Bipolar disorder (BPD) is a chronic and debilitating psychiatric illness, and proper treatment requires that each phase of the disease (acute manic episode, acute depressive episode, or maintenance phase) be addressed, which often requires treatment with multiple drugs and frequent treatment changes. Treatment of BPD is highly individualized, and physicians have a wide array of drugs to choose from when tailoring a patient’s treatment. Nevertheless, in general, mood stabilizers such as antiepileptic drugs are the cornerstone of BPD treatment, while atypical antipsychotics play a considerable role in the treatment of both bipolar mania and bipolar depression. At the same time, because of the armamentarium of drugs available, coupled with the fact that a large number of the drugs in most drug classes are generically available, emerging drugs will find it difficult to establish themselves in the market without a strong differentiating feature.

This report uses national patient-level claims data to explore the positioning of the leading maintenance therapies in the treatment of newly diagnosed BPD patients using 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. The report also quantifies a drug’s source of business among recently treated BPD patients compared with its competitors and details 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: More than 60% of BPD 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 following diagnosis, and how quickly do they do so? 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: Antiepileptic drugs and atypical antipsychotics are both used frequently among recently treated patients. Which specific drugs garner the most patient share among recently treated BPD patients? What is the duration of treatment in the preceding line before a BPD patient progresses to a key therapy, and how does this pattern differ among key drugs? Are most BPD patients recently treated 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; combination therapy is common in the treatment of BPD. 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 newer-to-market agents on BPD treatment?

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 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 BPD (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic codes 296.00-296.06, 296.10-296.16, 296.40-296.46, 296.50-296.56, 296.60-296.66, 296.70, 296.80, 296.89) 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 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.

Author(s): Angela M. Sparrow, Ph.D.
Bethany A. Kiernan, Ph.D.

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