Beyond the shadow of a doubt, the Rheumatoid arthritis (RA) treatment market has witnessed strides of improvements during the last few years. There was a time when the treatment for RA was confined to Non-steroidal anti-inflammatory drugs (NSAIDs) and steroids, which could only address pain and swelling. However, today the available medications can change the course of the disease.
Rheumatoid arthritis treatment goals focus on achieving remission or low disease activity. It is worth mentioning that early treatment intervention acts as a watershed moment as joint damage, if done, is irreversible. The present treatment regimen can decrease joint damage as well as suppress the radiographic prevention of the RA. The present Rheumatoid arthritis treatment landscape constitutes an integrated approach, including both pharmacologic and nonpharmacologic therapies. Nonpharmacologic treatments such as exercise, diet, massage, counseling, stress reduction, physical therapy, and surgery are available in the Rheumatoid arthritis treatment market that ensures compliance and a positive mindset of the patient and caretakers. Pharmacologic treatments comprise medicines such as NSAIDs, biologic, and nonbiologic disease-modifying antirheumatic drugs (DMARDs), immunosuppressants, and corticosteroids to address the symptoms of the disease.
Early therapy with DMARDs is the present standard of care for RA patients. They are an integral part of the traditional treatment regimen followed for Rheumatoid arthritis (RA) as they cannot only hinder the disease progression efficiently but also induce more remissions. These are immunosuppressive and immunomodulatory agents. They can be either conventional DMARDs or biologic DMARDs. More than a dozen conventional DMARDs are available in the RA treatment market, including methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine. However, Methotrexate is the most commonly used first-line DMARD agent for patients with RA. The majority of RA patients continue to go for methotrexate owing to its safety, efficacy, tolerability, and affordability. While most patients respond well to MTX, many continue to have active disease.
Past decades experienced a rush of cytokines and their receptors undergoing trials for the treatment of RA. In cases where conventional DMARDs fail to provide relief, genetically engineered biologic DMARDs come into the picture. According to the NICE guidelines, biologic drugs are prescribed to only those patients who have previously failed on two conventional DMARDs, one of which must be methotrexate (unless there is a medical reason for not having it) and have high levels of persistent disease activity. Many are categorized as interleukins (ILs) and tumor necrosis factor (TNF), also termed TNF-α. The RA market currently owns the following approved classes of biologic DMARDs: anti-TNF, T cell inhibitor, B cell Inhibitor, Interleukin (IL) Inhibitors, and targeted synthetic DMARDs like JAK Inhibitors.
TNF-α neutralizing drugs are further subdivided into neutralizing monoclonal antibodies, antibody fragments, and soluble TNF receptor constructs. The US FDA approved TNF-α inhibitors for RA in the following order: etanercept (1998), infliximab (1999), adalimumab (2002), certolizumab pegol (2009), and golimumab (2009). Several B-cell targeting therapies have been investigated in the last years, with rituximab being the only one approved by the US FDA in 2006.
IL-blockers offer another possibility for RA treatment. Tocilizumab, and Sarilumab, both are widely used in the treatment of RA. Besides, Kineret is also approved by the US FDA for the decrease in signs and symptoms of moderate to severe RA patients of age group 18 or older who have failed 1 or more DMARDs.
In place of Biologics, JAK inhibitors can also be used as they are also considered equally efficient as that of the former. A bonus point is JAK inhibitors, unlike biologics, can be taken orally. Till now, four JAK inhibitors, namely Tofacitinib (Xeljanz), Baricitinib (Olumiant), Upadacitinib (Rinvoq), and Peficitinib (Smyraf; only approved in Japan) has been approved by different regulatory authorities for RA.
Conventional DMARDs are often used as monotherapy. They can also be used in combinations with others. However, several randomized controlled trials point out that combination therapy of a biologic DMARD with a conventional DMARD such as methotrexate over either agent alone proves to be much more effective. In cases where biologics do not seem to work, physicians turn to JAK inhibitors. However, it is not to lose sight of the fact that the use of Biologics and JAK inhibitors are associated with higher risks and costs. Furthermore, while traditional DMARDs target the entire immune system, biologics zeroes down specific steps that lead to inflammatory processes, and JAK inhibitors prevent the inflammation from even starting.
The current Rheumatoid Arthritis treatment market is dominated by DMARDs, biological, and conventional. Biologics including JAKi and upcoming BTKi due to patient convenient RoA are significantly contributing to the Rheumatoid Arthritis market growth. However, the entry of biosimilars of approved biologics will significantly dampen down the RA market revenue. The US and EU RA markets are already witnessing the approval of biosimilars such as Remicade biosimilars, due to which the sales value of the market has started declining. Generics of some blockbuster drugs like adalimumab (i.e., 2023 in the US), tocilizumab (i.e., 2025 in the US) are expected to significantly impact the RA market size growth negatively. Biogen/Samsung’s Etanercept biosimilar Eticovo/Benepali has been approved and marketed in the European Union. In addition to this, the MAA application has been filed for another Etanercept biosimilar (YLB113; Lupin/Yoshindo) in Europe.
In a nutshell, there is still a huge demand for novel RA therapies with better efficacy and improved safety profile. Several pharma companies like GlaxoSmithKline [Otilimab (MOR103/GSK3196165)], Taisho Pharmaceutical [Ozoralizumab (TS-152)], Gilead and Galapagos NV [Filgotinib (GS-6034; Jyseleca)], R-Pharm (Olokizumab), Merck KGaA (Evobrutinib), Pfizer (PF-06650833, and PF-06651600), Roche (Fenebrutinib), and others are testing the waters in the RA market. With a considerable number of key investigational candidates in different stages of trials that are expected to enter the RA market in the next decade, DelveInsight estimates a bright future for the RA market in the forecast period 2020-30.