Exton, PA, Sept. 11, 2026 (GLOBE NEWSWIRE) -- Japan's ulcerative colitis (UC) treatment landscape is becoming increasingly competitive as biologics, JAK inhibitors, S1P modulators, and a growing pipeline of novel mechanisms expand physician choice. But expanding choice has not yet translated into a corresponding shift in treatment strategy. Despite broad support for earlier advanced therapy, step-up treatment remains the dominant approach, revealing a disconnect between how gastroenterologists believe moderate-to-severe UC should be treated and how treatment is currently being delivered.
New findings from Spherix Global Insights’ Market Dynamix™: Ulcerative Colitis (Japan) 2026, based on a survey of 103 gastroenterologists practicing in Japan, quantify that gap. Nearly three-quarters agree that the long-term risks of uncontrolled disease outweigh the risks associated with advanced therapy, and more than half believe top-down treatment should be the standard of care for newly diagnosed patients with moderate-to-severe disease. In practice, however, step-up treatment remains firmly dominant, and top-down initiation is rare.
Nearly half of Japanese UC patients are not currently receiving an advanced therapy, and physicians estimate that more than one-third of conventionally treated patients would benefit from escalation. At the same time, physicians most commonly cite adequate control on conventional therapy as the reason for maintaining the status quo. The findings suggest that the threshold for what constitutes sufficient disease control may itself be an important factor slowing earlier use of advanced therapies.
Institutional factors add further friction for many physicians. Four-in-ten surveyed physicians indicate that many patients who could benefit from earlier advanced therapy face institutional or administrative constraints. Taken together, the findings indicate that the gap between treatment philosophy and prescribing behavior is driven by more than clinical preference alone, with practice-level constraints also influencing when advanced therapy is initiated.
Within the advanced-therapy market, TNF inhibitors continue to command the largest share, even as physicians increasingly favor JAK inhibitors and IL-23 inhibitors on clinical grounds. AbbVie’s Rinvoq has emerged as the current share leader among newer advanced agents, while Johnson & Johnson's Tremfya is capturing a disproportionate share of new prescriptions relative to its overall share, suggesting early momentum as prescribing begins to evolve.
The research also identifies patient populations where existing options appear to leave greater room for differentiation. Gastroenterologists identify women of childbearing age and patients who have failed or lost response to a prior advanced therapy as having the greatest unmet need, alongside a substantial subset of patients who prefer oral treatment. For manufacturers, these segments point to several potential areas of differentiation, including treatment considerations for women of childbearing age, efficacy following prior advanced-therapy failure, and route of administration.
Clinical differentiation alone, however, may not be enough to change established treatment behavior in Japan. When considering a newly approved therapy, physicians place considerable importance on inclusion in Japanese Society of Gastroenterology (JSGE) guidelines and the availability of local clinical data. That places an additional burden on new entrants: demonstrating compelling efficacy and safety may be necessary, but building confidence through Japan-specific evidence and guideline inclusion could be equally important to changing established prescribing behavior.
Those dynamics create both opportunity and challenge for the next wave of UC therapies. Unaided awareness of late-stage pipeline agents remains limited, with only two in five gastroenterologists able to name any agent in development and no individual asset yet commanding a clear familiarity advantage. That relatively open awareness landscape creates an opportunity for developers of late-stage assets—including Merck’s tulisokibart, Abivax’s obefazimod, Johnson & Johnson’s icotrokinra and JNJ-4804, Roche’s afimkibart, and Sanofi/Teva’s duvakitug—to shape physician perceptions before prescribing preferences become established. Success, however, will require more than adding another option to an increasingly crowded treatment armamentarium. Manufacturers will need to demonstrate where their therapies address a meaningful unmet need, generate evidence that resonates with Japanese gastroenterologists, and build familiarity early enough to influence future treatment algorithms.
"Japanese gastroenterologists express real concern about the risks of undertreating UC, and many support earlier, more aggressive therapy for the right patient," said Jim Hickey, Gastroenterology Franchise Head at Spherix Global Insights. "But that support isn't absolute. When asked what they consider to be the optimal approach in UC, most gastroenterologists still land on a step-up strategy. For established brands and pipeline entrants alike, understanding how perceptions of advanced therapies and the top-down approach are evolving will be critical as competition in Japan intensifies.”
Findings are drawn from Spherix Global Insights’ Market Dynamix™: Ulcerative Colitis (Japan) 2026, a quantitative survey of 103 Japanese gastroenterologists, fielded July 20–31, 2026. A corresponding study in Crohn’s Disease, Market Dynamix™: Crohn’s Disease (Japan) 2026, will be available at the end of September, 2026.
About Market Dynamix™
Market Dynamix™ is an independent service that provides an in-depth analysis of markets anticipated to experience a paradigm shift within the next three to five years. The service examines market size, current treatment approaches, unmet needs, and physician perspectives on the potential impact of emerging therapies.
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Jim Hickey Spherix Global Insights 484-879-4284 james.hickey@spherixglobalinights.com