Bipolar disorder (BPD) is a chronic illness characterized by recurrent episodes of aberrant mood. Treatment must be tailored to each patient’s current disease stage (i.e., acute manic episode, acute depressive episode, and maintenance phase). Historically, mood stabilizers such as lithium and antiepileptic drugs (AEDs) were the mainstay of treatment, but in recent years, atypical antipsychotics have played a larger role following their regulatory approval for bipolar depression and bipolar mania and as maintenance therapies. Use of antidepressants continues to occupy a large place in the BPD treatment algorithm, despite the lack of consistent evidence of their efficacy in this patient population. Preferred agents include the AED lamotrigine (GlaxoSmithKline’s Lamictal, generics), whose patient share in BPD has remained steady over the past five quarters of our analysis. Physicians perceive lamotrigine as an effective prophylaxis for bipolar depression and one of the safest therapies among the mood stabilizers and antipsychotics used for BPD, despite the risk of a rare, life-threatening rash.
Within the atypical antipsychotic drug class, Bristol-Myers Squibb/Otsuka’s Abilify (aripiprazole) and quetiapine (AstraZeneca’s Seroquel, generics) continue to play the large roles in BPD treatment; among newly diagnosed patients, Abilify and quetiapine are virtually tied for first-line patient share. Thought leaders consider Abilify and ziprasidone (Pfizer’s Geodon, generics) as having a lower propensity to cause weight gain and metabolic side effects compared with quetiapine and olanzapine (Eli Lilly’s Zyprexa, generics) but also as being less effective than quetiapine and olanzapine for certain phases of treatment. Quetiapine’s approval for treatment of both poles of BPD—mania and depression—sets this agent apart from other atypical antipsychotics and has helped make it a key market leader in this drug class. Newly emerging agents, more specifically, those in the atypical antipsychotic drug class, will compete in a crowded and genericized market. It is not enough for emerging agents to offer a better weight-gain profile over current agents; they must also demonstrate efficacy for more than just the treatment of mania to make an impact on the market. Using patient-level claims data, this report determines the share of each currently marketed drug by line of therapy, evaluates therapy flow, and analyzes why key drugs are chosen over others.
Primary patient-level data: Quantitative findings from our analysis of data covering approximately 40 million lives providing 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 with claims that are less than six months old at the time of publication.
Patients aged 18 or older 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 BPD (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic codes (296.0, 296.1, 296.4, 296.5, 296.6, 296.7, 296.80, and 296.89) during the study period.
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.
Newly Diagnosed Patients:
- Patient share by drug class and key products across three lines of therapy, within one year of diagnosis.
- Patient flowchart 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.
- Quarterly trending of patient share for all key therapies.