Antipsychotics are the standard of care for treating schizophrenia, with oral atypical antipsychotics (e.g., olanzapine, risperidone) experiencing preferential use. Because of the heterogeneity of schizophrenia and patients' varied response to antipsychotics, the treatment of the disease is highly individualized and psychiatrists consider multiple factors (e.g., tolerability, compliance) when making treatment choices. As a result, both depot and oral formulations of antipsychotics are prescribed by EU5 psychiatrists, such as the branded depot atypical antipsychotics Abilify Maintena, Risperdal Consta, Trevicta, and Xeplion. Given the highly crowded and competitive schizophrenia landscape, it is necessary for marketers of current branded therapies, as well as developers of emerging schizophrenia therapies, to understand the many decision points and challenges psychiatrists face when treating this disease. The Current Treatment EU5 content provides a detailed snapshot of how EU5 psychiatrists are managing their patients with schizophrenia, including the use of atypical and typical antipsychotics, as well as insight into the factors driving such prescribing habits.

Questions answered

  • Prompt treatment of schizophrenia is recommended due to the negative impact of symptoms on a patient’s quality of life. How quickly do psychiatrists initiate their schizophrenia patients on pharmacotherapies and what percentage of patients are drug treated? Do treatment rates differ across the EU5 countries?
  • Even though generically available oral atypical antipsychotics dominate the EU5 market, depot oral atypical antipsychotics also experience use within the schizophrenia treatment paradigm. What is the patient share for individual antipsychotics, including the branded oral therapies Invega and Latuda? How are depots, such as Abilify Maintena, currently being used by psychiatrists? How does treatment differ across each line of therapy?
  • Given that schizophrenia treatment is highly individualized, psychiatrists may consider multiple factors when initiating pharmacotherapies. What are the most important clinical and nonclinical factors that drive prescribing of antipsychotics? What drives switching to and from specific brands? What obstacles constrain use of branded therapies?
  • CIAS and negative symptoms are not as frequently diagnosed as positive symptoms; however, these two symptom domains greatly hinder schizophrenia patients’ QOL. What percentage of patients in each of the EU5 countries presents with CIAS, and/or negative symptoms? How are physicians currently managing these patients?
  • Scope:
    • Markets covered: EU5 (France, Germany, Italy, Spain, and the United Kingdom)
    • Methodology: Survey of 257 psychiatrists in the EU5 (56 in France, 50 in Germany, 50 in Italy, 51 in Spain, and 50 in the United Kingdom), completed in January 2017
    • Indication coverage: Schizophrenia
    • Key drugs covered: aripiprazole, Abilify Maintena, haloperidol, Invega, Latuda, olanzapine, Risperdal Consta, Trevicta, Xeplion, Zypadhera
    • Key companies mentioned: AstraZeneca, Eli Lily, Ferrer International, Janssen, Johnson & Johnson, Lundbeck, Otsuka Pharmaceutical, and Sumitomo Dainippon Pharma

Table of contents

  • Schizophrenia - Current Treatment - Detailed, Expanded Analysis (EU)
    • Key Updates
      • December 2017
        • September 2017
          • June 2017
          • Introduction to Current Treatment for Schizophrenia
            • Key Findings
            • Introduction to Current Treatment and Medical Practice for Schizophrenia
            • Drugs Included in this Study of Current Treatment of Schizophrenia
          • Physician Prescribing Practices
            • Key Findings
            • Patient Characteristics
              • Patient Characteristics Vary Slightly Across the EU5
              • Percentage of Patients Properly Diagnosed with Schizophrenia Across by Country
              • Percentage of Patients Diagnosed with Schizophrenia by Specialty per Country
              • Percentage of Diagnosed Schizophrenia Patients Presenting with Each Symptom Domain: EU5 Total
              • Percentage of Diagnosed Schizophrenia Patients Presenting with Each Symptom Domain by Country
              • Percentage of Diagnosed Schizophrenia Patients with Comorbidities and Other Attributes by Country
            • Treatment Practices
              • Psychiatrists Across the EU5 Preferentially Use Generic Atypical Antipsychotics
              • EU5 Psychiatrists Quickly Initiate Long-Term Maintenance Treatment for Schizophrenia
              • Time to Long-Term Maintenance Treatment by Country: Number of Weeks
              • Drug-Treatment Rates for Schizophrenia Differ Across the EU5 Countries
              • Percentage of Drug-Treated Schizophrenia Patients by Country
              • Percentage of Treatment-Resistant Schizophrenia Patients by Country
              • EU5 Psychiatrists' Definition of Treatment Failure in Schizophrenia by Country
              • Treatment Paradigm for Failure in Schizophrenia by Country
              • Antipsychotic Prescribing for Schizophrenia Is Fragmented Across the EU5
              • Current Psychiatrist-Reported Antipsychotic Patient Share for Schizophrenia by Country
              • Treatment Duration Is Influenced by Efficacy of Antipsychotics
              • Treatment Duration in Weeks for Antipsychotics by Country
              • Nonpharmacological Approaches Treat Residual Symptoms and Pharmacological Side Effects
              • Nonpharmacological Therapies for the Treatment of Schizophrenia by Country
              • Generic Oral Antipsychotics Are the Most Common First-Line Therapies
              • The Majority of EU5 Schizophrenia Patients Are on Second- or Later-Line Therapies
              • Distribution of Patients with Schizophrenia in Each Line of Therapy
              • Time Between Line of Therapy Progression by Country: Number of Weeks
              • Line of Therapy Progression Is Influenced by Polypharmacy Use
              • Time Between Line of Therapy Progression: Total EU5
              • Generic Oral Atypical Antipsychotics Dominate Early-Line Treatment of Schizophrenia
              • Antipsychotic Patient Share by Line of Therapy: EU5 Total
              • Antipsychotic Patient Share of First-Line Therapies by Country
              • Antipsychotic Patient Share of Second-Line Therapies by Country
              • Antipsychotic Patient Share of Third-Line Therapies by Country
              • Polypharmacy Is a Method of Treatment Implemented Across the EU5
              • Polypharmacy Use by Line of Therapy and Country
              • Psychiatrists' Most Commonly Prescribed Drug Combinations for Positive Symptoms by Country
              • Low Drug-Treatment Rates for CIAS and Negative Symptoms in the EU5
              • Percentage of Schizophrenia Patients Treated with Pharmacotherapies for CIAS and Negative Symptoms by Country
              • Monotherapy and Adjunctive Therapy Use for CIAS by Country
              • Monotherapy and Adjunctive Therapy Use for Negative Symptoms by Country
              • Most Common Drug Classes Prescribed for CIAS by Country
              • Most Common Drug Classes Prescribed for Negative Symptoms by Country
              • Percentage of Psychiatrists Who Prescribe Off-Label Therapies for CIAS and Negative Symptoms by Country
            • Persistency and Compliance
              • Patient Compliance and Persistence Rates Vary by Antipsychotic Drug Formulation
              • Psychiatrist-Reported Compliance Rates for Key Antipsychotics by Country
              • Psychiatrist-Reported Compliance Rates for Key Antipsychotics: EU5 Total
              • Psychiatrist-Reported Persistency Rates for Key Antipsychotics by Country
              • Psychiatrist-Reported Persistency Rates for Key Antipsychotics: EU5 Total
            • Sequencing of Treatment
              • Schizophrenia Patients Are Likely to Be Switched to Antipsychotic Depots
              • Source of Schizophrenia Patients Who Have Initiated Select Branded Atypical Antipsychotics: EU5 Total
              • Switch Patterns by Prior Atypical Antipsychotic: EU5 Total
              • Switch Patterns by Prior Atypical Antipsychotic: France
              • Switch Patterns by Prior Atypical Antipsychotic: Germany
              • Switch Patterns by Prior Atypical Antipsychotic: Italy
              • Switch Patterns by Prior Atypical Antipsychotic: Spain
              • Switch Patterns by Prior Atypical Antipsychotic: United Kingdom
              • Switch and Cease Patterns by Prior Atypical Antipsychotics: EU5 Total
            • Recent/Anticipated Changes in Brand Use/Treatment Approach
              • Select Depot Antipsychotic Agents Will Continue to Experience an Increase in Use
              • Change in the Use of Select Antipsychotics to Treat Schizophrenia Within the Past Year by Country
              • Change in the Use of Select Antipsychotics to Treat Schizophrenia Within the Past Year: EU5 Total
              • Anticipated Change in the Use of Select Antipsychotics to Treat Schizophrenia by Country
              • Anticipated Change in the Use of Select Antipsychotics to Treat Schizophrenia: EU5 Total
          • Physician Insight on Medical Practice
            • Key Findings
            • Drivers of Treatment Selection
              • Efficacy, Tolerability, and Reimbursement Restrictions Influencing Prescribing Decisions
              • Efficacy Drives Drug Selection for Oral and Depot Atypical Antipsychotics in the EU5
              • Factors Influencing Psychiatrists' Choice of an Oral or Depot Atypical Antipsychotic: EU5 Total
              • Factors Influencing Psychiatrists' Choice of an Oral or Depot Atypical Antipsychotic: France
              • Factors Influencing Psychiatrists' Choice of an Oral or Depot Atypical Antipsychotic: Germany
              • Factors Influencing Psychiatrists' Choice of an Oral or Depot Atypical Antipsychotic: Italy
              • Factors Influencing Psychiatrists' Choice of an Oral or Depot Atypical Antipsychotic: Spain
              • Factors Influencing Psychiatrists' Choice of an Oral or Depot Atypical Antipsychotic: United Kingdom
              • Factors Influencing the Introduction of an Adjunctive Therapy: EU5 Total
              • Factors Influencing the Introduction of an Adjunctive Therapy: France
              • Factors Influencing the Introduction of an Adjunctive Therapy: Germany
              • Factors Influencing the Introduction of an Adjunctive Therapy: Italy
              • Factors Influencing the Introduction of an Adjunctive Therapy: Spain
              • Factors Influencing the Introduction of an Adjunctive Therapy: United Kingdom
              • Multiple Factors Contribute to Antipsychotic Selection Due to Individualization of Treatment
              • Most Important Factors Driving the Prescribing of Invega and Latuda for Schizophrenia: EU5 Total
              • Most Important Factors Driving the Prescribing of Invega and Latuda for Schizophrenia: France
              • Most Important Factors Driving the Prescribing of Invega and Latuda for Schizophrenia: Germany
              • Most Important Factors Driving the Prescribing of Invega and Latuda for Schizophrenia: Italy
              • Most Important Factors Driving the Prescribing of Invega and Latuda for Schizophrenia: Spain
              • Most Important Factors Driving the Prescribing of Invega and Latuda for Schizophrenia: United Kingdom
              • Most Important Factors Driving the Prescribing of Select Atypical Antipsychotic Depots for Schizophrenia: EU5
              • Most Important Factors Driving the Prescribing of Select Atypical Antipsychotic Depots for Schizophrenia: France
              • Most Important Factors Driving the Prescribing of Select Atypical Antipsychotic Depots for Schizophrenia: Germany
              • Most Important Factors Driving the Prescribing of Select Atypical Antipsychotic Depots for Schizophrenia: Italy
              • Most Important Factors Driving the Prescribing of Select Atypical Antipsychotic Depots for Schizophrenia: Spain
              • Most Important Factors Driving the Prescribing of Select Atypical Antipsychotic Depots for Schizophrenia: United Kingdom
              • Product Availability and Reimbursement Issues Constrain Prescribing of Branded Atypical Antipsychotics in the EU5
              • Most Important Factors Constraining Prescribing of Invega for the Treatment of Schizophrenia by Country
              • Most Important Factors Constraining Prescribing of Latuda for the Treatment of Schizophrenia by Country
              • Most Important Factors Constraining Prescribing of Abilify Maintena for the Treatment of Schizophrenia by Country
              • Most Important Factors Constraining Prescribing of Risperdal Consta for the Treatment of Schizophrenia by Country
              • Most Important Factors Constraining Prescribing of Trevicta for the Treatment of Schizophrenia by Country
              • Most Important Factors Constraining Prescribing of Xeplion for the Treatment of Schizophrenia by Country
              • Expectations of Improved Efficacy, Tolerability, and Compliance Drive Switching Behavior in Schizophrenia
              • Rationale for Switching to Select Atypical Antipsychotics: EU5 Total
              • Rationale for Switching to Select Atypical Antipsychotics: France
              • Rationale for Switching to Select Atypical Antipsychotics: Germany
              • Rationale for Switching to Select Atypical Antipsychotics: Italy
              • Rationale for Switching to Select Atypical Antipsychotics: Spain
              • Rationale for Switching to Select Atypical Antipsychotics: United Kingdom
              • Rationale for Switching off Select Antipsychotics: EU5 Total
              • Rationale for Switching off Select Antipsychotics: France
              • Rationale for Switching off Select Antipsychotics: Germany
              • Rationale for Switching off Select Antipsychotics: Italy
              • Rationale for Switching off Select Antipsychotics: Spain
              • Rationale for Switching off Select Antipsychotics: United Kingdom
              • Rationale for Discontinuing Oral or Depot Atypical Antipsychotics: Total EU5
          • Methodology
            • Primary Market Research Methodology
            • Distribution of Surveyed Psychiatrists' Clinical Practice by Country
            • Surveyed Psychiatrists' Duration of Clinical Practice by Country
            • Average Number of Patients Clinically Managed per Month by Country
            • Surveyed Psychiatrists' Prescribed Antipsychotic Drug Classes by Country
          • Appendix
            • Bibliography
            • Key Abbreviations
            • Primary Market Research
              • EU5 Psychiatrists' Primary Practice Type by Country
              • Patient Share by Oral Atypical Antipsychotics: EU5 Total
              • Patient Share by Atypical Antipsychotics Depot: EU5 Total
              • Source of Schizophrenia Patients Who Have Initiated Select Branded Atypical Antipsychotics: France
              • Source of Schizophrenia Patients Who Have Initiated Select Branded Atypical Antipsychotics: Germany
              • Source of Schizophrenia Patients Who Have Initiated Select Branded Atypical Antipsychotics: Italy
              • Source of Schizophrenia Patients Who Have Initiated Select Branded Atypical Antipsychotics: Spain
              • Source of Schizophrenia Patients Who Have Initiated Select Branded Atypical Antipsychotics: United Kingdom
              • Switch and Cease Patterns by Prior Atypical Antipsychotics: France
              • Switch and Cease Patterns by Prior Atypical Antipsychotics: Germany
              • Switch and Cease Patterns by Prior Atypical Antipsychotics: Italy
              • Switch and Cease Patterns by Prior Atypical Antipsychotics: Spain
              • Switch and Cease Patterns by Prior Atypical Antipsychotics: United Kingdom
              • Most Important Factors Constraining Prescribing of Invega and Latuda to Treat Schizophrenia by Prescribers and Nonprescribers: EU5 Total
              • Most Important Factors Constraining Prescribing of Atypical Antipsychotic Depots to Treat Schizophrenia by Prescribers and Nonprescribers: EU5 Total
              • Most Important Factors Constraining Prescribing of Invega to Treat Schizophrenia by Country
              • Most Important Factors Constraining Prescribing of Latuda to Treat Schizophrenia by Country
              • Most Important Factors Constraining Prescribing of Abilify Maintena to Treat Schizophrenia by Country
              • Most Important Factors Constraining Prescribing of Risperdal Consta to Treat Schizophrenia by Country
              • Most Important Factors Constraining Prescribing of Trevicta to Treat Schizophrenia by Country
              • Most Important Factors Constraining Prescribing of Xeplion to Treat Schizophrenia by Country
              • Rationale for Discontinuing Oral Atypical Antipsychotics by Country
              • Rationale for Discontinuing Depot Atypical Antipsychotics by Country

        Author(s): Lisa Cloonan, BA; Emma McFadden, PhD

        Lisa joined Decision Resources Group in 2015 as a business insights analyst for the Central Nervous System and Ophthalmology division. In this role, she analyzes the commercial opportunities for pharmacological therapies across the psychiatry space.

        Prior to joining Decision Resources Group, Lisa spent 6 years in clinical stroke research at Massachusetts General Hospital. While in the clinical research field, Lisa developed an expertise in neuroimaging analysis, as well as authored and co-authored articles on the influence of white matter hyperintensity burden on stroke risk and recovery. Lisa holds bachelor of arts from Connecticut College, where her course work focused on behavioral neuroscience.

        Emma McFadden, Ph.D., is a Director within the Central Nervous System/Ophthalmology disorders group. Her main focus is on ophthalmic indications, such as age-related macular degeneration, diabetic retinopathy, and diabetic macular edema, although she has authored research across a number of other indications, including multiple sclerosis and epilepsy. 

        Prior to joining Decision Resources Group, Emma earned a B.A. in neuroscience and a Ph.D. in biochemistry from Trinity College Dublin.

         


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