Systemic lupus erythematosus (SLE) is a complex autoimmune disease affecting multiple organ systems, manifesting at various levels of severity, and involving periods of remission and relapse. The autoimmune reactions that characterize SLE can result in severe organ damage and, in some instances, ultimately lead to death. Antimalarial agents are the recommended first-line treatment for all patients regardless of disease severity or clinical manifestation. In 2011, IV belimumab (GlaxoSmithKline’s Benlysta) became the first drug approved for SLE in more than 50 years, highlighting the difficulty of successfully bringing agents to market to treat this multifactorial disease. This report uses national patient-level claims data to explore the use of key therapies in newly diagnosed SLE patients with a quantitative analysis of treatment patterns and share by line of therapy, as well as progression between lines, duration of treatment on each line, and use of concomitant treatment. Among recently treated patients, we quantify a drug’s source of business compared with its competitors and detail which drugs precede others through an analysis of add-versus-switch patterns. Additional analyses explore persistency and compliance by brand.
Questions Answered in This Report:
- Newly diagnosed patients: Only 22.7% of SLE patients begin treatment with a key therapy within a year of their initial diagnosis. 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: Antimalarial agents continue to capture the majority of recently treated patient prescriptions. Which specific drugs garner the most patient share for recently treated SLE patients? When do patients progress from one therapy to the next in SLE, 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: Longitudinal claims data reveal relatively consistent use patterns of key therapies among recently treated patients; use of immunosuppressants and B-cell and T-cell modulators increases in the later lines of therapy. 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 has been the impact of recently approved drugs for SLE?
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 between 6-12 months old at 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 SLE (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic codes 7100) 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:
- 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 trends in 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.