Table of Contents

Table of Contents
ABOUT DATAMONITOR HEALTHCARE 2
About the Immunology and Inflammation pharmaceutical analysis team 2
CHAPTER 1 EXECUTIVE SUMMARY 3
Scope of the analysis 3
Datamonitor insight into the inflammatory bowel disease market 4
Contributing experts 5
Previous and related reports 6
CHAPTER 2 INTRODUCTION AND SCOPE 8
Coverage of the Stakeholder Insight Survey 8
Epidemiology and patient segmentation 8
Diagnosis 8
Treatment options and guidelines 9
Treatment trends 9
Key prescribing influences 9
Brand assessment 9
CHAPTER 3 COUNTRY TREATMENT TREES 10
Introduction to treatment trees 10
US 11
Japan 15
France 19
Germany 23
Italy 27
Spain 31
UK 35
CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION 39
Disease definition 40
Classification of inflammatory bowel disease 40
Crohn's disease 40
Ulcerative colitis 40
Montreal classification of Crohn's disease and ulcerative colitis 41
Etiology 43
Genes associated with inflammatory bowel disease influence phenotype 44
Smoking 45
Appendectomy 45
Oral contraceptives 46
Infection with a pathogenic organism 46
Abnormal immune response to gut flora 47
Pathogenesis 48
Crohn's disease and ulcerative colitis are mediated by Th1 and Th2 lymphocytes, respectively 48
Disease incidence and prevalence 49
Crohn's disease 51
Ulcerative colitis 52
US 53
Europe 56
France 56
Germany 57
Italy 57
Spain 59
UK 60
Japan 61
Patient segmentation according to disease severity 64
Severity is measured using different disease activity scales 64
Majority of Crohn's disease and ulcerative colitis patients suffer mild to moderate disease 65
CHAPTER 5 DIAGNOSIS OF INFLAMMATORY BOWEL DISEASE 68
Diagnosis 69
Diagnosis of inflammatory bowel disease combines many avenues of investigation 69
Initial investigation begins with laboratory tests 70
Endoscopy is the most direct way of diagnosing inflammatory bowel disease 71
Radiology is a crucial adjunct to endoscopy 71
Serological markers are not yet used for clinical diagnosis 72
A high diagnosis rate is observed in inflammatory bowel disease 73
Just over 70% of Crohn's disease patients are diagnosed 73
Physicians report a higher diagnosis rate for ulcerative colitis than Crohn's disease 75
Complications arising in Crohn's disease and ulcerative colitis 76
Abscesses, strictures and fistulae are the most commonly physician-reported complications in Crohn's disease patients 77
Over 25% of Crohn's disease patients suffer from nutritional deficiencies 78
Bleeding is reported by almost all gastroenterologists in patients with ulcerative colitis 79
Almost half of ulcerative colitis patients experience bleeding complications 80
Association of IBD with immune disorders and co-morbidities 82
Anemia and anxiety and depression are the most commonly associated co-morbidities in inflammatory bowel disease 82
Patients with inflammatory bowel disease also suffer from irritable bowel disease 83
Immune-mediated diseases occur at greater frequency among patients with inflammatory bowel disease 83
CHAPTER 6 TREATMENT OPTIONS AND GUIDELINES 85
Treatment options 86
Non-pharmacological treatment of inflammatory bowel disease 86
Diet 86
Probiotics 86
Pharmacological treatment 87
Antibiotics 87
Anti-diarrheals and anti-spasmodics 87
Topical and oral aminosalicylates 88
Corticosteroids 89
Traditional immunosuppressants 89
Targeted biologics 89
Pharmacological versus non-pharmacological 91
Majority of patients with inflammatory bowel disease are treated pharmacologically 91
There are some patients who do not receive any therapy for inflammatory bowel disease 94
Treatment guidelines 97
Several treatment guidelines exist for the treatment of inflammatory bowel disease 97
Guidelines published by the British Society of Gastroenterology 97
NICE guidelines on the use of infliximab for Crohn's disease 99
NICE is appraising the use of infliximab for ulcerative colitis 100
American College of Gastroenterology guidelines for Crohn's disease 101
American College of Gastroenterology guidelines for ulcerative colitis 102
The European Crohn's and Colitis Organisation has published consensus guidelines for Crohn's disease 103
CHAPTER 7 TREATMENT TRENDS 105
Changes in therapy 106
Disease severity influences treatment 106
Despite lack of evidence to support efficacy, Crohn's disease and ulcerative colitis patients receive antibiotics at all levels of severity 106
Anti-spasmodics and anti-diarrheals are used as accompanying therapies for all severities of Crohn's disease and ulcerative colitis 107
Up to 60% of Crohn's disease and ulcerative colitis patients receive oral aminosalicylates 111
Topical aminosalicylates are used more for ulcerative colitis than Crohn's disease 113
Use of corticosteroids increases with disease severity 115
Gradual increase in use of immunosuppressants according to Crohn's disease severity 117
Immunosuppressants are largely reserved for moderate and severe ulcerative colitis patients 119
Use of biologics in Crohn's disease occurs in moderate-to-severe disease, but to a limited extent in mild patients 120
Use of biologic increases significantly with severity of ulcerative colitis 121
Monotherapy versus combination therapy 122
Increasing disease severity promotes use of combination therapy 122
First-line therapy 127
Oral 5-ASAs are used first-line for Crohn's disease 127
Corticosteroids are being prescribed at first-line for Crohn's disease 129
A combination of oral and topical 5-ASAs is the preferred first-line treatment regimen for ulcerative colitis 129
Almost 45% of Crohn's disease patients move to a second-line therapy 131
About a third of ulcerative colitis patients progress to treatment with second-line therapy 131
Second-line therapy 132
Immunosuppressants are the most commonly prescribed drug class by gastroenterologists at second-line for Crohn's disease 132
Biologics are prescribed at second-line for Crohn's disease 134
Corticosteroids are prescribed at second-line for ulcerative colitis 134
Immunosuppressants are also prescribed at second-line for ulcerative colitis 135
Almost a quarter of Crohn's disease patients progress from second-line to third-line treatment 135
A fifth of ulcerative colitis patients progress from second-line to third-line treatment 136
Third-line therapy 137
Biologics alone, or in combination with immunosuppressants, are the most commonly prescribed therapies for Crohn's disease at third-line 137
Like Crohn's disease, biologics are prescribed most frequently by gastroenterologists for ulcerative colitis 139
Surgery 141
Surgery is more effective for ulcerative colitis than Crohn's disease 141
Just under a third of Crohn's disease patients will eventually require surgery 142
Almost half as many patients with ulcerative colitis will eventually require surgery than those with Crohn's disease 143
Ulcerative colitis patients receive pharmacological therapy for longer than Crohn's disease patients before requiring surgery 144
"Step-up" versus a "top-down" approach to the treatment of inflammatory bowel disease 145
Current algorithms promote use of a "step-up" approach, but a "top-down" approach is now being suggested 145
Is there scope for a "top-down" approach? 146
Clinical trial data provide evidence showing a "top-down" approach is more effective than "step-up" 146
A "top-down" approach may change the natural history of Crohn's disease 147
There are a number of advantages and risks associated with a "top-down" treatment approach 149
The SONIC study will assess early use of azathioprine, infliximab or both in combination 149
Only 20% of severe Crohn's disease patients receive a "top-down" treatment approach 150
The potential for side effects ranks as the leading reason for not using a "top-down" approach in Crohn's disease 152
Similar percentage of ulcerative colitis and Crohn's disease patients receive a "top-down" treatment approach 153
The potential for side effects is also the leading reason for not using a "top-down" approach in ulcerative colitis 154
Gastroenterologists also reported that a lack of evidence and experience prevents use of a "top-down" approach 155
CHAPTER 8 PRESCRIBING INFLUENCES 158
Factors influencing physician decision making 159
Symptomatic improvement and healing of the mucosa are the most important factors influencing physician prescribing 159
Efficacy 163
Symptomatic improvement 163
Efficacy in promoting mucosal healing 166
Speed of onset of remission 167
Safety 168
Side-effect profile 168
Dosing 170
Convenient dosing and convenient administration frequency 170
Cost 172
Availability (formulary/reimbursement status) 172
Physician factors 173
Familiarity with product 173
Patient factors 174
Patient compliance 174
Other 176
Prevention of colon cancer 176
CHAPTER 9 BRAND ASSESSMENT 177
Brand map 178
How to interpret a brand map 178
5-ASAs: Lialda may offer advantages in a class where there is little differentiation 183
Pentasa (mesalazine) 184
Pentasa is an oral, controlled-release formulation that delivers mesalazine from the duodenum to the rectum 184
New dose of Pentasa reduces the number of pills taken per day 184
Gastroenterologists rated Pentasa well on familiarity and availability 185
Lialda/Mezavant (mesalazine) 185
Lialda is an oral sustained-release, multimatrix formulation of mesalamine 185
Lialda is marketed as a once-daily treatment for ulcerative colitis 186
Lialda has been compared with Asacol in a Phase III clinical trial 187
Gastroenterologists scored Lialda well on side-effect profile 188
Lialda is perceived by gastroenterologists to perform well on patient compliance, convenient dose and convenient administration frequency 189
Asacol (mesalazine) 189
Asacol is a delayed-release formulation of mesalazine, which is marketed by Proctor & Gamble 189
Asacol well perceived on familiarity with product and availability 190
Salofalk (mesalazine) 190
Salofalk is a Eudragit-L-coated pellet formulation of mesalazine 190
Salofalk and Pentasa are equally effective in achieving remission in mild to moderate ulcerative colitis patients 191
Salofalk did not perform well on patient compliance and convenient administration frequency 192
Claversal (mesalazine) 192
Like Salofalk, Claversal is a micropellet formulation of mesalazine 192
Fivasa (mesalazine) 192
In France, Asacol is marketed as Fivasa by Norgine Pharma 192
Salazopyrin (sulfasalazine) 193
Gastroenterologists did not rate Salazopyrin well on side-effect profile 193
Biologics: brand comparison shows that Remicade remains the leader, but Humira is perceived well by physicians 194
Remicade (infliximab) 195
Gastroenterologists rate Remicade well on familiarity with product and symptomatic improvement 195
Mucosal healing is associated most with Remicade than the other biologics 198
Remicade is not associated with a convenient dose and convenient administration frequency 198
More than three-quarters of severe patients with inflammatory bowel disease receive Remicade as their first biologic therapy 199
40% of patients who receive Remicade as their first biologic will terminate therapy 201
Most patients terminate Remicade therapy within the first year 202
An inadequate response is the most common reason for terminating Remicade therapy within the first year 204
Inadequate response remains the most common reason for terminating Remicade therapy after 1 year 206
Over a third of patients who fail Remicade therapy will move on to treatment with Humira 206
Surgery is the next step for many patients who fail Remicade therapy 209
Almost a quarter of Remicade-refractory patients progress to therapy with corticosteroids 209
Despite no evidence of efficacy in Crohn's disease, a small percentage of Remicade-refractory patients go on to receive Enbrel (etanercept) 210
Humira (adalimumab) 211
Humira is a self-administered, humanized anti-TNF monoclonal antibody 211
Clinical trials for Humira demonstrate efficacy in biologic-naïve patients and infliximab-refractory patients with Crohn's disease 211
Gastroenterologists scored Humira better than Remicade on a number of attributes 212
Cimzia (certolizumab pegol) 214
Cimzia is a pegylated, humanized anti-TNF therapy 214
PRECISE 1 and PRECISE 2 trials demonstrated the safety and efficacy of Cimzia, but the therapy was rejected by the FDA 214
Cimzia was rejected for Crohn's disease in the EU in November 2007 215
Cimzia was perceived by gastroenterologists to perform well on convenient dose and administration frequency 216
Tysabri (natalizumab) 218
Tysabri prevents leukocytes migrating into the gut in Crohn's disease 218
The EMEA's CHMP returned a final negative opinion for Tysabri in Crohn's disease in November 2007 218
The ENACT and ENCORE trials demonstrated the efficacy of Tysabri in Crohn's disease 219
Tysabri was not rated well on symptomatic improvement or side-effect profile 220
BIBLIOGRAPHY 222
Journal papers 222
Websites 234
Other 237
APPENDIX A 238
Physician research methodology 238
Physician sample breakdown 238
US 238
Japan 239
France 239
Germany 240
Italy 240
Spain 241
UK 241
Contributing experts 242
APPENDIX B 243
The survey questionnaire 243
1. Patient Segmentation 243
2. Prescribing factors 250
3. Treatment classes and severity 255
4. Treatment of severe disease 265
APPENDIX C 273
About Datamonitor 273
About Datamonitor Healthcare 273
About the Immunology and Inflammation analysis team 274
Disclaimer 275
List of Tables
Table 1: Montreal sub-classification for Crohn's disease, 2005 42
Table 2: Montreal classification for ulcerative colitis covering extent and anatomy, 2005 42
Table 3: Epidemiological studies into incidence and prevalence of Crohn's disease and ulcerative colitis, 1978-2007 49
Table 4: Prevalence and incidence of Crohn's disease in the seven major markets by country, 2007 51
Table 5: Prevalence and incidence of ulcerative colitis in the seven major markets by country, 2007 52
Table 6: Age- and sex-specific and adjusted prevalence of ulcerative colitis in Olmsted County, Minnesota, January 2001 54
Table 7: Age- and sex-specific and adjusted prevalence of Crohn's disease in Olmsted County, Minnesota, January 2001 54
Table 8: Incidence and prevalence of Crohn's disease and ulcerative colitis in the UK, 1995 61
Table 9: Annual prevalence and incidence of Crohn's disease and ulcerative colitis in Japan, 1991 63
Table 10: Number of respondents reporting Crohn's disease patients with each complication, by country, 2007 77
Table 11: Number of respondents reporting ulcerative colitis patients with each complication, by country, 2007 80
Table 12: Number and percentage of gastroenterologists prescribing each therapy at first-line for Crohn's disease, 2007 128
Table 13: Number and percentage of gastroenterologists prescribing each therapy at first-line for ulcerative colitis, 2007 130
Table 14: Number and percentage of gastroenterologists prescribing each therapy at second-line for Crohn's disease, 2007 133
Table 15: Number and percentage of gastroenterologists prescribing each therapy at second-line for ulcerative colitis, 2007 134
Table 16: Number and percentage of gastroenterologists prescribing each therapy at third-line for Crohn's disease 138
Table 17: Number and percentage of gastroenterologists prescribing each therapy at third-line for ulcerative colitis 140
Table 18: Mean ranking for each reason for not using a top-down approach in severe Crohn's disease, 2007 153
Table 19: Mean ranking for each reason for not using a top-down approach in severe ulcerative colitis, 2007 155
Table 20: Number and percentage of physicians able to rate each brand of 5-ASA 162
Table 21: Number and percentage of physicians able to rate each brand of biologic 162
Table 22: Comparison of key studies for Remicade, Humira, Cimzia and Tysabri 165
Table 23: Side effects associated with sulfasalazine and 5-ASAs 169
Table 24: Dosing schedule for the 5-ASA brands 171
Table 25: Attributes scores for each of the 5-ASA brands 183
Table 26: Attributes scores for each of the biologic brands 194
Table 27: Remicade's attribute scores by country 197
Table 28: Percentage of patients who terminate Remicade therapy in each time period, by country 203
Table 29: Percentage of inflammatory bowel disease patients terminating Remicade therapy within the first year because of each reason, by country 205
Table 30: Percentage of inflammatory bowel disease patients terminating Remicade therapy after the first year because of each reason, by country 206
Table 31: Percentage of inflammatory bowel disease patients who fail Remicade therapy that are switched to Humira (adalimumab), by country, 2007 208
Table 32: Percentage of Remicade-refractory patients who move on to therapy with Enbrel (etanercept), by country 210
Table 33: Cimzia's attribute scores, by country 217
Table 34: US physician sample breakdown, 2007 238
Table 35: Japan physician sample breakdown, 2007 239
Table 36: France physician sample breakdown, 2007 239
Table 37: Germany physician sample breakdown, 2007 240
Table 38: Italy physician sample breakdown, 2007 240
Table 39: Spain physician sample breakdown, 2007 241
Table 40: UK physician sample breakdown, 2007 241
List of Figures
Figure 1: Crohn's disease treatment tree split by disease severity in the US, 2007 11
Figure 2: Ulcerative colitis treatment tree split by disease severity in the US, 2007 12
Figure 3: Physician-preferred first-, second- and third-line treatment regimen for Crohn's disease in the US, 2007 13
Figure 4: Physician-preferred first-, second- and third-line treatment regimen for ulcerative colitis in the US, 2007 14
Figure 5: Crohn's disease treatment tree split by disease severity in Japan, 2007 15
Figure 6: Ulcerative colitis treatment tree split by disease severity in Japan, 2007 16
Figure 7: Physician-preferred first-, second- and third-line treatment regimen for Crohn's disease in Japan, 2007 17
Figure 8: Physician-preferred first-, second- and third-line treatment regimen for ulcerative colitis in Japan, 2007 18
Figure 9: Crohn's disease treatment tree split by disease severity in France, 2007 19
Figure 10: Ulcerative colitis treatment tree split by disease severity in France, 2007 20
Figure 11: Physician-preferred first-, second- and third-line treatment regimen for Crohn's disease in France, 2007 21
Figure 12: Physician-preferred first-, second- and third-line treatment regimen for ulcerative colitis in France, 2007 22
Figure 13: Crohn's disease treatment tree split by disease severity in Germany, 2007 23
Figure 14: Ulcerative colitis treatment tree split by disease severity in Germany, 2007 24
Figure 15: Physician-preferred first-, second- and third-line treatment regimen for Crohn's disease in Germany, 2007 25
Figure 16: Physician-preferred first-, second- and third-line treatment regimen for ulcerative colitis in Germany, 2007 26
Figure 17: Crohn's disease treatment tree split by disease severity in Italy, 2007 27
Figure 18: Ulcerative colitis treatment tree split by disease severity in Italy, 2007 28
Figure 19: Physician-preferred first-, second- and third-line treatment regimen for Crohn's disease in Italy, 2007 29
Figure 20: Physician-preferred first-, second- and third-line treatment regimen for ulcerative colitis in Italy, 2007 30
Figure 21: Crohn's disease treatment tree split by disease severity in Spain, 2007 31
Figure 22: Ulcerative colitis treatment tree split by disease severity in Spain, 2007 32
Figure 23: Physician-preferred first-, second- and third-line treatment regimen for Crohn's disease in Spain, 2007 33
Figure 24: Physician-preferred first-, second- and third-line treatment regimen for ulcerative colitis in Spain, 2007 34
Figure 25: Crohn's disease treatment tree split by disease severity in the UK, 2007 35
Figure 26: Ulcerative colitis treatment tree split by disease severity in the UK, 2007 36
Figure 27: Physician-preferred first-, second- and third-line treatment regimen for Crohn's disease in the UK, 2007 37
Figure 28: Physician-preferred first-, second- and third-line treatment regimen for ulcerative colitis in the UK, 2007 38
Figure 29: Age- and sex-adjusted incidence of Crohn's disease and ulcerative colitis in Olmsted County, Minnesota, 1940-2000 53
Figure 30: Estimated annual prevalence and incidence rates of Crohn's disease in Japan, 1986-1998 62
Figure 31: Diagnosed Crohn's disease patients by severity in the seven major markets, 2007 66
Figure 32: Diagnosed ulcerative colitis patients by severity in the seven major markets, 2007 67
Figure 33: Diagnosis of inflammatory bowel disease 70
Figure 34: Crohn's disease diagnosis rates, by country, 2007 73
Figure 35: Ulcerative colitis diagnosis rates, by country, 2007 76
Figure 36: Percentage of Crohn's disease patients suffering from each complication, 2007 79
Figure 37: Percentage of ulcerative colitis patients suffering from each complication, 2007 81
Figure 38: Percentage of inflammatory bowel disease patients with various co-morbidities, 2007 82
Figure 39: Mean percentage of Crohn's disease patients receiving each type of therapy by disease severity, 2007 92
Figure 40: Mean percentage of ulcerative colitis patients receiving each type of therapy by disease severity, 2007 93
Figure 41: Percentage of patients with Crohn's disease not receiving treatment, split by disease severity, by country, 2007 95
Figure 42: Percentage of patients with ulcerative colitis not receiving treatment, split by disease severity, by country, 2007 96
Figure 43: American College of Gastroenterology: Management of Crohn's disease in adults 101
Figure 44: Algorithm for the medical management of Crohn's disease, 2003 102
Figure 45: American College of Gastroenterology: Ulcerative colitis practice guidelines in adults 103
Figure 46: Percentage of Crohn's disease patients receiving antibiotics by disease severity in the seven major markets, 2007 106
Figure 47: Percentage of ulcerative colitis patients receiving antibiotics by disease severity in the seven major markets, 2007 107
Figure 48: Percentage of Crohn's disease patients receiving anti-spasmodics by disease severity in the seven major markets, 2007 108
Figure 49: Percentage of ulcerative colitis patients receiving anti-spasmodics by disease severity in the seven major markets, 2007 109
Figure 50: Percentage of Crohn's disease patients receiving anti-diarrheals by disease severity in the seven major markets, 2007 110
Figure 51: Percentage of ulcerative colitis patients receiving anti-diarrheals by disease severity in the seven major markets, 2007 111
Figure 52: Percentage of Crohn's disease patients receiving oral 5-ASAs by disease severity in the seven major markets, 2007 112
Figure 53: Percentage of ulcerative colitis patients receiving oral 5-ASAs by disease severity in the seven major markets, 2007 113
Figure 54: Percentage of Crohn's disease patients receiving topical 5-ASAs by disease severity in the seven major markets, 2007 114
Figure 55: Percentage of ulcerative colitis patients receiving topical 5-ASAs by disease severity in the seven major markets, 2007 115
Figure 56: Percentage of Crohn's disease patients receiving corticosteroids by disease severity in the seven major markets, 2007 116
Figure 57: Percentage of ulcerative colitis patients receiving corticosteroids by disease severity in the seven major markets, 2007 117
Figure 58: Percentage of Crohn's disease patients receiving traditional immunosuppressants by disease severity in the seven major markets, 2007 119
Figure 59: Percentage of ulcerative colitis patients receiving traditional immunosuppressants by disease severity in the seven major markets, 2007 120
Figure 60: Percentage of Crohn's disease patients receiving biological therapy by disease severity in the seven major markets, 2007 121
Figure 61: Percentage of ulcerative colitis patients receiving biological therapy by disease severity in the seven major markets, 2007 122
Figure 62: Percentage of mild Crohn's disease patients receiving monotherapy or combination therapy in the seven major markets, 2007 123
Figure 63: Percentage of moderate Crohn's disease patients receiving monotherapy or combination therapy in the seven major markets, 2007 124
Figure 64: Percentage of severe Crohn's disease patients receiving monotherapy or combination therapy in the seven major markets, 2007 125
Figure 65: Percentage of mild ulcerative colitis patients receiving monotherapy or combination therapy in the seven major markets, 2007 126
Figure 66: Percentage of moderate ulcerative colitis patients receiving monotherapy or combination therapy in the seven major markets, 2007 126
Figure 67: Percentage of severe ulcerative colitis patients receiving monotherapy or combination therapy in the seven major markets, 2007 127
Figure 68: Percentage of Crohn's disease patients progressing from first-line to second-line treatment regimen, by country, 2007 131
Figure 69: Percentage of ulcerative colitis patients progressing from first-line to second-line treatment regimen, by country 132
Figure 70: Percentage of Crohn's disease patients progressing from second-line to third-line treatment regimen, by country 136
Figure 71: Percentage of ulcerative colitis patients progressing from second-line to third-line treatment regimen, by country 137
Figure 72: Percentage of Crohn's disease patients that will eventually require surgery, by country 142
Figure 73: Percentage of ulcerative colitis patients that will eventually require surgery, by country 143
Figure 74: Number of years a Crohn's disease or ulcerative colitis patient will receive pharmacological therapy before requiring surgery, by country 144
Figure 75: Step-up versus a top-down treatment approach 146
Figure 76: Results of the first "top-down" versus "step-up" randomized controlled trial presented at the DDW 2006 147
Figure 77: Potential advantages and risks of a "top-down" treatment approach 149
Figure 78: Percentage of Crohn's disease and ulcerative colitis patients receiving a biologic in combination with an Immunosuppressant, by country, 2007 150
Figure 79: Percentage of severe Crohn's disease patients who receive a step-up versus a top-down treatment approach, by country, 2007 151
Figure 80: Percentage of severe ulcerative colitis patients who receive a step-up versus a top-down treatment approach, by country, 2007 154
Figure 81: Reasons, and frequency of each reason, for not using a "top-down" treatment approach in Crohn's disease, 2007 156
Figure 82: Reasons, and frequency of each reason, for not using a "top-down" treatment approach in ulcerative colitis, 2007 157
Figure 83: Average influence on prescribing decision: weightings assigned by gastroenterologists to key attributes for 5-ASAs and biologics, 2007 160
Figure 84: Weightings for attributes in 5-ASAs and targeted biologics assigned by physicians, by country, 2007 161
Figure 85: Importance of symptomatic improvement to prescribing of 5-ASAs and biologics, by country, 2007 164
Figure 86: Importance of efficacy in promoting mucosal healing to prescribing of 5-ASAs and biologics, by country, 2007 166
Figure 87: Physicians' scores for mucosal healing and symptomatic improvement for biologic brands, 2007 167
Figure 88: Importance of speed of onset of remission to prescribing of 5-ASAs and biologics by country, 2007 168
Figure 89: Dosing schedule for biologics in Crohn's disease 171
Figure 90: Importance of availability to prescribing of 5-ASAs and biologics by country, 2007 172
Figure 91: Importance of familiarity with product to prescribing of 5-ASAs and biologics by country, 2007 173
Figure 92: Overview brand map of attributes versus brand perception for 5-ASAs and biologics 179
Figure 93: Brand map of the marketed 5-ASAs 180
Figure 94: Brand map of the marketed and pipeline targeted biologics 181
Figure 95: Pentasa's attribute scores 185
Figure 96: Dosing of Lialda for ulcerative colitis 187
Figure 97: Attribute scores for Lialda/Mezavant 188
Figure 98: Attribute scores for Asacol 190
Figure 99: Physician perception of the targeted biologics 195
Figure 100: Attribute scores for Remicade 196
Figure 101: Gastroenterologists' scores for mucosal healing for the biologics 198
Figure 102: Mean percentage of inflammatory bowel disease patients receiving each drug as their first biologic, 2007 200
Figure 103: Percentage of patients with inflammatory bowel disease receiving Remicade as their first biologic who will terminate therapy, by country, 2007 201
Figure 104: Percentage of patients who terminate Remicade therapy In each time period 203
Figure 105: Percentage of inflammatory bowel disease patients terminating Remicade therapy within the first year because of each reason 204
Figure 106: Percentage of inflammatory bowel disease patients who fail Remicade therapy that are switched to each of the following therapy options, 2007 207
Figure 107: Humira's attribute scores 213