 Treatment Algorithms --
March 2008
 In This Issue...
Introduction:
Although multiple sclerosis (MS) afflicts a small percentage
of the population, the MS market in the United States swelled to $3 billion in
2006. Expensive, biological therapies are often prescribed first line because
they are the only drugs that provide disease-modifying treatment. The interferon-beta
(IFN-beta) therapies make up the lion’s share of the MS market, but Teva
Pharmaceutical’s Copaxone (glatiramer acetate) has been gaining significant
market share because of its benign side-effect/safety profile and adequate
efficacy in mild disease. Within the IFN-beta drug class, Biogen Idec’s
Avonex (IFN-beta-1a [intramuscular (IM)]) amasses the highest patient and
market share. However, physicians increasingly favor Merck Serono/Pfizer’s
Rebif (IFN-beta-1a [subcutaneous (SC)]) for its greater efficacy. The
introduction of a newly reformulated version of Rebif, Rebif New Formulation
(RNF), has the potential to draw more patients to the Rebif franchise because of its more tolerable
side-effect/safety profile compared with the current formulation of the drug.
Questions Answered in This Report:
- Lines of therapy: While MS treatment guidelines recommend that
physicians initiate disease-modifying treatment soon after a definite diagnosis
of MS, they also allow for individual patient and physician choice and,
therefore, variability in treatment. What percentage of MS patients begin
treatment after receiving their first diagnosis for the disease? What
percentages of relapsing-remitting MS (RR-MS) patients receive Avonex, Rebif, Betaseron,
or Copaxone as first-line treatment? Which disease-modifying therapies have the
greatest retention rates in the first year after diagnosis?
- Pathways to key therapies: Tysabri relaunched in July 2006
under a limited prescribing program owing to its rare but fatal side effects. What
drugs are used directly before Tysabri? How do the pathways to each of
the MS drugs differ? What do the drugs used prior to each
disease-modifying therapy tell us about why patients move to a new line of
therapy in MS?
- Physician behavior: Although many interviewed thought
leaders consider Avonex’s efficacy profile superior to that of Copaxone, the
two drugs aggressively compete for patient share among patients with
early-stage or mild disease. What attributes of Copaxone and Avonex drive
neurologists and PCPs to choose one over the other? What are the main triggers
for practicing physicians to move a patient to Rebif or Betaseron? What factors
influence each physician type when making drug choices?
- Forecast: Although Avonex’s superior side-effect/safety
profile is a key factor in its rise to sales leader in the IFN-beta drug
class, RNF (launching in 2008) offers Rebif’s superior efficacy coupled with greater
tolerability compared with the current formulation of the drug. How will
neurologists and PCPs shift their prescribing of Avonex, Rebif, and RNF over
the next two years? To what extent will physicians embrace Tysabri? How will
they integrate the newly emerging therapies oral cladribine (from Merck Serono), FTY-720 (from Novartis and Mitsubishi Tanabe), and daclizumab
(from PDL BioPharma and Biogen Idec)?
Includes:
Primary research: Quantitative results from our
survey of 150 physicians (75 neurologists 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 55 million lives from more than 80
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: Avonex,
Rebif, Betaseron, Copaxone, Tysabri, CellCept, azathioprine, methotrexate,
cyclophosphamide, mitoxantrone, prednisone, other oral corticosteroids,
injectable methylprednisolone, and other injectable corticosteroids.
- Flowcharts tracking the preceding therapy patterns for patients
taking each of the following key therapies: Avonex, Rebif, Betaseron,
Copaxone, Tysabri, CellCept, azathioprine, mitoxantrone, prednisone, and injectable
methylprednisolone.
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