Table of Contents
- ABOUT DATAMONITOR HEALTHCARE
- About the Immunology and Inflammation pharmaceutical analysis team
- CHAPTER 1 EXECUTIVE SUMMARY
- Scope of the analysis
- Datamonitor insight into the inflammatory bowel disease market
- Contributing experts
- Previous and related reports
- CHAPTER 2 INTRODUCTION AND SCOPE
- Coverage of the Stakeholder Insight Survey
- Epidemiology and patient segmentation
- Diagnosis
- Treatment options and guidelines
- Treatment trends
- Key prescribing influences
- Brand assessment
- CHAPTER 3 COUNTRY TREATMENT TREES
- Introduction to treatment trees
- US
- Japan
- France
- Germany
- Italy
- Spain
- UK
- CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION
- Disease definition
- Classification of inflammatory bowel disease
- Crohn' s disease
- Ulcerative colitis
- Montreal classification of Crohn' s disease and ulcerative colitis
- Etiology
- Genes associated with inflammatory bowel disease influence phenotype
- Smoking
- Appendectomy
- Oral contraceptives
- Infection with a pathogenic organism
- Abnormal immune response to gut flora
- Pathogenesis
- Crohn' s disease and ulcerative colitis are mediated by Th1 and Th2
lymphocytes, respectively
- Disease incidence and prevalence
- Crohn' s disease
- Ulcerative colitis
- US
- Europe
- France
- Germany
- Italy
- Spain
- UK
- Japan
- Patient segmentation according to disease severity
- Severity is measured using different disease activity scales
- Majority of Crohn' s disease and ulcerative colitis patients suffer
mild to moderate disease
- CHAPTER 5 DIAGNOSIS OF INFLAMMATORY BOWEL DISEASE
- Diagnosis
- Diagnosis of inflammatory bowel disease combines many avenues of
investigation
- Initial investigation begins with laboratory tests
- Endoscopy is the most direct way of diagnosing inflammatory bowel
disease
- Radiology is a crucial adjunct to endoscopy
- Serological markers are not yet used for clinical diagnosis
- A high diagnosis rate is observed in inflammatory bowel disease
- Just over 70% of Crohn' s disease patients are diagnosed
- Physicians report a higher diagnosis rate for ulcerative colitis
than Crohn' s disease
- Complications arising in Crohn' s disease and ulcerative colitis
- Abscesses, strictures and fistulae are the most commonly
physician-reported complications in Crohn' s disease patients
- Over 25% of Crohn' s disease patients suffer from nutritional
deficiencies
- Bleeding is reported by almost all gastroenterologists in patients
with ulcerative colitis
- Almost half of ulcerative colitis patients experience bleeding
complications
- Association of IBD with immune disorders and co-morbidities
- Anemia and anxiety and depression are the most commonly associated
co-morbidities in inflammatory bowel disease
- Patients with inflammatory bowel disease also suffer from irritable
bowel disease
- Immune-mediated diseases occur at greater frequency among patients
with inflammatory bowel disease
- CHAPTER 6 TREATMENT OPTIONS AND GUIDELINES
- Treatment options
- Non-pharmacological treatment of inflammatory bowel disease
- Pharmacological treatment
- Antibiotics
- Anti-diarrheals and anti-spasmodics
- Topical and oral aminosalicylates
- Corticosteroids
- Traditional immunosuppressants
- Targeted biologics
- Pharmacological versus non-pharmacological
- Majority of patients with inflammatory bowel disease are treated
pharmacologically
- There are some patients who do not receive any therapy for
inflammatory bowel disease
- Treatment guidelines
- Several treatment guidelines exist for the treatment of inflammatory
bowel disease
- Guidelines published by the British Society of Gastroenterology
- NICE guidelines on the use of infliximab for Crohn' s disease
- NICE is appraising the use of infliximab for ulcerative colitis
- American College of Gastroenterology guidelines for Crohn' s disease
- American College of Gastroenterology guidelines for ulcerative
colitis
- The European Crohn' s and Colitis Organisation has published
consensus guidelines for Crohn' s disease
- CHAPTER 7 TREATMENT TRENDS
- Changes in therapy
- Disease severity influences treatment
- Despite lack of evidence to support efficacy, Crohn' s disease and
ulcerative colitis patients receive antibiotics at all levels of severity
- Anti-spasmodics and anti-diarrheals are used as accompanying
therapies for all severities of Crohn' s disease and ulcerative colitis
- Up to 60% of Crohn' s disease and ulcerative colitis patients receive
oral aminosalicylates
- Topical aminosalicylates are used more for ulcerative colitis than
Crohn' s disease
- Use of corticosteroids increases with disease severity
- Gradual increase in use of immunosuppressants according to Crohn' s
disease severity
- Immunosuppressants are largely reserved for moderate and severe
ulcerative colitis patients
- Use of biologics in Crohn' s disease occurs in moderate-to-severe
disease, but to a limited extent in mild patients
- Use of biologic increases significantly with severity of ulcerative
colitis
- Monotherapy versus combination therapy
- Increasing disease severity promotes use of combination therapy
- First-line therapy
- Oral 5-ASAs are used first-line for Crohn' s disease
- Corticosteroids are being prescribed at first-line for Crohn' s
disease
- A combination of oral and topical 5-ASAs is the preferred first-line
treatment regimen for ulcerative colitis
- Almost 45% of Crohn' s disease patients move to a second-line therapy
- About a third of ulcerative colitis patients progress to treatment
with second-line therapy
- Second-line therapy
- Immunosuppressants are the most commonly prescribed drug class by
gastroenterologists at second-line for Crohn' s disease
- Biologics are prescribed at second-line for Crohn' s disease
- Corticosteroids are prescribed at second-line for ulcerative colitis
- Immunosuppressants are also prescribed at second-line for ulcerative
colitis
- Almost a quarter of Crohn' s disease patients progress from
second-line to third-line treatment
- A fifth of ulcerative colitis patients progress from second-line to
third-line treatment
- Third-line therapy
- Biologics alone, or in combination with immunosuppressants, are the
most commonly prescribed therapies for Crohn' s disease at third-line
- Like Crohn' s disease, biologics are prescribed most frequently by
gastroenterologists for ulcerative colitis
- Surgery
- Surgery is more effective for ulcerative colitis than Crohn' s disease
- Just under a third of Crohn' s disease patients will eventually require
surgery
- Almost half as many patients with ulcerative colitis will eventually
require surgery than those with Crohn' s disease
- Ulcerative colitis patients receive pharmacological therapy for longer
than Crohn' s disease patients before requiring surgery
- "Step-up" versus a "top-down" approach to the treatment of inflammatory
bowel disease
- Current algorithms promote use of a "step-up" approach, but a
"top-down" approach is now being suggested
- Is there scope for a "top-down" approach?
- Clinical trial data provide evidence showing a "top-down" approach
is more effective than "step-up"
- A "top-down" approach may change the natural history of Crohn' s
disease
- There are a number of advantages and risks associated with a
"top-down" treatment approach
- The SONIC study will assess early use of azathioprine, infliximab or
both in combination
- Only 20% of severe Crohn' s disease patients receive a "top-down"
treatment approach
- The potential for side effects ranks as the leading reason for not
using a "top-down" approach in Crohn' s disease
- Similar percentage of ulcerative colitis and Crohn' s disease patients
receive a "top-down" treatment approach
- The potential for side effects is also the leading reason for not
using a "top-down" approach in ulcerative colitis
- Gastroenterologists also reported that a lack of evidence and
experience prevents use of a "top-down" approach
- CHAPTER 8 PRESCRIBING INFLUENCES
- Factors influencing physician decision making
- Symptomatic improvement and healing of the mucosa are the most
important factors influencing physician prescribing
- Efficacy
- Symptomatic improvement
- Efficacy in promoting mucosal healing
- Speed of onset of remission
- Safety
- Dosing
- Convenient dosing and convenient administration frequency
- Cost
- Availability (formulary/reimbursement status)
- Physician factors
- Patient factors
- Other
- Prevention of colon cancer
- CHAPTER 9 BRAND ASSESSMENT
- Brand map
- How to interpret a brand map
- 5-ASAs: Lialda may offer advantages in a class where there is little
differentiation
- Pentasa (mesalazine)
- Pentasa is an oral, controlled-release formulation that delivers
mesalazine from the duodenum to the rectum
- New dose of Pentasa reduces the number of pills taken per day
- Gastroenterologists rated Pentasa well on familiarity and
availability
- Lialda/Mezavant (mesalazine)
- Lialda is an oral sustained-release, multimatrix formulation of
mesalamine
- Lialda is marketed as a once-daily treatment for ulcerative colitis
- Lialda has been compared with Asacol in a Phase III clinical trial
- Gastroenterologists scored Lialda well on side-effect profile
- Lialda is perceived by gastroenterologists to perform well on
patient compliance, convenient dose and convenient administration
frequency
- Asacol (mesalazine)
- Asacol is a delayed-release formulation of mesalazine, which is
marketed by Proctor & Gamble
- Asacol well perceived on familiarity with product and availability
- Salofalk (mesalazine)
- Salofalk is a Eudragit-L-coated pellet formulation of mesalazine
- Salofalk and Pentasa are equally effective in achieving remission in
mild to moderate ulcerative colitis patients
- Salofalk did not perform well on patient compliance and convenient
administration frequency
- Claversal (mesalazine)
- Like Salofalk, Claversal is a micropellet formulation of mesalazine
- Fivasa (mesalazine)
- In France, Asacol is marketed as Fivasa by Norgine Pharma
- Salazopyrin (sulfasalazine)
- Gastroenterologists did not rate Salazopyrin well on side-effect
profile
- Biologics: brand comparison shows that Remicade remains the leader, but
Humira is perceived well by physicians
- Remicade (infliximab)
- Gastroenterologists rate Remicade well on familiarity with product
and symptomatic improvement
- Mucosal healing is associated most with Remicade than the other
biologics
- Remicade is not associated with a convenient dose and convenient
administration frequency
- More than three-quarters of severe patients with inflammatory bowel
disease receive Remicade as their first biologic therapy
- 40% of patients who receive Remicade as their first biologic will
terminate therapy
- Most patients terminate Remicade therapy within the first year
- An inadequate response is the most common reason for terminating
Remicade therapy within the first year
- Inadequate response remains the most common reason for terminating
Remicade therapy after 1 year
- Over a third of patients who fail Remicade therapy will move on to
treatment with Humira
- Surgery is the next step for many patients who fail Remicade therapy
- Almost a quarter of Remicade-refractory patients progress to therapy
with corticosteroids
- Despite no evidence of efficacy in Crohn' s disease, a small
percentage of Remicade-refractory patients go on to receive Enbrel
(etanercept)
- Humira (adalimumab)
- Humira is a self-administered, fully human anti-TNF monoclonal
antibody
- Clinical trials for Humira demonstrate efficacy in biologic-naïve
patients and infliximab-refractory patients with Crohn' s disease
- Gastroenterologists scored Humira better than Remicade on a number
of attributes
- Cimzia (certolizumab pegol)
- Cimzia is a pegylated, humanized anti-TNF therapy
- PRECISE 1 and PRECISE 2 trials demonstrated the safety and efficacy
of Cimzia, but the therapy was rejected by the FDA
- Cimzia was rejected for Crohn' s disease in the EU in November 2007
- Cimzia was perceived by gastroenterologists to perform well on
convenient dose and administration frequency
- Tysabri (natalizumab)
- Tysabri prevents leukocytes migrating into the gut in Crohn' s disease
- The EMEA' s CHMP returned a final negative opinion for Tysabri in
Crohn' s disease in November 2007
- The ENACT and ENCORE trials demonstrated the efficacy of Tysabri in
Crohn' s disease
- Tysabri was not rated well on symptomatic improvement or side-effect
profile
- BIBLIOGRAPHY
- Journal papers
- Websites
- Other
- APPENDIX A
- Physician research methodology
- Physician sample breakdown
- US
- Japan
- France
- Germany
- Italy
- Spain
- UK
- Contributing experts
- APPENDIX B
- The survey questionnaire
- 1. Patient Segmentation
- 2. Prescribing factors
- 3. Treatment classes and severity
- 4. Treatment of severe disease
- APPENDIX C
- About Datamonitor
- About Datamonitor Healthcare
- About the Immunology and Inflammation analysis team
- Disclaimer
- List of Tables
- Table 1: Montreal sub-classification for Crohn' s disease, 2005
- Table 2: Montreal classification for ulcerative colitis covering
extent and anatomy, 2005
- Table 3: Epidemiological studies into incidence and prevalence of
Crohn' s disease and ulcerative colitis, 1978─2007
- Table 4: Prevalence and incidence of Crohn' s disease in the seven
major markets by country, 2007
- Table 5: Prevalence and incidence of ulcerative colitis in the seven
major markets by country, 2007
- Table 6: Age- and sex-specific and adjusted prevalence of ulcerative
colitis in Olmsted County, Minnesota, January 2001
- Table 7: Age- and sex-specific and adjusted prevalence of Crohn' s
disease in Olmsted County, Minnesota, January 2001
- Table 8: Incidence and prevalence of Crohn' s disease and ulcerative
colitis in the UK, 1995
- Table 9: Annual prevalence and incidence of Crohn' s disease and
ulcerative colitis in Japan, 1991
- Table 10: Number of respondents reporting Crohn' s disease patients
with each complication, by country, 2007
- Table 11: Number of respondents reporting ulcerative colitis patients
with each complication, by country, 2007
- Table 12: Number and percentage of gastroenterologists prescribing
each therapy at first-line for Crohn' s disease, 2007
- Table 13: Number and percentage of gastroenterologists prescribing
each therapy at first-line for ulcerative colitis, 2007
- Table 14: Number and percentage of gastroenterologists prescribing
each therapy at second-line for Crohn' s disease, 2007
- Table 15: Number and percentage of gastroenterologists prescribing
each therapy at second-line for ulcerative colitis, 2007
- Table 16: Number and percentage of gastroenterologists prescribing
each therapy at third-line for Crohn' s disease
- Table 17: Number and percentage of gastroenterologists prescribing
each therapy at third-line for ulcerative colitis
- Table 18: Mean ranking for each reason for not using a top-down
approach in severe Crohn' s disease, 2007
- Table 19: Mean ranking for each reason for not using a top-down
approach in severe ulcerative colitis, 2007
- Table 20: Number and percentage of physicians able to rate each brand
of 5-ASA
- Table 21: Number and percentage of physicians able to rate each brand
of biologic
- Table 22: Comparison of key studies for Remicade, Humira, Cimzia and
Tysabri
- Table 23: Side effects associated with sulfasalazine and 5-ASAs
- Table 24: Dosing schedule for the 5-ASA brands
- Table 25: Attributes scores for each of the 5-ASA brands
- Table 26: Attributes scores for each of the biologic brands
- Table 27: Remicade' s attribute scores by country
- Table 28: Percentage of patients who terminate Remicade therapy in
each time period, by country
- Table 29: Percentage of inflammatory bowel disease patients
terminating Remicade therapy within the first year because of each reason,
by country
- Table 30: Percentage of inflammatory bowel disease patients
terminating Remicade therapy after the first year because of each reason,
by country
- Table 31: Percentage of inflammatory bowel disease patients who fail
Remicade therapy that are switched to Humira (adalimumab), by country, 2007
- Table 32: Percentage of Remicade-refractory patients who move on to
therapy with Enbrel (etanercept), by country
- Table 33: Cimzia' s attribute scores, by country
- Table 34: US physician sample breakdown, 2007
- Table 35: Japan physician sample breakdown, 2007
- Table 36: France physician sample breakdown, 2007
- Table 37: Germany physician sample breakdown, 2007
- Table 38: Italy physician sample breakdown, 2007
- Table 39: Spain physician sample breakdown, 2007
- Table 40: UK physician sample breakdown, 2007
- List of Figures
- Figure 1: Crohn' s disease treatment tree split by disease severity in
the US, 2007
- Figure 2: Ulcerative colitis treatment tree split by disease severity
in the US, 2007
- Figure 3: Physician-preferred first-, second- and third-line treatment
regimen for Crohn' s disease in the US, 2007
- Figure 4: Physician-preferred first-, second- and third-line treatment
regimen for ulcerative colitis in the US, 2007
- Figure 5: Crohn' s disease treatment tree split by disease severity in
Japan, 2007
- Figure 6: Ulcerative colitis treatment tree split by disease severity
in Japan, 2007
- Figure 7: Physician-preferred first-, second- and third-line treatment
regimen for Crohn' s disease in Japan, 2007
- Figure 8: Physician-preferred first-, second- and third-line treatment
regimen for ulcerative colitis in Japan, 2007
- Figure 9: Crohn' s disease treatment tree split by disease severity in
France, 2007
- Figure 10: Ulcerative colitis treatment tree split by disease severity
in France, 2007
- Figure 11: Physician-preferred first-, second- and third-line
treatment regimen for Crohn' s disease in France, 2007
- Figure 12: Physician-preferred first-, second- and third-line
treatment regimen for ulcerative colitis in France, 2007
- Figure 13: Crohn' s disease treatment tree split by disease severity in
Germany, 2007
- Figure 14: Ulcerative colitis treatment tree split by disease severity
in Germany, 2007
- Figure 15: Physician-preferred first-, second- and third-line
treatment regimen for Crohn' s disease in Germany, 2007
- Figure 16: Physician-preferred first-, second- and third-line
treatment regimen for ulcerative colitis in Germany, 2007
- Figure 17: Crohn' s disease treatment tree split by disease severity in
Italy, 2007
- Figure 18: Ulcerative colitis treatment tree split by disease severity
in Italy, 2007
- Figure 19: Physician-preferred first-, second- and third-line
treatment regimen for Crohn' s disease in Italy, 2007
- Figure 20: Physician-preferred first-, second- and third-line
treatment regimen for ulcerative colitis in Italy, 2007
- Figure 21: Crohn' s disease treatment tree split by disease severity in
Spain, 2007
- Figure 22: Ulcerative colitis treatment tree split by disease severity
in Spain, 2007
- Figure 23: Physician-preferred first-, second- and third-line
treatment regimen for Crohn' s disease in Spain, 2007
- Figure 24: Physician-preferred first-, second- and third-line
treatment regimen for ulcerative colitis in Spain, 2007
- Figure 25: Crohn' s disease treatment tree split by disease severity in
the UK, 2007
- Figure 26: Ulcerative colitis treatment tree split by disease severity
in the UK, 2007
- Figure 27: Physician-preferred first-, second- and third-line
treatment regimen for Crohn' s disease in the UK, 2007
- Figure 28: Physician-preferred first-, second- and third-line
treatment regimen for ulcerative colitis in the UK, 2007
- Figure 29: Age- and sex-adjusted incidence of Crohn' s disease and
ulcerative colitis in Olmsted County, Minnesota, 1940-2000
- Figure 30: Estimated annual prevalence and incidence rates of Crohn' s
disease in Japan, 1986-1998
- Figure 31: Diagnosed Crohn' s disease patients by severity in the seven
major markets, 2007
- Figure 32: Diagnosed ulcerative colitis patients by severity in the
seven major markets, 2007
- Figure 33: Diagnosis of inflammatory bowel disease
- Figure 34: Crohn' s disease diagnosis rates, by country, 2007
- Figure 35: Ulcerative colitis diagnosis rates, by country, 2007
- Figure 36: Percentage of Crohn' s disease patients suffering from each
complication, 2007
- Figure 37: Percentage of ulcerative colitis patients suffering from
each complication, 2007
- Figure 38: Percentage of inflammatory bowel disease patients with
various co-morbidities, 2007
- Figure 39: Mean percentage of Crohn' s disease patients receiving each
type of therapy by disease severity, 2007
- Figure 40: Mean percentage of ulcerative colitis patients receiving
each type of therapy by disease severity, 2007
- Figure 41: Percentage of patients with Crohn' s disease not receiving
treatment, split by disease severity, by country, 2007
- Figure 42: Percentage of patients with ulcerative colitis not
receiving treatment, split by disease severity, by country, 2007
- Figure 43: American College of Gastroenterology: Management of Crohn' s
disease in adults
- Figure 44: Algorithm for the medical management of Crohn' s disease,
2003
- Figure 45: American College of Gastroenterology: Ulcerative colitis
practice guidelines in adults
- Figure 46: Percentage of Crohn' s disease patients receiving
antibiotics by disease severity in the seven major markets, 2007
- Figure 47: Percentage of ulcerative colitis patients receiving
antibiotics by disease severity in the seven major markets, 2007
- Figure 48: Percentage of Crohn' s disease patients receiving
anti-spasmodics by disease severity in the seven major markets, 2007
- Figure 49: Percentage of ulcerative colitis patients receiving
anti-spasmodics by disease severity in the seven major markets, 2007
- Figure 50: Percentage of Crohn' s disease patients receiving
anti-diarrheals by disease severity in the seven major markets, 2007
- Figure 51: Percentage of ulcerative colitis patients receiving
anti-diarrheals by disease severity in the seven major markets, 2007
- Figure 52: Percentage of Crohn' s disease patients receiving oral
5-ASAs by disease severity in the seven major markets, 2007
- Figure 53: Percentage of ulcerative colitis patients receiving oral
5-ASAs by disease severity in the seven major markets, 2007
- Figure 54: Percentage of Crohn' s disease patients receiving topical
5-ASAs by disease severity in the seven major markets, 2007
- Figure 55: Percentage of ulcerative colitis patients receiving topical
5-ASAs by disease severity in the seven major markets, 2007
- Figure 56: Percentage of Crohn' s disease patients receiving
corticosteroids by disease severity in the seven major markets, 2007
- Figure 57: Percentage of ulcerative colitis patients receiving
corticosteroids by disease severity in the seven major markets, 2007
- Figure 58: Percentage of Crohn' s disease patients receiving
traditional immunosuppressants by disease severity in the seven major
markets, 2007
- Figure 59: Percentage of ulcerative colitis patients receiving
traditional immunosuppressants by disease severity in the seven major
markets, 2007
- Figure 60: Percentage of Crohn' s disease patients receiving biological
therapy by disease severity in the seven major markets, 2007
- Figure 61: Percentage of ulcerative colitis patients receiving
biological therapy by disease severity in the seven major markets, 2007
- Figure 62: Percentage of mild Crohn' s disease patients receiving
monotherapy or combination therapy in the seven major markets, 2007
- Figure 63: Percentage of moderate Crohn' s disease patients receiving
monotherapy or combination therapy in the seven major markets, 2007
- Figure 64: Percentage of severe Crohn' s disease patients receiving
monotherapy or combination therapy in the seven major markets, 2007
- Figure 65: Percentage of mild ulcerative colitis patients receiving
monotherapy or combination therapy in the seven major markets, 2007
- Figure 66: Percentage of moderate ulcerative colitis patients
receiving monotherapy or combination therapy in the seven major markets,
2007
- Figure 67: Percentage of severe ulcerative colitis patients receiving
monotherapy or combination therapy in the seven major markets, 2007
- Figure 68: Percentage of Crohn' s disease patients progressing from
first-line to second-line treatment regimen, by country, 2007
- Figure 69: Percentage of ulcerative colitis patients progressing from
first-line to second-line treatment regimen, by country
- Figure 70: Percentage of Crohn' s disease patients progressing from
second-line to third-line treatment regimen, by country
- Figure 71: Percentage of ulcerative colitis patients progressing from
second-line to third-line treatment regimen, by country
- Figure 72: Percentage of Crohn' s disease patients that will eventually
require surgery, by country
- Figure 73: Percentage of ulcerative colitis patients that will
eventually require surgery, by country
- Figure 74: Number of years a Crohn' s disease or ulcerative colitis
patient will receive pharmacological therapy before requiring surgery, by
country
- Figure 75: Step-up versus a top-down treatment approach
- Figure 76: Results of the first "top-down" versus "step-up" randomized
controlled trial presented at the DDW 2006
- Figure 77: Potential advantages and risks of a "top-down" treatment
approach
- Figure 78: Percentage of Crohn' s disease and ulcerative colitis
patients receiving a biologic in combination with an Immunosuppressant, by
country, 2007
- Figure 79: Percentage of severe Crohn' s disease patients who receive a
step-up versus a top-down treatment approach, by country, 2007
- Figure 80: Percentage of severe ulcerative colitis patients who
receive a step-up versus a top-down treatment approach, by country, 2007
- Figure 81: Reasons, and frequency of each reason, for not using a
"top-down" treatment approach in Crohn' s disease, 2007
- Figure 82: Reasons, and frequency of each reason, for not using a
"top-down" treatment approach in ulcerative colitis, 2007
- Figure 83: Average influence on prescribing decision: weightings
assigned by gastroenterologists to key attributes for 5-ASAs and
biologics, 2007
- Figure 84: Weightings for attributes in 5-ASAs and targeted biologics
assigned by physicians, by country, 2007
- Figure 85: Importance of symptomatic improvement to prescribing of
5-ASAs and biologics, by country, 2007
- Figure 86: Importance of efficacy in promoting mucosal healing to
prescribing of 5-ASAs and biologics, by country, 2007
- Figure 87: Physicians' scores for mucosal healing and symptomatic
improvement for biologic brands, 2007
- Figure 88: Importance of speed of onset of remission to prescribing of
5-ASAs and biologics by country, 2007
- Figure 89: Dosing schedule for biologics in Crohn' s disease
- Figure 90: Importance of availability to prescribing of 5-ASAs and
biologics by country, 2007
- Figure 91: Importance of familiarity with product to prescribing of
5-ASAs and biologics by country, 2007
- Figure 92: Overview brand map of attributes versus brand perception
for 5-ASAs and biologics
- Figure 93: Brand map of the marketed 5-ASAs
- Figure 94: Brand map of the marketed and pipeline targeted biologics
- Figure 95: Pentasa' s attribute scores
- Figure 96: Dosing of Lialda for ulcerative colitis
- Figure 97: Attribute scores for Lialda/Mezavant
- Figure 98: Attribute scores for Asacol
- Figure 99: Physician perception of the targeted biologics
- Figure 100: Attribute scores for Remicade
- Figure 101: Gastroenterologists' scores for mucosal healing for the
biologics
- Figure 102: Mean percentage of inflammatory bowel disease patients
receiving each drug as their first biologic, 2007
- Figure 103: Percentage of patients with inflammatory bowel disease
receiving Remicade as their first biologic who will terminate therapy, by
country, 2007
- Figure 104: Percentage of patients who terminate Remicade therapy In
each time period
- Figure 105: Percentage of inflammatory bowel disease patients
terminating Remicade therapy within the first year because of each reason
- Figure 106: Percentage of inflammatory bowel disease patients who fail
Remicade therapy that are switched to each of the following therapy
options, 2007
- Figure 107: Humira' s attribute scores
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