The symptomology of Parkinson’s disease (PD) is heterogeneous; individual patients experience different combinations of primary motor symptoms, complications of therapy, and/or key nonmotor comorbidities (e.g., dementia, psychosis) associated with the disease. Moreover, in each patient, the balance of the many disease- and therapy-related symptoms typically changes over time with disease progression. PD treatment is thus highly individualized as physicians settle on a drug regimen that best addresses the myriad of signs and symptoms specific to each patient at a given point in time, and make therapeutic adjustments as needed—potentially frequently. The availability of numerous and complementary therapeutic options adds to the complexity of the treatment algorithm in PD, and growing generics competition in this market further complicates treatment decisions. Using national patient-level claims data, this report explores the evolving position of current drugs in the treatment of PD. Quantitative analyses of the “Newly Diagnosed Patients” data query include share by line of therapy, progression between lines, duration of treatment on each line, and the use of concomitant treatment. For the “Recently Treated Patients” query, the report expands the understanding of PD treatment patterns by quantifying drugs’ source of business and patient flow through preceding therapies. Additional analyses explore persistency and compliance by brand.

Questions Answered in This Report:

  • Newly diagnosed patients: Within the first year of diagnosis, slightly more than half of PD patients initiate treatment. 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 does Azilect (Teva’s rasagiline) fare in early treatment decisions?

  • Recently treated patients: Consistent with historical treatment patterns, levodopa continues to capture the majority of recent prescriptions, but other key drug classes in PD continue to hold strong positions in the treatment algorithm of the disease. Has the uptake of Azilect, one of the few remaining branded agents in the PD market, changed with the growing generic availability of other commonly used PD drugs? How and when do patients progress from one therapy to the next in PD, and how does this differ between key drugs? How are off-label agents targeted at the nonmotor symptoms of PD being used by patients?

  • Pathways to key therapies: Our query of longitudinal claims data reveals that use of dopamine agonists in the treatment of PD remains relatively stable. How does the relaunched Neupro (UCB’s rotigotine transdermal patch) fare overall in our sample? How do patients progress to Neupro? Has generic availability of some dopamine agonists affected uptake of other drugs in the class? From which specific therapies do patients receiving dopamine agonists originate?

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 with claims that are less than a year old at the time of publication.

Patient Sample: 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 PD (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic codes 332.0) during the study period.

Quantified lines of therapy analysis 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:

- 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.


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