Parkinson’s disease (PD) is the second-most common neurodegenerative disorder that, according to DRG epidemiology, afflicts more than 1.5 million people in the EU5. Although PD treatment has been relatively stable in recent years, the treatment paradigm is complex. PD is heterogeneous, requiring individualized treatment, chronic polypharmacy, and frequent adjustments to achieve symptom control throughout a patient’s disease course. Moreover, two recent entrants (Xadago and Ongentys) have added more complexity to this largely generic market. With the treatment landscape poised to expand even further thanks to a dynamic pipeline of unique therapies designed to optimize levodopa, reduce the frequency and impact of motor response complications, or treat key nonmotor symptoms, understanding the many forces that drive EU neurologists’ clinical decision making in PD today is crucial for developers of new PD therapeutics entering an increasingly complicated market.

Questions Answered

  • How does the treatment paradigm evolve as PD progresses, especially regarding motor complications and nonmotor comorbidities? What are the typical patient pathways through treatment?
  • What factors influence drug selection and the treatment paradigm for primary motor symptoms, motor fluctuations, and dyskinesia as the disease progresses?
  • Which factors drive brand use in the highly generic PD market, and how do neurologists expect their use of branded therapies to change over the next year?

Product Description

Current Treatment: Provides physician insights on prescribing behavior, treatment paths, and the factors and perceptions driving brand use so that you can understand each brand’s performance and improve or defend your competitive position.

Table of contents

  • Parkinson's Disease - Current Treatment - Detailed, Expanded Analysis (EU5)
    • Key Updates
      • November 2017
      • September 2017
    • Introduction to Current Treatment for Parkinson's Disease
      • Key Findings
      • Introduction to Current Treatment and Medical Practice for Parkinson's Disease
      • Drugs Included in This Study of Current Treatment of Parkinson's Disease
    • Physician Prescribing Practices
      • Key Findings
      • Patient Characteristics
        • Though Variable, PD Progress Is Marked by Worsening Severity, Polypharmacy, and Increasing Comorbidities
        • Disease Stage Distribution Among PD Patients
        • Neurologists' Definition of PD Disease Stages
        • Percentage of PD Patients Experiencing Key Motor Complications and Comorbidities
        • Disease Stage During Which Key Motor Complications and Comorbidities Most Frequently Arise in PD
      • Physician Treatment Practices
        • Treatment Choice in PD Is Multifactorial and Variable
        • Most PD Patients Initiate Drug Therapy Soon After Diagnosis
        • Time from Diagnosis to Treatment Initiation in PD Patients
        • Common Reasons for Treatment Delay After PD Diagnosis
        • The Majority of PD Patients Receive Medication for Motor Symptoms While Less Than Half Are Treated for Nonmotor Symptoms
        • Drug-Treatment Rate for Motor Symptoms in PD
        • Drug-Treatment Rate for Key Comorbidities in PD
        • Overall Drug-Treatment Rate in PD
        • Prescribing of Drug Classes in PD Is Generally Consistent Across the EU5 with Variability in Drug Preference
        • Patient Shares for Key PD Drugs and Drug Classes in PD
        • Patient Shares for Oral Levodopa Formulations in PD
        • Combination Use of Levodopa Formulations in PD
        • Patient Shares for Dopamine Agonists in PD
        • Patient Shares for MAO-B Inhibitors in PD
        • Patient Shares for COMT Inhibitors in PD
        • Patient Shares for Antipsychotics in PD
        • Patient Shares for Antidementia Agents in PD
        • Efficacy, Tolerability, and Disease Stage Influence Duration of Use for PD Therapies
        • Average Treatment Duration Among PD Patients by Drug in Years
        • Later-Line Use of DBS May Be Shifting to Earlier in the Disease Course
        • Patient Share for DBS Among PD Patients
        • Disease Stage During Which Most PD Patients Initiate Deep Brain Stimulation
        • Impact of the EARLYSTIM Study on DBS Use in PD
        • Positioning for Early-Line Use Is Important in the PD Market
        • Most Surveyed Neurologists' PD Patients Are on Early Lines of Therapy
        • Time to Progression by Line of Therapy Among PD Patients
        • Line of Therapy Distribution Among PD Patients
        • Early-Line PD Treatment Paradigms Vary
        • Common Strategies for Addressing the Reappearance of Primary Motor Symptoms in PD by Regimen: EU5
        • Common Strategies for Addressing the Appearance of Motor Fluctuations in PD by Regimen: EU5
        • Common Strategies for Addressing the Appearance of Dyskinesia in PD by Regimen: EU5
        • Levodopa and Dopamine Agonists Claim the Highest Patient Shares in Early Lines of Therapy
        • Patient Shares for Key PD Drugs and Drug Classes in the First Three Lines of Therapy
        • First-Line Treatment Strategies for PD Patients Diagnosed with Mild and Disruptive Motor Symptoms
        • Physician Opinion on Early-Line Strategies for Disease Modification in PD
        • Polypharmacy Is the Norm in PD Treatment
        • Drug Burden Among PD Patients
      • Physician Insight on Compliance and Persistency
        • Compliance and Persistence Is High Among PD Patients
        • Rates of Discontinuation by Therapy Among PD Patients Within One Year of Initiation
        • Compliance Rates by Therapy Among PD Patients
      • Sequencing of Treatment
        • Adjusting Levodopa Therapy and Prescribing Adjunctive Agents Are Common Treatment Strategies in PD Management
        • Common Treatment Sequencing Strategies for Motor Fluctuations: EU5
        • Common Treatment Sequencing Strategies for Dyskinesia: EU5
        • Common Treatment Sequencing Strategies for Psychosis: EU5
        • Common Treatment Sequencing Strategies for Dementia: EU5
      • Recent and Anticipated Changes in Treatment Practices
        • Surveyed Neurologists Expect Brand Prescribing Will Increase Over the Next Year
        • Changing Use of PD Therapies in the Past Year
        • Current and Anticipated Patient Shares for Key PD Therapies
        • Current and Anticipated Prescriber Bases for Key PD Therapies
    • Physician Insight on Medical Practice
      • Key Findings
      • Factors Influencing Treatment Practice
        • Treatment Selection in PD Is Influenced by Multiple Factors That Vary by Disease Stage
        • Factors Influencing Treatment Selection in Early PD Patients
        • Factors Influencing Treatment Selection in Intermediate PD Patients
        • Factors Influencing Treatment Selection in Advanced PD Patients
        • Efficacy Is a Strong Driver of Prescribing for Most PD Therapies
        • Major Drivers of the Use of Generic PD Therapies: EU5
        • Major Drivers of the Use of Branded PD Therapies: EU5
        • Major Drivers of the Use of Antipsychotic and Antidementia Agents in PD: EU5
        • Drivers of Switching from Generic to Brand Within the Same Class in PD
        • Obstacles to PD Drug Use Are Varied and Drug-Specific
        • Major Obstacles to the Use of Generic PD Therapies: EU5
        • Major Obstacles to the Use of Branded PD Therapies: EU5
        • Major Obstacles to the Use of Antipsychotic and Antidementia Agents in PD: EU5
        • Tolerability Issues and Lack of Efficacy Drive Discontinuations for Most PD Therapies
        • Common Reasons for Patient Discontinuation in PD by Drug: Noninvasive Motor Therapies
        • Common Reasons for Patient Discontinuation in PD by Drug: Invasive Motor Therapies and Nonmotor Agents
    • Methodology
      • Primary Market Research Methodology
      • Surveyed Neurologists' Length of Time in Clinical Practice by Country
      • Average Number of PD Patients Managed per Month by Country
      • PD Drug Classes Prescribed by Surveyed Neurologists by Country
      • Surveyed Neurologists' Primary Practice Type by Country
      • Percentage of Surveyed Neurologists Specializing in Movement Disorders by Country
    • Appendix
      • Bibliography
      • Key Abbreviations
      • Primary Market Research
        • Frequency of Patients' Use of the Apomorphine Injection Pen
        • Common Strategies for Addressing the Reappearance of Primary Motor Symptoms in PD by Regimen
        • Common Strategies for Addressing the Appearance of Motor Fluctuations in PD by Regimen
        • Common Strategies for Addressing the Appearance of Dyskinesia in PD by Regimen
        • Common Treatment Sequencing Strategies for Motor Fluctuations
        • Common Treatment Sequencing Strategies for Dyskinesia
        • Common Treatment Sequencing Strategies for Psychosis
        • Common Treatment Sequencing Strategies for Dementia
        • Major Drivers of Amantadine Use in PD
        • Major Drivers of Entacapone Use in PD: All Formulations
        • Major Drivers of Oral Dopamine Agonist Use in PD
        • Major Drivers of Rasagiline Use in PD
        • Major Drivers of Selegiline Use in PD
        • Major Drivers of Apomorphine Pump Use in PD
        • Major Drivers of Injectable Apomorphine Use in PD
        • Major Drivers of Duodopa Use in PD
        • Major Drivers of Ongentys Use in PD
        • Major Drivers of Neupro Use in PD
        • Major Drivers of Xadago Use in PD
        • Major Drivers of Clozapine Use in PD
        • Major Drivers of Off-Label Antipsychotic Use in PD
        • Major Drivers of Rivastigmine Use in PD: All Formulations
        • Major Drivers of Off-Label Antidementia Agent Use in PD
        • Major Obstacles to Amantadine Use in PD
        • Major Obstacles to Entacapone Use in PD: All Formulations
        • Major Obstacles to Oral Dopamine Agonist Use in PD
        • Major Obstacles to Rasagiline Use in PD
        • Major Obstacles to Selegiline Use in PD
        • Major Obstacles to Apomorphine Pump Use in PD
        • Major Obstacles to Injectable Apomorphine Use in PD
        • Major Obstacles to Duodopa Use in PD
        • Major Obstacles to Ongentys Use in PD
        • Major Obstacles to Neupro Use in PD
        • Major Obstacles to Xadago Use in PD
        • Major Obstacles to Clozapine Use in PD
        • Major Obstacles to Off-Label Antipsychotic Use in PD
        • Major Obstacles to Rivastigmine Use in PD: All Formulations
        • Major Obstacles to Off-Label Antidementia Agent Use in PD
        • Common Reasons for Patient Discontinuation of Levodopa IR and CR in PD
        • Common Reasons for Patient Discontinuation of Oral Dopamine Agonists in PD
        • Common Reasons for Patient Discontinuation of Neupro in PD
        • Common Reasons for Patient Discontinuation of Selegiline in PD
        • Common Reasons for Patient Discontinuation of Rasagiline in PD
        • Common Reasons for Patient Discontinuation of Xadago in PD
        • Common Reasons for Patient Discontinuation of Entacapone in PD: All Formulations
        • Common Reasons for Patient Discontinuation of Amantadine in PD
        • Common Reasons for Patient Discontinuation of Injectable Apomorphine in PD
        • Common Reasons for Patient Discontinuation of the Apomorphine Pump in PD
        • Common Reasons for Patient Discontinuation of Duodopa in PD
        • Common Reasons for Patient Discontinuation of Clozapine in PD
        • Common Reasons for Patient Discontinuation of Off-Label Antipsychotics in PD
        • Common Reasons for Patient Discontinuation of Rivastigmine in PD: All Formulations
        • Common Reasons for Patient Discontinuation of Off-Label Antidementia Agents in PD

Author(s): Bethany Christmann, PhD

Bethany Christmann, Ph.D., has been with DRG since 2015, and is a Senior Business Insights Analyst with the Central Nervous System/Ophthalmology team. In this role, she covers the neurology space, specializing in Parkinson’s disease and epilepsy; she provides expert insight and authors primary market research and forecasting content focused on these and other neurology indications. Prior to joining DRG, Bethany earned her Ph.D. in neuroscience from Brandeis University, where she studied the cellular interactions involved in memory consolidation and their link to sleep behavior.


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