Market Outlook

Osteoarthritis (OA) pain is an extremely prevalent type of chronic pain, affecting more than 30 million individuals in the United States, and is the second-largest segment of the overall chronic pain market. Treatment of OA pain is dominated by cost-effective generic treatments, in addition to costly abuse-deterrent reformulations of opioid analgesics and new combinations of existing analgesics that attempt to mitigate side effects; no truly novel or mechanism-based therapies are currently available. The key drug classes prescribed to treat OA pain, nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics, are associated with a host of side effects including gastrointestinal, cardiovascular, and/or abuse risks. As such, treatment of this indication can be challenging for physicians because existing therapies are frequently inadequate in achieving long-term analgesia in many patients.

Questions Answered

  • How is OA pain being treated in the United States today, and what are the drivers and constraints influencing physicians’ treatment decisions?
  • What impact have the recent launches of new analgesics such as Iroko’s Vivlodex and Purdue’s Hysingla ER had on physician prescribing behavior for OA pain?
  • What factors drive switching between or discontinuation of select analgesics (e.g., Depomed’s Nucynta ER, Horizon’s Vimovo, Pfizer’s Embeda)?
  • How does patient risk for abuse/history of abuse influence physicians’ prescribing of opioid analgesics for OA pain?

Product Description

Current Treatment: Physician Insights provides physician insights on treatment paths, prescribing behaviors, and the factors and perceptions driving brand usage so you can create specific messaging around these treatment dynamics in order to more effectively increase or defend your market position.

Table of contents

  • Osteoarthritic Pain - Current Treatment - Detailed, Expanded Analysis (US)
    • Key Updates
      • November 2017
        • August 2017
        • Introduction to Current Treatment for OA Pain
          • Key Findings
          • Summary Figures
            • Progression Rate Between Lines of Therapy for OA Pain Patients Treated by PCPs and Rheumatologists
            • Top Three Factors Driving Treatment Selection for OA Pain
            • Percentage of OA Pain Patients with a History or High Risk of Abuse
          • Introduction to Current Treatment and Medical Practice for OA Pain
          • Drugs Included in This Study of Current Treatment of Osteoarthritic Pain
        • Physician Prescribing Practices
          • OA Pain Patient Journeys Are Highly Individualized
          • Patient Characteristics
            • OA Pain Patients Face Significant Treatment and Cost Burdens
            • Proportion of OA, RA, and Other Arthritis Pain Patients Seen by Rheumatologists and PCPs
            • Insurance Coverage for OA Pain Patients Presenting to PCPs and Rheumatologists
            • Comorbidities of OA Pain Patients Presenting to PCPs and Rheumatologists
            • Severity of Pain Experienced by OA Patients Presenting to Rheumatologists or PCPs
          • Physician Treatment Practices
            • OA Pain Patients Undergo Diverse Journeys
            • Rheumatologists Initiate Treatment in OA Pain Patients Much Faster Than PCPs
            • Average Length of Time Between Diagnosis of OA Pain and Treatment Initiation: Rheumatologists and PCPs
            • Physicians Have Similar Treatment Rates for OA and RA Pain Patients
            • Treatment Rates for OA, RA, and Other Chronic Arthritis Pain Patients: Rheumatologists and PCPs
            • Patient Share of Analgesics Underscores Cost Sensitivity of the OA Pain Market
            • Analgesic Drug-Treatment Rates for OA Pain Patients: Rheumatologists and PCPs
            • Patient Share of NSAIDs Among OA Pain Patients: Rheumatologists and PCPs
            • Patient Share of Opioids Among OA Pain Patients: Rheumatologists and PCPs
            • Patient Share of Opioid Plus Acetaminophen/NSAID Combinations Among OA Pain Patients: Rheumatologists and PCPs
            • Patient Share of Dual Opioid Analgesics Among OA Pain Patients: Rheumatologists and PCPs
            • Physicians' Reliance on Nonpharmacological Approaches Explains Low Rates of Treatment
            • Use of Nonpharmacological Agents in OA Pain Patients: Rheumatologists and PCPs
            • Branded Analgesic Use Varies by Physician Type Across Lines of Therapy
            • Rheumatologists Treat a Greater Percentage of Patients on the Third Line of Therapy
            • Percentage of Drug-Treated OA Pain Patients by Line of Therapy: Rheumatologists and PCPs
            • Transition Between Lines of Therapy Is Slow in OA Pain Management
            • Percentage of Drug-Treated OA Pain Patients by Line of Therapy One Year After Treatment Initiation: Rheumatologists and PCPs
            • Percentage of Drug-Treated OA Pain Patients Who Progress from One Line of Therapy to the Next: Rheumatologists and PCPs
            • Progression Rate Between Lines of Therapy for OA Pain Patients Treated by PCPs
            • Progression Rate Between Lines of Therapy for OA Pain Patients Treated by Rheumatologists
            • Some Differences Exist Between Physicians in Their Use of Analgesics for OA Pain
            • Profiles of OA Pain Patients Who Physicians Would Treat with Specific Drugs
            • Drug Classes Used in First, Second, and Third Lines of Therapy by PCPs and Rheumatologists
            • Analgesic Combinations Used by Physicians Are Highly Diverse
            • Percentage of Drug-Treated OA Pain Patients on Combination Therapy: Rheumatologists and PCPs
            • Most Common Analgesic Combination Regimens by Drug Class in OA Pain Patients: Rheumatologists and PCPS
            • Most Common Analgesic Combinations of Formulations in OA Pain Patients: Rheumatologists and PCPs
          • Physician Insight on Compliance and Persistency
            • Physicians Estimate Similar Rates of Compliance and Persistency Among Analgesics
            • Percentage of OA Pain Patients Who Are Compliant with Analgesic Therapies: Rheumatologists and PCPs
            • Discontinuation Rates for Analgesics Among OA Pain Patients One Year After Treatment Initiation: Rheumatologists and PCPs
            • Duration of Analgesic Treatment in OA Pain Patients: Rheumatologists and PCPs
          • Sequencing of Treatment
            • Course of Treatment Varies Widely Between and Within Physician Type
            • Most Common Course of Action After Discontinuation of OA Pain Analgesics: Rheumatologists and PCPs
            • Second- and Third-Most Common Courses of Action After Discontinuation of OA Pain Analgesics: Rheumatologists and PCPs
            • Most Common Scenario of OA Pain Patients Upon Treatment Initiation of Select Pain Analgesics: Rheumatologists and PCPs
            • Second- and Third-Most Common Scenario of OA Pain Patients Upon Treatment Initiation of Select Pain Analgesics: Rheumatologists and PCPs
            • Most Common Reason for OA Pain Patients Switching Off Select Analgesics: PCPs
            • Most Common Reason for OA Pain Patients Switching Off Select Analgesics: Rheumatologists
            • Most Common Reason for OA Pain Patients Switching to Select Analgesics: PCPs
            • Most Common Reason for OA Pain Patients Switching to Select Analgesics: Rheumatologists
          • Recent and Anticipated Changes in Treatment Practices
            • Measures to Curb Use of Opioids Are Proving Effective
            • Physician-Reported Recent Changes in Prescription of Select Analgesics for OA Pain Patients
            • Physician-Estimated Magnitude of Change in Prescription Levels for Select Analgesics
            • Effect of Hydrocodone Plus Acetaminophen Rescheduling on Its Prescribing for OA Pain: Rheumatologists and PCPs
            • Impact of the March 2016 CDC Guidelines for Safe Opioid Prescribing in the Primary Care Setting on Opioid Prescribing for OA Pain: PCPs
            • Anticipated Change in Drug-Treatment Rates for Analgesics in OA Pain in a Year: Rheumatologists and PCPs
            • Anticipated Change in Patient Share for Select Analgesic Drug Classes in OA Pain in a Year: PCPs
            • Anticipated Change in Patient Share for Select Analgesic Drug Classes in OA Pain in a Year: Rheumatologists
            • Anticipated Change in Patient Share for Select NSAIDs in OA Pain in a Year: PCPs
            • Anticipated Change in Patient Share for Select NSAIDs in OA Pain in a Year: Rheumatologists
            • Anticipated Change in Patient Share for Select Opioids in OA Pain in a Year: Rheumatologists and PCPs
            • Anticipated Change in Patient Share for Select Opioid Plus Acetaminophen/NSAID Combinations in OA Pain in a Year: PCPs
            • Anticipated Change in Patient Share for Select Opioid Plus Acetaminophen/NSAID Combinations in OA Pain in a Year: Rheumatologists
            • Anticipated Change in Patient Share for Select Dual-Acting Opioid Analgesics in OA Pain in a Year: PCPs
            • Anticipated Change in Patient Share for Select Dual-Acting Opioid Analgesics in OA Pain in a Year: Rheumatologists
        • Physician Insight on Medical Practice
          • Key Findings
          • Factors Influencing Treatment Practice
            • Pain Severity and Clinical Factors Are Key Influencers in Treating OA Pain
            • Safety Concerns, Risk of Abuse, and Patient Choice Are Key Influencers of Analgesic Treatment
            • Primary Reasons Why More OA Pain Patients Do Not Receive Prescription Analgesic Treatment
            • Percentage of Physicians' OA Pain Patients with a History/High Risk of Abuse
            • Percentage of OA Pain Patients with a History/High Risk of Abuse Who Are Prescribed Opioid Analgesics
            • Preferred First-Choice Opioid Analgesic for Chronic OA Pain Patients Based on History/Risk of Abuse
            • Physician Perceptions on Opioid Analgesic ADFs
            • Efficacy, Safety, and Abuse Potential Are the Top Drivers of Analgesic Use for OA Pain
            • Top Three Factors Driving Treatment Selection for OA Pain
            • Key Drivers of Use of Select Analgesics in OA Pain
            • Market Access Considerations and Risk of Abuse/Misuse Are Key Obstacles to Select Analgesic Prescribing in OA Pain
            • Major Obstacles Constraining Use of Analgesics for OA Pain
            • Treatment Discontinuation Is Largely Due to Efficacy and Safety/Tolerability
            • Subsequent Treatment Approach Following Discontinuation of Prescription Analgesic Treatment
            • Reasons for Discontinuing Prescription Analgesic Treatment
            • OTC, Nonpharmacological Approaches May Precede Prescription Treatment
        • Methodology
          • Primary Market Research Methodology
          • Board-Certified Specialty of Surveyed Physicians
          • Regional Distribution of Surveyed Physicians
          • Years in Practice Postresidency
          • Use of Key Drug Classes for OA Pain
        • Appendix
          • Key Abbreviations
          • Primary Market Research
            • Analgesic Drug-Treatment Rates for RA Pain Patients: Rheumatologists and PCPs
            • Physicians' Level of Agreement on Prescribing Opioid Analgesic ADFs
            • Physicians' Level of Agreement on Prescribing Opioid Analgesic ADFs: Mean Ratings
          • Bibliography

      Author(s): Bethany A. Kiernan, PhD; Andrea Witt, PhD; Joyce Spadafora, ALM

      Bethany A. Kiernan, Ph.D., is a senior director in the central nervous system/ophthalmology disorders unit of Decision Resources Group. While at Decision Resources Group, Dr. Kiernan has covered the market dynamics of numerous indications, including schizophrenia, depression, migraine, multiple sclerosis, epilepsy, and other disorders.

      Dr. Kiernan’s previous experience includes eight years of scientific research conducted at Tufts University School of Medicine, Case Western Reserve University, and the College of the Holy Cross. Dr. Kiernan earned her Ph.D. degree from Case Western Reserve University.

      Andrea S. Witt, Ph.D., is Therapy Leader of the Central Nervous System and Ophthalmology Disorders Portfolio at Decision Resources Group where she oversees a team of 14 Business Insights Analysts and Senior Directors responsible for market research encompassing Neurology, Psychiatry, Pain, and Ophthalmology.

       Dr. Witt has been with Decision Resources Group for over 12 years, following CNS markets and trends. Her interests beyond specific CNS indications included the market potential for neuroprotectants and the impact of biomarkers on CNS markets. Dr. Witt’s research, analysis, and commentaries have appeared in Barron’s, Pharmaceutical Executive, PharmaVoice, Nature Medicine, and CNBC. Dr. Witt’s previous experience includes 10 years of scientific research conducted on neurodegenerative disorders at Harvard Medical School/Brigham and Women’s Hospital, Duke University, and the University of Texas-Southwestern Medical Center, where she earned her Ph.D. degree.

      Joyce is a business insights analyst in Decision Resources Group’s central nervous systems and ophthalmology division, where she provides expert insight into commercial aspects of drug development and market sizing across psychiatric and pain indications. She has worked extensively in DRG’s schizophrenia and chronic pain content.

      Prior to joining DRG, Joyce spent several years in the biotech industry focused in research and development and in biotech consulting. Her project experience covered indications including psychiatry, pain, infectious diseases, respiratory, and ophthalmology. Beyond my therapeutic and industry knowledge, she holds a Masters in Extension Studies in Psychology from Harvard University and a B.S in Mechanical Engineering with Biology from the Massachusetts Institute of Technology.


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