Introduction:
Early-line treatment for generalized anxiety disorder (GAD) is
focused on the use of benzodiazepines for immediate relief of the somatic
symptoms and/or the use of selective serotonin reuptake inhibitors (SSRIs),
including Forest’s Lexapro (escitalopram), sertraline, and paroxetine, for the relief
of both psychic and somatic symptoms associated with the condition. However,
SSRIs are commonly associated with metabolic and sexual side effects and are
not always efficacious in a given patient. Many other drug classes are
available to treat GAD, and they have struggled to penetrate the market. The
serotonin-norepinephrine reuptake inhibitors (SNRIs), consisting of Eli Lilly’s
Cymbalta (duloxetine), Wyeth’s Effexor XR (venlafaxine XR), and venlafaxine IR
(Wyeth’s Effexor, generics), commonly follow failed SSRI therapy.
Our analysis of patient-level claims data shows what
patients take before moving to later-line drugs like Pfizer’s Lyrica
(pregabalin) and atypical antipsychotics such as AstraZeneca’s Seroquel
(quetiapine), Seroquel XR (quetiapine extended release), Bristol-Myers Squibb/Otsuka’s
Abilify (aripiprazole), and Eli Lilly’s Zyprexa (olanzapine). Using
patient-level claims data and insight from 153 surveyed U.S. psychiatrists and
PCPs, this report determines the share of each currently marketed drug by line
of therapy, analyzes why key drugs are chosen over others, and explains how physicians
expect prescribing practices to
change over the next two years.
Questions Answered in This Report:
*
Lines of therapy: Benzodiazepines
and SSRIs continue to dominate early lines of therapy, with Lexapro the single leading
first-line agent for newly diagnosed patients.
What is the treatment initiation rate for newly
diagnosed GAD patients, and what are the major barriers to initiating
treatment? What are the retention rates for early-line treatments, including
Lexapro? When and why do physicians turn to SNRIs, and how does the early-line
patient share for Effexor XR and Cymbalta compare?
*
Pathways to key
therapies: Longitudinal claims data reveal which agents of a given class are
placed ahead of other agents in lines of therapy.
How long does it take for patients to move to SNRI
therapy? How are Effexor XR and Cymbalta positioned relative to each other? Why
do physicians use atypical antipsychotics, and what is limiting the uptake of
Seroquel/Seroquel XR in the GAD market? What drugs precede the use of Lyrica,
and what does this say about how physicians use this agent?
*
Physician behavior: GAD patients are treated by both psychiatrists and PCPs; the reasons to
change treatment from a given drug class differ between the two types of
treating physicians.
What
percentage of surveyed physicians prescribes each agent for GAD? What factors
drive each specialty when making drug choices? What attributes are most
critical in differentiating between Lexapro and Effexor XR, and between Effexor
XR and Cymbalta? What do physicians do upon failure of a given class (i.e., do they
switch to a different drug class before increasing the dose or switch to
another agent within the class)?
*
Forecast: Many surveyed
physicians say that they will increase their use of specific drug classes in
early lines of treatment and their use of combination therapy in second-line
therapy.
For which drug classes
do physicians anticipate writing more prescriptions over the next two years?
How do the anticipated changes of psychiatrists differ from those of PCPs? Will
the availability of generic formulations of Effexor XR change prescribing
habits? How will the use of atypical antipsychotics change between now and 2011,
and what impact will the patent expirations of Zyprexa and Invega have on the
GAD market? Are physicians aware of Takeda/Lundbeck’s emerging agent, LY
AA21004?Scope:
Primary research: Quantitative results from our
survey of 153 physicians (75 psychiatrists and 78 PCPs):
- Physician opinion on how drug use differs by patient severity.
- Most-influential drug attributes when physicians choose between
agents.
- Anticipated changes in the line of therapy in which physicians
use key agents.
Primary patient-level data: Quantitative findings
from our analysis of data covering 61 million lives from 98 geographically
diverse U.S. health plans:
- Quantified lines of therapy analysis showing exact share of each
agent in each line of therapy, including rate of progression between lines and
length of time patients are on each line.
- Progression flowcharts through one year of treatment for newly
diagnosed patients receiving each of the following first-line agents: Lexapro,
Effexor XR, Cymbalta, Lyrica, Seroquel, Janssen’s Risperdal, Zyprexa, Pfizer’s
Geodon (ziprasidone), benzodiazepines, sertraline, citalopram,
paroxetine, fluoxetine, fluvoxamine, venlafaxine IR, tricyclic agents, mirtazapine,
modified cyclics, bupropion, buspirone, hydroxyzine pamoate, hydroxyzine
hydrochloride, and other antiepileptics.
- Flowcharts tracking the preceding therapy patterns for patients
taking each of the following key therapies: Lexapro, Effexor XR, Cymbalta,
Lyrica, Seroquel, Risperdal, Zyprexa, Geodon, Wyeth’s Pristiq (desvenlafaxine),
Abilify, benzodiazepines, sertraline, citalopram, paroxetine, fluoxetine,
venlafaxine IR, mirtazapine, and buspirone.