+ REACTIONS. Kantar Health discusses. disease (IBD) market. pharma.

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1 REACTIONS the evolving inflammatory bowel disease (IBD) market Kantar Health discusses the increased prevalence of ibd, how it will affect the current and future market, and opportunities for pharma. april 2016 catalysts driving successful decisions in life sciences

2 reactions 2 ABOUT THE experts carey strader, mph Director, Epidemiology Services Inflammatory bowel disease (IBD) is an autoimmune disease composed of two conditions: Crohn s disease (CD) and ulcerative colitis (UC). These conditions share clinical features and symptoms but are separate entities. Both are associated with inflammation of the bowel as well as bleeding or black stools. While both CD and UC patients are likely to experience abdominal cramping, diarrhea and hematochezia, those with UC are more likely to experience bloody stool. Because of this, those with UC are more likely to seek medical attention earlier than those with CD. 1 IBD should not be confused with irritable bowel syndrome (IBS). While IBD and IBS patients are likely to experience similar symptoms, those with IBS do not experience bloody or black stool as IBS is not associated with inflammation of the bowel. The cause of IBD is unknown; however, a combination of genetic and environmental factors presumably plays a role. Recently, Kantar Health updated epidemiology and treatment data in Epi Database, indicating an increasing rate of prevalence of IBD across the G7 population (U.S., France, Germany, Italy, Spain, the United Kingdom and Japan). Our experts weighed in on how the growth of this condition is affecting patients and the future treatment market. how does ibd affect patients lives? kathy annunziata Vice President, Research Services In addition to the previously mentioned symptoms of IBD, patients are likely to experience a wide range of comorbidities including pain, headache, high blood pressure and allergies. Based on results from our 2014 National Health and Wellness Survey (NHWS), U.S. patients diagnosed with IBD are more than twice as likely as those not diagnosed with the condition to experience arthritis and gastroesophageal reflux disease or acid reflux. IBD patients also report a higher use of healthcare resources than those not diagnosed with IBD, as well as higher rates of overall work productivity and activity impairment (WPAI). Activity impairment was 40% for patients diagnosed with IBD, compared with 23% of those without IBD. Work productivity loss was 34%, compared with 16% of those not diagnosed with IBD. Patients experiences with IBD also affect their quality of life, as U.S. patients have lower levels of mental and physical well-being, based on the SF36v2, compared with those not diagnosed with IBD. what is the current status of the ibd market? Based on recently updated results from Epi Database, IBD currently affects approximately 0.18% of the G7 population, with the incidence and prevalence of both CD and UC increasing at similar rates. The reason for this increase in prevalence is unclear, though the growth is seen throughout Western countries and in developed countries in Asia. In some countries, prevalence is rising dramatically. There s a steep rise in the incidence of IBD in developing countries, so we expect that developing markets will trend up more rapidly than industrialized countries. Results from Epi Database suggest that the growth of IBD is expected to continue for the foreseeable future. Multiple studies have echoed this trend of increased prevalence. Recently, we updated our epidemiology data, utilizing diffusion curve techniques to conservatively trend future increases in prevalence based on the historical prevalence rates we are seeing in the market.

3 REACTIONS 3 more than half of ibd patients treat their symptoms with prescription medications. How is the treatment market changing as a result of the increased prevalence of IBD? In most geographies, half or more of patients treat their symptoms with prescription medications. CD has a higher treatment rate than UC across the G7 population (Table 1). TABLE 1: Treatment Rates for Crohn s Disease and Ulcerative Colitis Patients treated for CD Patients treated for UC U.S. france germany italy spain united kindgom japan 65% 66% 60% 65% 70% 70% 83%* 55% 49% 50% 50% 50% 60% 56%* Source: Epi Database, *U.S. National Health and Wellness Survey, Based on data from NHWS, it does not appear that treatment has increased at the same rate as IBD prevalence within the past decade. 2 This could be related to the ineffectiveness of medications currently available. In the U.S., many patients have had issues with tolerance and limited or no responsiveness with their current treatments. 3 The newest drugs in the market and in development are biologics, which are genetically engineered to target the proteins that may cause inflammation. The effectiveness of this class of therapy is still under investigation. New therapies that target other immune pathways have shown promising early results. Anti-adhesion therapies that limit cells going to the intestine are expected to present opportunities for the treatment of IBD in the coming years. The other interest in the treatment market is therapies related to the bacterial make-up of the gastrointestinal tract, including prebiotics and probiotics. As more patients are beginning to suffer from IBD, it will be interesting to see how the treatment market evolves. How will the increased prevalence of IBD affect the future market? Our Epi Database projections show that by 2040, the prevalence rate of CD is expected to grow by 11%, to affect 0.16% of the G7 population, while UC prevalence is expected to grow by 18%, to affect 0.24% of the G7 population. The prevalence of IBD will nearly double from affecting 0.18% of the current population to 0.32% of the population in Due to the low mortality rates associated with these conditions, the rising number of IBD patients will require significant healthcare resources, which could present a societal burden in the future. NHWS results show that adults in the U.S. diagnosed with IBD report higher rates of healthcare resource utilization than those not diagnosed with IBD, including more general practitioner and healthcare provider visits, hospitalizations and emergency room (ER) visits, with those diagnosed with IBD reporting more than twice as many ER visits within the past six months than those not diagnosed with IBD.

4 REACTIONS 4 the growing prevalence of ibd will create opportunities for manufacturers to develop new therapies. How will the increased prevalence of IBD affect the pharma industry? With more than half of patients in the G7 population currently treating their symptoms, the growing prevalence of IBD will create opportunities for manufacturers to develop new therapies to treat patients symptoms more effectively than those currently available. Results from NHWS show that in the U.S. gastroenterologists diagnose and treat more than three-quarters of IBD patients, so there are opportunities for pharma to work with these physicians to develop educational programs to improve patient outcomes. REFERENCES 1. Szigethy E, McLafferty L, Goyal A. Inflammatory bowel disease. Child Adolesc Psychiatr Clin N Am Apr;19(2): , ix. Review. 2. National Health and Wellness Survey, (US, 5EU [France, Germany, Italy, Spain, UK], Japan). Princeton, NJ. 3. Perrier C and Rutgeerts P. New drug therapies on the horizon for IBD. Dig Dis. 2012;30 (Suppl) 1: doi: / Epub 2012 Oct gov/pubmed/

5 reactions 5 WHY KANTAR HEALTH Kantar Health is a leading global healthcare consulting firm and trusted advisor to many of the world s leading pharmaceutical, biotech and medical device and diagnostic companies. It combines evidence-based research capabilities with deep scientific, therapeutic and clinical knowledge, commercial development know-how, and brand and marketing expertise to help clients evaluate opportunities, launch products and maintain brand and market leadership. Kantar Health deeply understands the influence of patients, payers and physicians, especially as they relate to the performance and payment of medicines and the delivery of healthcare services. Our advisory services, built on a solid foundation of market research and data, span three areas critical to bringing new medicines and pharmaceutical products to market commercial development, clinical strategies and marketing effectiveness. Kantar Health operates in more than 40 countries and employs more than 600 healthcare industry specialists and practitioners, including a high number of medical doctors, epidemiologists, PhDs, PharmDs and pharmacists, and biologists, biochemists and biophysicists. We work across the product lifecycle, from preclinical development to launch, and are experts at bringing multiple stakeholders together to advance the commercialization of pharmaceutical products. Our team acts as catalysts to successful decision making in the life sciences industry, helping our clients prioritize their product development and portfolio activities, differentiate their brands and drive product success post-launch. Kantar Health is part of Kantar, the data investment management division of WPP. If you would like us to act as catalysts for you, contact us at contactus. For more information Please info@kantarhealth.com. Why Kantar Health? Kantar Health is a leading global healthcare consulting firm and trusted advisor to many of the world s leading pharmaceutical, biotech and medical device and diagnostic companies. It combines evidence-based research capabilities with deep scientific, therapeutic and clinical knowledge, commercial development know-how, and brand and marketing expertise to help clients evaluate opportunities, launch products and maintain brand and market leadership. Our advisory services span three areas critical to bringing new medicines and pharmaceutical products to market commercial development, clinical strategies and marketing effectiveness.