Nephrology: An Analysis of Erythropoiesis Stimulating Agents in Late Stage Chronic Kidney Disease and Phosphate Binders in Dialysis | Treatment Algorithms | Claims Data Analysis | US | 2014

Publish date: September 2014

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Chronic kidney disease (CKD) affects approximately 26 million people in the United States. While there are multiple prescription therapies that are available for treating the associated symptoms, nothing is available today that is indicated for delaying progression of the disease. However, renal anemia and hyperphosphatemia, or elevated serum phosphorous, are two primary complications of CKD that are treated with erythropoiesis-stimulating agents (ESAs) and phosphate binders, respectively. Using national patient-level claims data, this report analyzes physician adherence to the treatment guidelines by exploring the use of ESAs in the newly diagnosed and recently treated late-stage CKD nondialysis (CKD-ND) patient population. Among the newly diagnosed patients, the report provides a quantitative analysis of treatment patterns and share by line of ESA therapy, as well as progression between lines, and duration of treatment on each line. Among recently treated patients, the report quantifies a drug’s source of business compared with its competitors and details which drugs precede others through an analysis of add-versus-switch patterns for both the use of ESAs in late-stage CKD and the use of phosphate binders in the dialysis patient population. Additional analyses explore persistency and compliance by brand.

Questions Answered in This Report:

  • Newly diagnosed patients with renal anemia and late stage CKD-ND: Janssen’s Procrit and Amgen’s Aranesp are the predominant players in the CKD-ND ESA market. What percentage of these patients progress to a second- or third-line drug within the first year? Which products capture the most patient share in the first, second, and third lines of treatment? How often is combination therapy used in each line of therapy?

  • Recently treated patients: Consistent with historical treatment patterns, Renvela tablets continue to capture the majority of recently treated dialysis patient prescriptions. Which specific drugs garner the most patient share for recently treated dialysis patients? When do patients progress from one therapy to the next in dialysis patients, and how does this pattern differ among key drugs? Are most recently treated patients with each key brand coming from new (adds/switches) or continuing business?

  • Pathways to key therapies: Many new formulations have launched in recent years for the treatment of hyperphosphatemia in dialysis patients. Which therapies have experienced market growth or decline over the key therapy periods studied? To what extent are key therapies prescribed concomitantly to recently treated patients? What impact, if any, have new formulations (e.g., Renvela powder and Phoslyra) had on the marketplace?

Scope:

Primary patient-level data: This report provides quantitative findings from our analysis of data covering approximately 40 million lives and provides the most representative sample of U.S. treatment practice for Medicare and commercially insured patients. This report is delivered as a key findings slide deck and a dashboard that can be accessed using the internet and presents claims that are less than six months old at the time of publication.

Patient sample—ESAs: Patients who are continuously enrolled for the complete two-year study period must meet the following condition: at least one claim with a diagnosis code for anemia in CKD (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic code 285.21) during the study period.

Patient sample—phosphate binders: Patients who are continuously enrolled for the complete one-year study period must meet the following condition: at least one claim with a diagnosis code for end-stage renal disease (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic code 585.6) during the study period.

Quantified lines of therapy analyses show 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.

Newly Diagnosed Patients (ESAs only):

- Patient share by drug class and key products across three lines of therapy, within one year of diagnosis.

- Patient flowcharts through one year of treatment for all first-line products, including progression rates and add/switch behavior.

- Polypharmacy and key concomitant therapies by line of therapy.

- Quarterly trending of patient share by line of therapy.

Recently Treated Patients:

- Quarterly snapshot of patient share by drug class and key products.

- Pathway to key therapy flowcharts tracking the preceding therapy patterns for all key therapies, including add/switch behavior.

- Brand source of business, including share for continuing, new (switches/adds), and new (initial therapy) business.

- Polypharmacy and key concomitant therapies.

- Drug persistence and compliance.

- Quarterly trends in patient share for all key therapies.