The relatively recent FDA approvals of tedizolid (Merck’s Sivextro), dalbavancin (Allergan’s Dalvance), and oritavancin (The Medicines Company’s Orbactiv) for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) highlight the competitive nature of the hospital-treated MRSA market. Further, with the recent generic availability of the key anti-MRSA agents linezolid (Pfizer’s Zyvox) and daptomycin (Merck’s Cubicin), new and older brands will need to offer improvements in key areas of differentiation to gain uptake in this crowded market. This report analyzes the current and anticipated MRSA inpatient treatment landscape, providing critical information for manufacturers to position their products based on differentiating attributes that differentiate them from the competition to maximize uptake in the high-value hospital market segment.

QUESTIONS ANSWERED

  •  What percentage of patients received empiric treatment covering MRSA in eight common indications, including ABSSSI and osteomyelitis? What is the success rate of empiric treatment for these MRSA patients?
  • What are the most prescribed first-, second-, and third-line anti-MRSA therapies for inpatients with ABSSSI, bloodstream infection, nosocomial pneumonia, orand community-acquired bacterial pneumonia? What are the patients shares for key anti-MRSA agents in these indications?
  • What are the percentages of MRSA patients thatwho are ineligible for different key anti-MRSA agents? What are the common reasons that MRSA patients are ineligible for linezolid and daptomycin?
  •  What are the physician-reported drivers and constraints determining current prescribing patterns and recent/anticipated changes?

Table of contents

  • Methicillin-Resistant Staphylococcus Aureus Infections - Current Treatment - Detailed, Expanded Analysis (US)
    • Introduction to Current Treatment for MRSA
      • Key Findings
      • Summary Figures
        • Most Prescribed Antibiotics for Hospitalized Patients with MRSA cSSSIs (including ABSSSIs and SSIs) in Past 12 Months by Line of Therapy
        • Drivers of Vancomycin, Daptomycin, Dalbavancin, and Oritavancin Prescribing for MRSA Infections
        • Obstacles Limiting Vancomycin, Daptomycin, Dalbavancin, and Oritavancin Prescribing for MRSA Infections
      • Introduction to Current Treatment and Medical Practice for MRSA
      • Drugs Included in This Study of Current Treatment for MRSA
    • Physician Prescribing Practices
      • Key Findings
      • Patient Characteristics
        • BSIs, Osteomyelitis, and Implanted Medical Device Infections Are Common Difficult-to-Treat HT-MRSA Infections
        • Percentage of Patients with Microbiologically Confirmed MRSA Infections in the Past 12 Months
        • Percentage of Patients with MRSA cSSSIs, NP, or CABP Developing Secondary MRSA BSIs in the Past 12 Months
        • Most Common Reasons for Linezolid Ineligibility
        • Most Common Reasons for Daptomycin Ineligibility
      • Treatment Practices
        • Opportunities Exist for Later-Line Antibiotics with Benefits in Safety and Convenience
        • Suspected MRSA Infections Are Empirically Treated Immediately
        • Nearly All Inpatients Diagnosed with a MRSA Infection Are Treated with an Antibiotic
        • Percentage of Patients Treated Empirically for MRSA, by Infection Type
        • Vancomycin and Linezolid Are the Top Two Patient-Share Leaders in the HT-MRSA Market
        • Antibiotics Prescribed for Suspected or Confirmed MRSA Infections in Past 12 Months
        • Patient Shares for Antibiotics Used to Treat Hospitalized Patients with MRSA cSSSIs (including ABSSSIs and SSIs) in Past 12 Months
        • Patient Shares for Antibiotics Used to Treat Hospitalized Patients with MRSA NP (including VABP, HABP, and HCAP) in Past 12 Months
        • Patient Shares for Antibiotics Used to Treat Hospitalized Patients with MRSA CABP in Past 12 Months
        • Patient Shares for Antibiotics Used to Treat Hospitalized Patients with MRSA BSIs (including endocarditis and catheter-related infections) in Past 12 Months
        • Treatment Duration for HT-MRSA Infections Varies by Indication, Severity, and Choice of Antibiotic
        • Mean Treatment Duration in the Hospital for Different HT-MRSA Infections
        • Nonpharmacological Approaches Are Mainly Supplementary to Antibiotic Treatment for HT-MRSA Infections
        • Novel Antibiotics Can Find Market Opportunities as Later-Line Treatments
        • Half of MRSA Inpatients Are Successfully Treated with Empiric Therapy
        • Percentage of Hospitalized MRSA Patients Successfully Treated with Empiric Therapy in Past 12 Months
        • Percentage of ID Specialists Who Have Discharged MRSA Patients on OPAT in Past 12 Months
        • Percentage of Hospitalized MRSA Patients Discharged on OPAT in Past 12 Months
        • Older, Generically Available Antibiotics Have Higher Failure Rates with HT-MRSA Infections Than Newer Brands
        • Treatment Failure Rates Among Hospitalized Patients with MRSA cSSSIs in Past 12 Months
        • Treatment Failure Rates Among Hospitalized Patients with MRSA NP (including VABP, HABP, and HCAP) in Past 12 Months
        • Treatment Failure Rates Among Hospitalized Patients with MRSA CABP in Past 12 Months
        • Treatment Failure Rates Among Hospitalized Patients with MRSA BSIs (including endocarditis and catheter-related infections) in Past 12 Months
        • Branded Antibiotics Are Generally Reserved for Later Lines of Therapy
        • Most Prescribed Antibiotics for Hospitalized Patients with MRSA cSSSIs (including ABSSSIs and SSIs) in Past 12 Months by Line of Therapy
        • Most Prescribed Antibiotics for Hospitalized Patients with MRSA NP (including VABP, HABP, and HCAP) in Past 12 Months by Line of Therapy
        • Most Prescribed Antibiotics for Hospitalized Patients with MRSA CABP in Past 12 Months by Line of Therapy
        • Most Prescribed Antibiotics for Hospitalized Patients with MRSA BSIs (including endocarditis and catheter-related infections) in Past 12 Months by Line of Therapy
        • Reasons for Not Discharging Patients with MRSA Infections on OPAT
        • Most Prescribed OPAT Drugs for Treatment of MRSA Infections in Past 12 Months
        • MRSA Infections Are Primarily Managed with Monotherapy
        • Preferred Empiric Monotherapy and Combination Therapy for MRSA Infections
      • Persistency and Compliance
        • Persistency and Compliance Rates Are High Among Hospitalized MRSA Patients
      • Sequencing of Treatment
        • Oral Linezolid Is a Top Choice for Discharging MRSA Patients on Treatment
      • Recent/Anticipated Changes in Brand Use/Treatment Approach
        • Changes in Prescribing of Select Antibiotics for HT-cSSSIs (including ABSSSIs and SSIs) Due to MRSA in the Past 12 Months
        • Changes in Prescribing of Select Antibiotics for HT-NP (including VABP, HABP, and HCAP) Due to MRSA in the Past 12 Months
        • Changes in Prescribing of Select Antibiotics for HT-CABP Due to MRSA in the Past 12 Months
        • Changes in Prescribing of Select Antibiotics for HT-BSIs (including endocarditis and catheter-related infections) Due to MRSA in the Past 12 Months
        • Anticipated Changes in Prescribing of Select Antibiotics for Suspected or Confirmed MRSA Infections in the Next 12 Months
    • Physician Insight on Medical Practice
      • Key Findings
      • Drivers of Treatment Selection
        • Overall Cost of Treatment Is a Major Driver for Antibiotic Selections in the HT-MRSA Market
        • Antibiotic Selection Is Influenced by Factors Including Formulary Status, Antimicrobial Stewardship Measures, and Patient Drug Ineligibility
        • Formulary Status of Select Antibiotics for MRSA Infections
        • Percentage of Hospitals with Antimicrobial Stewardship Programs
        • Physician Access to Generic Linezolid
        • Physician Access to Generic Daptomycin
        • Percentage of HT-MRSA Patients Ineligible for Select Antibiotics in the Past 12 Months
        • A Drug's Convenience and Safety Are as Important as Efficacy in Driving Antibiotic Prescribing to Treat HT-MRSA Infections
        • Drivers of Vancomycin, Daptomycin, Dalbavancin, and Oritavancin Prescribing for MRSA Infections
        • Drivers of Linezolid, Tedizolid, Telavancin, and Ceftaroline Prescribing for MRSA Infections
        • Estimated Patient Share of Tedizolid for NP After Label Expansion
        • Estimated Patient Share of Telavancin for BSIs Due to MRSA After Label Expansion
        • Estimated Patient Share of Dalbavancin for BSIs Due to MRSA After a Successful Phase II Trial
        • Formulary Restrictions and Affordability Are Two Major Factors Limiting Antibiotic Prescribing for HT-MRSA Infections
        • Obstacles Limiting Vancomycin, Daptomycin, Dalbavancin, and Oritavancin Prescribing for MRSA Infections
        • Obstacles Limiting Linezolid, Tedizolid, Telavancin, and Ceftaroline Prescribing for MRSA Infections
        • Reasons Why the Most Preferred Therapy Is Not the Most Prescribed Therapy for MRSA Infections
        • Treatment Discontinuation for Hospitalized MRSA Patients Typically Occurs Only After Clinical Cure
        • Percentage of MRSA Inpatients Switched to Another Antibiotic in the Past 12 Months, by Prior Treatment
        • Reasons for Switching Treatment for Select Antibiotics
        • Treatment Deferral Is Not Typical for Hospitalized Patients with MRSA Infections
    • Methodology
      • Primary Market Research Methodology
      • Percentage of Hospital-Based Practice Among Surveyed ID Specialists
      • Number of MRSA Patients Surveyed ID Specialists Have Consulted on or Treated in the Past 30 Days
      • Physician Familiarity with Select Antibiotics
      • Physician Familiarity with Select Antibiotics (mean value)
      • MRSA Indications for which ID Specialists Have Consulted on or Treated in the Past 12 Months
      • Regional Distribution of Surveyed ID Specialists
      • Years in Practice Postresidency
      • Primary Practice Setting Among Surveyed ID Specialists
      • Regional Distribution of Surveyed ID Specialists
      • Size of Hospital Among Surveyed ID Specialists
      • Percentage of Surveyed ID Specialists Who Sit on Their Hospital’s P&T Committee
    • Appendix
      • Primary Market Research
        • Generic Erosion of Linezolid and Daptomycin
        • Most Preferred Antibiotics for Hospitalized Patients with MRSA cSSSIs (including ABSSSIs and SSIs) in Past 12 Months by Line of Therapy
        • Most Preferred Antibiotics for Hospitalized Patients with MRSA NP (including VABP, HABP, and HCAP) in Past 12 Months by Line of Therapy
        • Most Preferred Antibiotics for Hospitalized Patients with MRSA CABP in Past 12 Months by Line of Therapy
        • Most Preferred Antibiotics for Hospitalized Patients with MRSA BSIs (including endocarditis and catheter-related infections) in Past 12 Months by Line of Therapy
        • Percentage of Inpatient vs. Outpatient Use (via discharge therapy) of Antibiotics to Treat MRSA Infections in Past 12 Months
      • Key Abbreviations

Author(s): Jiamin Zhuo, PhD

Jiamin Zhuo, Ph.D., is a business insights analyst on the infectious, niche, and rare diseases team at Decision Resources Group. He provides expert insight into the commercial aspects of drug development and market dynamics in bacterial infections, including gram-negative infections and Methicillin-resistant Staphylococcus aureus.

He attained his Ph.D. at the Mayo Graduate School, Mayo Clinic, in Minnesota and his B.Sc. in physiology from Peking University in China. Prior to joining DRG, Dr. Zhuo was a postdoctoral fellow at Boston University and MIT, where he gained extensive experience in quantitative research methods.