Introduction:
Atypical antipsychotics remain the cornerstone of
schizophrenia treatment across all lines of therapy. One year after the launch
of the first generic atypical in the United States (generic risperidone, at the
end of June 2008), surveyed physicians weigh in on how generic risperidone has altered
the treatment landscape. Physicians indicate that cost is not the only factor
driving first-line treatment choice and highlight remaining opportunities for
differentiation among branded atypicals. Surveyed psychiatrists continue to
view risperidone and Eli Lilly’s Zyprexa as the most effective atypicals for
treating schizophrenia patients with delusions and/or hallucinations (the most
common presenting schizophrenia symptom), but concerns over the weight gain and
metabolic profiles of agents such as Zyprexa have allowed Bristol-Myers
Squibb/Otsuka’s Abilify and Pfizer’s Geodon to post strong gains in early-line
patient share in the schizophrenia market compared with our previous analysis
of patient-level claims in this market.
This Treatment Algorithms in Schizophrenia report analyzes
patient-level claims data to quantify schizophrenia drug share by line of
therapy in newly diagnosed patients and identifies, through our survey of 150 U.S.
physicians (75 psychiatrists and 75 PCPs), the factors that drive physicians’ first-line
choice among atypical antipsychotics. We identify physicians’ preferences among
key patient segments (e.g., patients presenting with delusions and/or
hallucination, with comorbid anxiety or depression, with cognitive dysfunction)
to reveal the specific patient segments driving each atypical’s patient share.
Finally, we examine how these factors differ among the primary care and
specialist settings and discuss how this treatment dynamic will change over the
next two years with the launches of novel atypical antipsychotics and several
depot formulations of current brands. Our primary research also shows which
drug attributes are most important to physicians in first-line treatment and
juxtaposes how each atypical antipsychotic performs on each of these attributes
versus their patient shares by line of therapy—using these leverage points,
brand sales and marketing teams can effectively build strategy for taking share
from competitors or building share in untapped areas of the schizophrenia
market.
Questions Answered in This Report:
*
Lines of therapy: With the exception of risperidone,
Abilify has surpassed other atypical antipsychotics, including agents that surveyed
psychiatrists perceive to be more effective such as Zyprexa and AstraZeneca’s
Seroquel/Seroquel XR, to take second place in first-line treatment of
schizophrenia.
How much of early-line patient share is devoted to each atypical
antipsychotic? How has early-line patient share shifted among newly diagnosed
patients from our 2008 analysis? How frequently do surveyed physicians
prescribe generic risperidone as a first-line atypical antipsychotic over its
branded competitors? What other classes of agents capture significant share in
early lines of therapy and which atypical antipsychotics do these patients move
to as they progress through treatment?
*
Pathways to key therapies: Surveyed physicians
differentiate the atypical antipsychotics based on their perceived efficacy and
side-effect profiles.
How might physician perceptions influence patient
movement from one atypical to another? Which agents are most often replaced by risperidone,
Abilify, Geodon, Zyprexa, Seroquel or Seroquel XR, Janssen’s
Risperdal Consta, and Janssen’s Invega? To what extent have patient flow
patterns to risperidone changed following the entry of generics?
*
Physician behavior: Schizophrenia treatment occurs largely
in the specialist setting. However, surveyed PCPs initiate first-line therapy
in a substantial percentage of their schizophrenia patients, highlighting the
primary care setting as an important entry point for schizophrenia drug therapy.
How do PCPs and psychiatrists differ in their preferences for specific atypical
antipsychotics? Which agents does each physician type prefer for
first-line treatment of patients with specific presenting symptoms (e.g.,
comorbid depression, hallucinations and/or delusions, cognitive dysfunction)? Does
physician use of other key drug classes, including antidepressants or antiepileptics,
vary by presenting symptoms and specialty?
*
Forecast: Over the next two years, the schizophrenia
market will see the introduction of two novel atypical antipsychotics and two
more depot formulations of currently branded products. However, these agents
will face an increasingly competitive generics market as formulations of Zyprexa
and Invega will join generic risperidone as alternatives to the higher-cost
branded atypicals.
How will the launch of
depot formulations of Zyprexa and Invega impact the treatment landscape by 2011?
How will currently marketed agents’ use shift by line of therapy over the next
two years as the second generic atypical antipsychotic, generic olanzapine,
enters the U.S. market? How likely are surveyed physicians to begin prescribing
the emerging atypical antipsychotics, Vanda’s Fanapt and Schering-Plough’s
Saphris? To what extent will physicians continue to prioritize concerns about
metabolic and weight-gain side effects compared with other potential trends in
schizophrenia treatment? Scope:
Includes:
Primary research: Quantitative results from our
survey of 150 physicians (75 psychiatrists and 75 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: Seroquel,
Abilify, Zyprexa, Zyprexa Zydis, Geodon, Invega, Risperdal Consta, Risperdal
M-Tabs, risperidone, antiepileptic drugs, typical antipsychotics, anticholinergic
agents, anxiolytics, benzodiazepines, SSRIs, SNRIs, bupropion, tricyclic
agents, trazodone, and lithium.
- Flowcharts tracking the preceding therapy patterns for patients
taking each of the following key therapies: Seroquel, Seroquel XR, Abilify,
Zyprexa, Geodon, Invega, Risperdal Consta, and risperidone.