Paradigm Shift in Therapy from Drugs to Biologics Drives Market Progress
Rheumatoid arthritis (RA) is an autoimmune condition in which the immune system attacks the lining of the joints. The anti-rheumatic is among top five therapy areas and conventional, and biologic disease-modifying anti-rheumatic drugs (DMARDs) are the two types of therapies in the anti-rheumatics space. In terms of revenue, biologics have overtaken the conventional disease modifying anti-rheumatic drugs by a significant margin. Compared with traditional DMARDs, biologics are more targeted, and effective in treating RA. Biologics, for the most part, are more potent than traditional DMARDs. The top five biologics contribute to more than half of the global anti-rheumatics market.
Conventional DMARDs: Sulfasalazine (Azulfidine, Sulazine), Hydroxychloroquine (Plaquenil, Quineprox), Leflunomide (Arava), Methotrexate (Otrexup, Rasuvo, Rheumatrex dose pack, Trexall), and Azathioprine (Azasan, Imuran)
Biologic DMARDs: Tumor necrosis factor (TNF) inhibitors: Aadalimumab (Humira), Certolizumab pegol (Cimzia), Etanercept (Enbrel), Golimumab (Simponi), and Infliximab (Remicade)); Interleukin-1 inhibitor: Anakinra (Kineret); Interleukin-6 inhibitors: Tocilizumab (Actemra), Sarilumab (Kevzara); T cell inhibitor: Abatacept (Orencia); and B cell inhibitor: Rituximab (Rituxan)
JAK inhibitors: Tofacitinib (Xeljanz), Upadacitinib (Rinvoq), and Baricitinib (Olumiant)
Growing RA Prevalence in Developed World and Novel Therapeutic Launches Fuel Anti-rheumatics Market Growth
The World Health Organization (WHO) statistics suggests that RA tends to strike between the ages of 20 and 40, and is a chronic disabling condition often causing pain, and deformity. Prevalence of RA varies between 0.3% and 1%, and is more common in women, especially in developed countries. Nearly 50% of RA patients in developed countries are unable to hold down a full-time job within 10 years of the onset. The anti-rheumatics market is growing with continued uptake and frequent new launches. In 2019, AbbVie launched Rinvoq. Olumiant was introduced in 2018 by Eli Lilly. Both are Janus kinase (JAK) 1 inhibitors.
Biosimilar Erosion for Existing Blockbuster Drugs Offsets High Growth Trajectory by Novel Drug Entrants
The anti-rheumatics sector is expected to grow at a steady pace till 2026, reaching estimated sales of US$ ~50 Bn. The decline of this area can be attributed to the patent expiry for market leading drugs such as Enbrel (Amgen), Humira (AbbVie), and Remicade (JNJ). The entry of biosimilars for these products in short span will hamper the market growth significantly in the near future. However, some of the novel entrants like Amjevita (Amgen), Rinvoq (AbbVie), and Filgotinib (Gilead) are set to boost the market growth.
Immunosuppressive Sale Declines amid COVID-19 Outbreak
Reduction in the number of new patients looking for immunosuppressive therapies for conditions like rheumatoid arthritis has also been observed during the pandemic in order to avoid immunocompromising vulnerable patients. The momentum for immunosuppressive therapies in RA is likely to be low because of apprehensions that they may reduce the efficacy of COVID-19 vaccinations.
North America Leads Global Anti-rheumatics Market
The US has notably high prevalence of RA and as per Arthritis Organization, RA was estimated to affect ~1.5 million adults in the US in 2005. Moreover, mortality hazards are 60-70% higher in patients with RA as compared to general population. RA is the most common form of inflammatory arthritis in Europe as well. A Eular-Endorsed Survey specified diverse overall prevalence of RA in Europe, from 0,29% to 0,57%.
Increasingly Crowded Anti-rheumatics Market with Multiple Therapies Represent Multiple Drug Classes
The existing RA space includes TNF-α inhibitors, non-TNF-α biologics (including the second IL-6 inhibitor Kevzara [Regeneron / Sanofi]), and oral JAK inhibitors—Olumiant (Eli Lilly), Rinvoq (AbbVie), Xeljanz (Pfizer), Jyseleca (Galapagos/Gilead/Eisai), and Smyraf (Astellas). The TNF-α inhibitors are the most preferred biologics for RA. The non-TNF-α biologics and JAK inhibitors largely compete for use in the TNF-refractory patients. With recent approvals for an additional JAK inhibitor (Gilead / Galapagos’s Jyseleca), and several biosimilars of TNF, and non-TNF biologics, the competition to gain higher revenue share in the anti-rheumatics market is getting fierce.
AbbVie Inc., Amgen Inc., Gilead Sciences Inc., Bristol-Myers Squibb Company, Eli Lilly and Company, F. Hoffmann-La Roche Ltd, Celgene Corporation, Johnson & Johnson, Merck & Co., Inc., Novartis AG, Pfizer Inc., and UCB S.A. are some of the key market players in anti-rheumatics space.