The EU5 market for multiple sclerosis (MS) disease-modifying therapies (DMTs) is dynamic and evolving. More than ten key branded DMTs are available, with several launching in the past five years, each delivering a unique balance of benefit, risk, and convenience. New agents, in particular oral DMTs, have meaningfully altered physician preferences and introduced new complexity into an already complicated treatment paradigm. Understanding the many decision points facing EU5 neurologists in the shifting treatment of MS provides, and in five unique countries, important context for developers of marketed and pipeline DMTs.

Table of contents

  • Multiple Sclerosis - Current Treatment - Detailed, Expanded Analysis (EU)
    • Thought Leadership
      • September 2016
        • Webinar: Current MS Market Landscape in the EU
    • Thought Leadership
      • September 2016
        • Webinar: Current MS Market Landscape in the EU
    • Physician Prescribing Practices
      • Key Findings
      • Patient Characteristics
        • Patient and Practice Characteristics Are Similar Across the EU5
        • Percentage of MS Patients Under Management by Subpopulation
        • Percentage of Progressive MS Patients with Evidence of Active Inflammation on MRI
        • Testing for Oligoclonal Bands and Anti-JCV Serostatus for MS Patients in the Past Year
        • Frequency of Office Visits for MS Patients
        • Frequency of MRI Screening for MS Patients
        • Frequency of Anti-JCV Antibody Screening in MS Patients
      • Treatment Practices
        • Neurologists Across the EU5 Generally Align Regarding Treatment Practices for MS
        • On Average, EU5 MS Patients Initiate Treatment Six Months After Diagnosis
        • Elapsed Time Between Diagnosis and Treatment Initiation in MS Patients
        • DMT Treatment Rates Vary by Disease Classification and by Country in the EU5
        • Treament Rate by MS Subpopulation
        • Primary Reason for Not Receiving DMT by MS Subpopulation: EU5 Average
        • Primary Reason for Not Receiving DMT by Country: CIS Patients
        • Primary Reason for Not Receiving DMT by Country: RR-MS Patients
        • Primary Reason for Not Receiving DMT by Country: SP-MS Patients
        • Primary Reason for Not Receiving DMT by Country: PP-MS Patients
        • DMT Prescribing in the EU5 Is Fragmented for All MS Subpopulations
        • Current Prescriber Base for Key DMTs
        • Patient Share by Product for MS Subpopulations: EU5 Average
        • Patient Share by Product and Country: CIS Patients
        • Patient Share by Product and Country: RR-MS Patients
        • Patient Share by Product and Country: SP-MS Patients
        • Patient Share by Product and Country: PP-MS Patients
        • Recent Changes in Prescribing for Key DMTs: EU5 Average
        • Avonex and Tecfidera Are the Most Common First-Line Agents for RR-MS in the EU5
        • Current Distribution of Patients by Line of Therapy for RR-MS and PP-MS: EU5 Average
        • Distribution of RR-MS and PP-MS Patients by Line of Therapy One Year After DMT Initiation
        • Three Most Common DMTs Prescribed by Line of Therapy for RR-MS Patients: EU5 Average
        • Three Most Common First-Line DMTs for RR-MS Patients by Country
        • Three Most Common Second-Line DMTs for RR-MS Patients by Country
        • Three Most Common DMTs Prescribed by Line of Therapy for PP-MS Patients: EU5 Average
        • Three Most Common First-Line DMTs for PP-MS Patients by Country
        • Three Most Common Second-Line DMTs for PP-MS Patients by Country
        • Combination Use of Key MS DMTs Is Rare
        • Percentage of MS Patients Receiving Combination Treatment with DMTs
      • Persistency and Compliance
        • MS Patients Are Generally Most Compliant with Gilenya and the Infused DMTs
        • Neurologist-Reported Compliance Rates for Key DMTs: EU5 Average
        • Neurologist-Reported Persistence Rates for Key DMTs: EU5 Average
        • Neurologist-Reported Persistence Rates for Key DMTs: Germany
        • Treatment Duration for Key DMTs in MS Patients: EU5 Average
      • Sequencing of Treatment
        • MS Patients Who Discontinue Treatment with Oral DMTs Are Unlikely to Receive an At-Home Injectable Drug
        • Previous DMT Allocation by Current DMT: EU5 Average
        • Switch Patterns by Prior DMT: EU5 Average
      • Recent/Anticipated Changes in Brand Usage/Treatment Approaches
        • EU5 Neurologists Expect a Continued Shift Toward Oral DMTs in RR-MS and a Major Impact for Ocrevus in PP-MS in the Next Year
        • Anticipated DMT Treatment Rate by MS Subpopulation
        • Anticipated Patient Share by Product for RR-MS Patients: EU5 Average
        • Anticipated Changes in Patient Share by Product for RR-MS Patients
        • Anticipated Patient Share by Product for PP-MS Patients: EU5 Average
        • Familiarity with Emerging Agents Zinbryta and Ocrevus
        • Anticipated Peak Patient Share for Zinbryta and Ocrevus in RR-MS and PP-MS Patients
    • Physician Insight on Medical Practice
      • Key Findings
      • Drivers of Treatment Selection
        • Drivers and Constraints of DMT Use Reflect the Tiers of Efficacy and Safety Risk Established by Marketed Drugs
        • Key Drivers and Obstacles of Use for MS Products Are Similar Across the EU5
        • Top Driver of Use for Key DMTs: France
        • Top Driver of Use for Key DMTs: Germany
        • Top Driver of Use for Key DMTs: Italy
        • Top Driver of Use for Key DMTs: Spain
        • Top Driver of Use for Key DMTs: United Kingdom
        • Main Obstacle Constraining Use of Key DMTs: France
        • Main Obstacle Constraining Use of Key DMTs: Germany
        • Main Obstacle Constraining Use of Key DMTs: Italy
        • Main Obstacle Constraining Use of Key DMTs: Spain
        • Main Obstacle Constraining Use of Key DMTs: United Kingdom
        • Efficacy and Safety Expectedly Govern EU5 Neurologists' DMT Switch Patterns
        • Rationale for Switching from Key DMTs in the Past Year: EU5 Average
        • Rationale for Switching to Key DMTs in the Past Year: EU5 Average
        • The Impact of Anti-JCV Antibody Serostatus Testing Is Largely Limited to the Use of Tysabri
        • Most Preferred DMTs for Anti-JCV Seronegative and Anti-JCV Seropositive Patients: EU5 Average
        • Clinical Scenarios Related to PML Risk for Which Physicians Are Unwilling to Prescribe Select DMTs: EU5 Average
        • Percentage of MS Patient Who Were Treatment Naive at the Time of Their First Test for JCV Serostatus
        • Neurologist-Reported Reasons for Complete DMT Discontinuation Vary by Country
        • Rationale for Treatment Cessation Within the Past Year
      • Face-To-Face Product Detailing Effectiveness
        • The Quality and Timing of Recent MS DMT Details Are Generally Similar But Frequency Varies by Country
        • Detailing Frequency Varies Considerably by Country and DMT
        • Number of Detailing Visits in the Past Six Months for Key DMTs
        • Timing of Most Recent DMT Detailing: EU5 Average
        • Detailing Within the Past Month for Key DMTs
        • Percentage of Respondents Who Report Sales Representative Access Is Restricted in Their Clinical Practice
        • Surveyed EU5 Neurologists Express Moderate to High Satisfaction with DMT Sales Representatives
        • Satisfaction with Sales Representatives for Key DMTs: EU5 Average
        • Many MS Developers Are Emphasizing a First-Line Role for Their Products
        • Aided Message Recall from Recent DMT Detailing: EU5 Average
    • Methodology
      • Primary Market Research Methodology
      • Significance Testing in This Study
      • Physician Demographics
        • Years in Practice
        • Practice Setting
        • Infusion Capability
    • Appendix
      • Line of Therapy Distribution for RR-MS Patients by Country
      • Three Most Common Third-Line DMTs for RR-MS Patients by Country
      • Three Most Common Third-Line DMTs for PP-MS Patients by Country
      • Recent Changes in Prescribing for Key DMTs by Country
      • Neurologist-Reported Compliance Rates for Key DMTs: France
      • Neurologist-Reported Compliance Rates for Key DMTs: Germany
      • Neurologist-Reported Compliance Rates for Key DMTs: Italy
      • Neurologist-Reported Compliance Rates for Key DMTs: Spain
      • Neurologist-Reported Compliance Rates for Key DMTs: United Kingdom
      • Neurologist-Reported Persistence Rates for Key DMTs: France
      • Neurologist-Reported Persistence Rates for Key DMTs: Italy
      • Neurologist-Reported Persistence Rates for Key DMTs: Spain
      • Neurologist-Reported Persistence Rates for Key DMTs: United Kingdom
      • Anticipated DMT Treatment Rate by MS Subpopulation: EU5 Average
      • Anticipated Changes in Patient Share by Product for PP-MS Patients
      • Most Preferred DMTs for Anti-JCV Seronegative and Anti-JCV Seropositive RR-MS Patients by Country
      • Second-Most Preferred DMTs for Anti-JCV Seronegative and Anti-JCV Seropositive RR-MS Patients by Country
      • Satisfaction with Sales Representatives for Key DMTs: France
      • Satisfaction with Sales Representatives for Key DMTs: Germany
      • Satisfaction with Sales Representatives for Key DMTs: Italy
      • Satisfaction with Sales Representatives for Key DMTs: Spain
      • Satisfaction with Sales Representatives for Key DMTs: United Kingdom
      • Aided Message Recall from Recent DMT Detailing: France
      • Aided Message Recall from Recent DMT Detailing: Germany
      • Aided Message Recall from Recent DMT Detailing: Italy
      • Aided Message Recall from Recent DMT Detailing: Spain
      • Aided Message Recall from Recent DMT Detailing: United Kingdom

Author(s): John Crowley

John leads DRG’s Infectious, Niche, & Rare Diseases team and manages the market research portfolio across niche and rare diseases, anti-infectives, and vaccines. Prior to his current role, he was a Director on the team overseeing syndicated and custom work on niche and rare disease markets, as well as atopic dermatitis content in DRG’s Dermatology portfolio. He also served as a DRG analyst in the neurology space, focused mainly on the multiple sclerosis market. John holds a Ph.D. from the University of Massachusetts Medical School and a Bachelor’s degree from Worcester Polytechnic Institute.


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