Directors from pharmaceutical and health insurance companies and gastroenterologists in the United States have expressed a positive opinion overall about the use of janus kinase (JAK) inhibitors for the treatment of inflammatory bowel disease (IBD), according to a recent survey.

In the United States, TNF-α inhibitors, such as Remicade (infliximab) and Humira (adalimumab), are commonly used to treat ulcerative colitis and Crohn’s disease.

However, the development of new therapies has brought alternative options to the market, especially for patients who do not respond to or cannot receive TNF-α inhibitors. This has begun to change the IBD treatment paradigm.

“Drugmakers looking to compete in the IBD market need to overcome the entrenched favorable reimbursement status of the long-marketed TNF inhibitors. That said, gastroenterologists are excited about the JAK inhibitors’ potential in a market where many patients are refractory to treatments already available although use may be relegated to later lines,” Brian Nasipak, an analyst at Decision Resources Group, said in a press release.

To provide a more informed and accurate state of the market regarding the real position of each of the available or potential therapies to treat patients with IBD, the Decision Resources Group conducted a survey targeting U.S. payer entities and gastroenterologists. The results of the survey were published in a report titled, “Ulcerative Colitis/Crohn’s Disease: U.S. Access & Reimbursement.”

According to survey results, most payers identified Pfizer’s Xeljanz (tofacitinib) as the emerging therapy that will have the most impact on treating ulcerative colitis. Filgotinib, which is being developed in a collaboration between Gilead and Galapagos, was also recognized as having great potential for the treatment of Crohn’s disease. Most physicians said that they expect to prescribe these two drugs during their first year of commercialization.

With the recent development and approval of new and less expensive drugs that have similar therapeutic effects as reference drugs, such as Inflectra, a biosimilar to Pfizer’s infliximab, the market was expected to show signs of change. The survey did show that Johnson & Johnson‘s (J&J) Remicade (infliximab) still has good market access, but doctors expected payers to urge them to use biosimilars in the future.

“At this time there is little evidence to suggest that Remicade’s market access position has suffered with the launch of biosimilar infliximab. J&J has had time to prepare for the biosimilar’s launch and, at least for now, appears to have protected its place in the IBD market. We will be watching carefully to see how long they can maintain their position and to see what levels of discounting and rebates are needed to do so,” Nasipak said.

Biologics have brought great improvements to patients’ care and quality of life. But many physicians said that there is a sizable discrepancy between patients who are eligible to take them and those who actually receive them. Doctors believe that this may be due to high prices, payer-imposed restrictions, and patient preferences.

Despite these market changes and the development of new biologics and oral therapies, both physicians and payers believe that TNF-α inhibitors will remain as first-line biologics for the treatment of IBD.