Sales of ulcerative colitis (UC) drug therapies will increase from $2.1 billion in 2012 to $3.6 billion in 2022 in France, Germany, Italy, Spain, the UK, the US and Japan, according to new forecasts.

Uptake of two premium-priced tumour necrosis factor-alpha (TNH-alpha) inhibitors – AbbVie/Eisai’s Humira (adalimumab) and Janssen/Merck/Mitsubishi Tanabe’s Simponi (golimumab) and two novel therapies - Takeda’s cell adhesion molecule (CAM) inhibitor vedolizumab and Pfizer’s oral Janus-activated kinase inhibitor tofacitinib, will primarily drive market growth during the period, accounting for approximately half the market share in 2022, says the study, from Decision Resources.

Increased physician acceptance of TNF-alpha inhibitors for the treatment of moderate-to-severe disease and patient preference for convenient subcutaneous administration will fuel the uptake of newer TNF-alpha inhibitors Humira and Simponi to 2022, it forecasts.

In particular, Simponi – approved this year for ulcerative colitis in the US and Europe – will challenge intravenous infliximab (Janssen/Merck/Mitsubishi’s Remicade) as the most frequently-prescribed agent in the TNF-alpha inhibitor class, given its perceived greater efficacy than Humira’s in separate Phase III trials and favourable gastroenterologist opinion.

Remicade will remain the patient-share leader among the TNF-alpha inhibitors, maintaining a relatively constant patient share across the G7 countries based on its well-established efficacy, while Simponi is expected to overtake Remicade as sales leader in 2019, based largely on the former’s premium price and approved high dosing in ulcerative colitis, says DR.

The launches of two promising premium-priced novel agents, vedolizumab and tofacitinib, in 2014 and 2017 respectively, will contribute to increasing sales over the next 10 years, and will initially gain use primarily in the TNF-refractory population, it adds.

“Although the TNF-refractory market is relatively limited in size, the high unmet need for treatments that cater to this population will drive major-market sales of approximately $690 million in 2022, constituting about 20% of total market share,” forecasts Decision Resources analyst Dr Kathrina Quinn.

The study anticipates that, towards the end of the forecast period, vedolizumab will begin to overtake adalimumab’s use, as gastroenterologists move to another drug class after trying up to two TNF-alpha inhibitors. Tofacitinib will challenge vedolizumab’s use upon its later entry to the market, although its use is unlikely to overtake that of vedolizumab, based on anticipated confirmation of the latter drug’s promising efficacy in Phase III trials by the time of tofacitinib’s launch, and its perceived better safety profile, it adds.