 Treatment Algorithms --
July 2008
 In This Issue...
Introduction: Questions Answered in This Report:
- Lines of therapy: Despite the serious nature of the
disease and the high costs to society, a minority of newly diagnosed with
schizophrenia receive a pharmacological agent within one year of their initial
diagnosis. How many newly diagnosed patients do not receive a prescription
for a drug upon diagnosis, and why do physicians withhold treatment? Why are
patients receiving but not filling prescriptions? How do polypharmacy levels
change across lines of therapy? How has polypharmacy changed over time, and
which drugs will gain or lose due to future trends in combination therapy?
- Pathways to key therapies: Some antipsychotics are
available in short-acting intramuscular (IM) formulations, which are used for
acute symptom control. What percentage of patients prescribed each IM
antipsychotic continue taking oral formulations of that same drug for long-term
therapy? In what percentage of patients would surveyed physicians consider
using long-acting depot formulations? What is the ideal duration of action for
a depot formulation antipsychotic, and how do psychiatrists’ and primary care
physicians’ (PCPs’) opinions differ on the use of depot formulations?
- Physician behavior: Selection of an antipsychotic is often
dictated by the specific clinical presentations for a given schizophrenia
patient. Surveyed physicians tell us what percentage of their schizophrenia
patients have significant presentations of major symptoms (e.g.,
delusions/hallucinations, affective flattening, cognitive dysfunction, depression,
agitation, and anxiety) and how these symptoms affect drug choice. What
percentages of schizophrenia patients have significant presentations of each of
these symptoms? Which drug do physicians prefer for first-line therapy in cases
of schizophrenia with each symptom? How do psychiatrists and PCPs differ in
their opinions, and what opportunities do these differences present?
- Forecast: The loss of market exclusivity for Risperdal
holds the potential to dramatically shift treatment dynamics in schizophrenia,
but some key brands will see substantial growth. Which drugs will be most
affected by the availability of generic forms of Risperdal? Which drugs will
weather the storm and see growth in patient share over the next two years? For
key brands that will gain patient share over the next two years, from which
other brands will they take their patients? Which agents are likely to gain
more use in earlier lines of therapy over the next two years? From which other
therapies will the recently launched agents AstraZeneca’s Seroquel XR
(quetiapine, extended release) and Janssen’s Invega (paliperidone) steal
patients from? How many physicians are aware of Invega’s depot formulation, Eli
Lilly’s Zyprexa Adhera (olanzapine depot), Vanda’s Fanapta (iloperidone), and
Schering-Plough’s asenapine?
Includes:
Primary research: Quantitative results from our
survey of 153 physicians (78 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 55 million lives from more than 80
geographically diverse U.S. health plans (including commercial, Medicare, and
Medicaid 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: Risperdal/M-tabs,
Seroquel, Zyprexa/Zydis (excluding IM), Abilify (excluding IM), Geodon
(excluding IM), clozapine, Risperdal Consta, Geodon (IM), typical
antipsychotics, antiepileptic drugs, selective serotonin reuptake inhibitors,
serotonin/norepinephrine reuptake inhibitors, bupropion, mirtazapine,
benzodiazepines, nonbenzodiazepine GABA-A agonists, anticholinergic agents,
anxiolytics, trazodone, lithium, tricyclic agents.
- Flowcharts tracking the preceding therapy patterns for patients
taking each of the following key therapies: Risperdal/M-tabs, Seroquel,
Zyprexa/Zydis (excluding IM), Abilify (excluding IM), Geodon (excluding IM),
clozapine, Risperdal Consta, Geodon (IM).
Using patient-level claims data, as well as insight from 153
surveyed specialists and PCPs, this report determines the share of each
currently marketed drug by line of therapy, why key drugs are chosen over others,
and how physicians predict that this dynamic will change over the next two
years.
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