Disease Modification in Rheumatoid Arthritis - Competition for the anti-TNF failure

The treatment of Rheumatoid Arthritis (RA) has been rapidly evolving over the last decade. The success of the next wave of novel RA therapies depends on their ability to address the key issue of cost effectiveness, as the patient population for anti-TNF's is reaching a maximum and competition moves to anti-TNF failure patients.

The anti-TNF failure segment will be an area of increased competition over the next five years, as new products avoid direct confrontation with the established anti-TNF's. This population will increase as more patients use biologics and cycle through the anti-TNF's, but there are a finite number of eligible patients, especially if prices remain high.

The race is on between the Roche/Genentech/Biogen Idec and the Genmab/GSK partnerships to launch a CD20-inhibiting monoclonal antibody to follow, and build upon, the success shown by Rituxan/MabThera (rituximab) in the RA indication. At present Roche with ocrelizumab have a slight, but uncertain, advantage.

The majority (58%) of projects in human clinical trials are in Phase II development showing the positive growth potential in the RA disease area. However, a large proportion are small molecule, orally available products, which have in the past shown a high attrition rate in Phase II.

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