcare Consulting Figure 48: Therapeutic Consulting capabilities AbstractRheumatoid arthritis is a debilitating disease that involves the inflammation of the lining of the joints. While no cure exists, physicians can utilize a number of strategies and products in an attempt to control the disesase and the accompanying pain and swelling. Based on 245 physician interviews, this analysis examines current treatment trends in the ongoing fight against rheumatoid arthritis.Covers the seven major pharmaceutical markets: US, Japan, France, Germany, Italy, Spain, and the UKThe drug classes covered include DMARDs, biologics, traditional NSAIDs, COX-II inhibitors, immunosuppressants, and oral and injectable steroidsTreatment strategies vary from country to country in terms of use of biologics and DMARDs, particularly with regard to mild and moderate RA casesRheumatoid arthritis is an uncurable disease. However, the availability of DMARDs and biologics have allowed physicians the opportunity to slow progression of the disease and improve the patient's condition from an early stage. Across all markets, physicians are using DMARDs and combinations of them to treat mild and moderate RA patients in an attempt to control the arthritis from diagnosis.Despite the highly specialized nature of rheumatoid arthritis treatment, the majority of patients in all markets except Japan initially present their RA symptoms to primary care physicians. As a result, these physicians play a vital role in the treatment and referral of rheumatoid arthritis patients; companies must continue to encourage awareness and understanding of the disease at a primary care level, to ensure maximum diagnosis.The battle between Enbrel and Remicade for sales within the biologic DMARD drug class has become the focus of the RA market in the past year. A number of factors have influenced physician choice during this period, including availability and method of administration, and as a result the success of each product has varied significantly from market to market.Understand treatment trends across seven markets, by disease severity, to evaluate potential for current and pipeline productsAssess the current and perceived role of biologic DMARDs in the treatment of RA, amidst varied market challengesEvaluate markets where the patient population or use of a drug class is underpenetrated, in order to best position your productsIdentify the leading products in each market to build an understanding of the factors that contribute to success on the RA market in each countryGet Full Details About This Report >> |
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