Contents:

CHAPTER 1 EXECUTIVE SUMMARY 3 Scope of the analysis 3 Insight into the IBD market 3 Conclusion 1 3 Conclusion 2 4 Conclusion 3 4 CHAPTER 2 INTRODUCTION AND SCOPE 11 Coverage of the Stakeholder Insight: Inflammatory Bowel Disease survey 11 Country treatment trees 12 Supporting data sets 12 Key stakeholder organizations 12 CHAPTER 3 COUNTRY TREATMENT TREES 14 US 16 Japan 20 France 24 Germany 28 Italy 32 Spain 36 UK 40 US 44 Japan 48 France 52 Germany 56 Italy 60 Spain 64 UK 68 CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION 72 Disease definition and classification 72 CD 72 UC 73 Epidemiology of the IBD population 75 Segmentation of the IBD population 78 CD 78 Mild to moderate 78 Moderate to severe 78 Severe fulminant disease 79 Remission 79 UC 79 Mild 79 Moderate 79 Severe 79 CHAPTER 5 DIAGNOSIS AND TREATMENT OPTIONS 81 Diagnosis and severity 81 Diagnosis 81 Severity 82 Treatment rates 83 Influences on diagnosis and treatment rates 86 CHAPTER 6 PRESCRIBING TRENDS AND INFLUENCING FACTORS 88 CD prescribing trends 88 Global trends 88 Mild CD 92 Moderate CD 92 Severe CD 93 Topical ASAs and oral ASAs 93 Topical corticosteroids and oral, injectable and iv corticosteroids 96 Antibiotics 99 Immunosuppressants and biologics 101 Biologics in Japan 102 UC prescribing trends 106 Global trends 106 Mild UC 109 Moderate UC 110 Severe UC 111 Topical ASAs and oral ASAs 111 Topical corticosteroids and oral, injectable, and iv corticosteroids 114 Antibiotics 117 Immunosuppressants 119 Changes in therapy 120 Monotherapy and combination therapy 120 Progression to second- and third-line therapy 122 Factors influencing physician decision making 125 Physician perceptions of drug class performance on factors influencing prescribing in CD 128 Relative performance of major classes in CD 128 ASAs in CD 130 Corticosteroids in CD 133 Immunosuppressants in CD 136 Remicade in CD 140 Physician perceptions of drug class performance on factors influencing prescribing in UC 143 Relative performance of major classes in UC 143 ASAs in UC 145 Corticosteroids in UC 148 Immunosuppressants in UC 151 Biologics and other IBD therapies: uses, influences and issues 154 Remicade: second or third line? 155 Remicade: optimal methods of use 156 Remicade: length of use in maintenance therapy 160 Remicade: loss of response 161 Remicade: restoring response 162 Remicade: disease modifying? 165 Remicade: increased risk of infection or cancer? 167 Remicade: reserved for those who fail traditional immunosuppressants? 169 Remicade: effective in episodic use? 171 Remicade: episodic use justified due to lower costs? 173 Remicade: under pressure to limit use to episodic use? 175 Remicade: effective in UC? 177 Remicade: safety concerns limit use? 179 Remicade: price limits use? 181 Probiotics and ASAs 183 Probiotics: efficacious in CD? 183 Probiotics: efficacious in UC? 185 ASAs: effective in cancer prevention? 187 CHAPTER 7 IMPROVING TREATMENT OUTCOMES 190 Treatment outcomes 190 Compliance 191 Unmet needs 195 New product development 198 APPENDIX A 207 Bibliography 207 Exchange rates and calendrical notes 209 APPENDIX B 211 Physician research methodology 211 Physician sample breakdown 211 US 211 Japan 211 France 212 Germany 212 Italy 212 Spain 213 UK 213 APPENDIX C 214 Survey questionnaire 214 Section 1: Presentation and diagnosis 214 Section 2: Prescribing patterns and disease severity 216 Section 3: Remicade and other therapies 223 Section 4: Awareness and potential of emerging therapies 227 Section 5: Prescribing influences 228 Section 6: Treatment outcomes and compliance 231 Disclaimer 239