The CurrentTreatment Bone and Mineral Metabolism (BMM) disorders content examines the management of dialysis and mid- to late-stage chronic kidney disease (CKD) patients from the perspective of nephrologists. The emphasis of this content is on calcium-phosphorus metabolism, secondary hyperparathyroidism (SHPT), and hyperkalemia. This content provides a detailed expanded analysis and longitudinal information on the BMM market dynamics. It provides insight into practice patterns, physician attitudes and perceptions, and current and projected use of various products such as phosphate binders, nutritional and active vitamin D and calcimimetic agents as well as persistency, compliance, drivers, and obstacles of these classes of medications. We also include sales and messaging efforts of key market players and coverage of late-stage products for the treatment of BMM.

Table of contents

  • Bone And Mineral Metabolism - Current Treatment - Detailed, Expanded Analysis (US) Q1 2016
    • Physician Prescribing Practices
      • Key Findings: Physician Prescribing Practices
      • Patient Characteristics
        • Key Findings: Patient Characteristics
        • Patients Initiated on Chronic Dialysis in the Past Year
        • Patients with Predialysis Nephrology Care vs. No Predialysis Nephrology Care
        • Primary Cause of Kidney Disease
        • Patient Healthcare Plans
        • Common Comorbidities in CKD-ND and Dialysis
      • Treatment Practices
        • Key Findings: Treatment Practices
        • Key Findings: Time to Start Treatment
        • Duration of Time After SHPT Diagnosis to Start Pharmacological Therapy
        • Duration of Time After Hyperphosphatemia Diagnosis to Start Pharmacological Therapy
        • Key Findings: Treatment Rates in BMM Disorders
        • Percentage of Patients on NVD
        • Percentage of Patients on AVD
        • Percentage of Patients on Sensipar
        • Percentage of Patients on Phosphate Binders
        • Percentage of Nephrologists with Patients on Phosphate Binders
        • Key Findings: Patient Share for SHPT Treatment (AVD)
        • AVD Patient Share: HD
        • Percentage of Nephrologists with any Oral Vitamin D Use in HD
        • IV vs. Oral AVD Use in HD
        • AVD Patient Share: PD
        • AVD Patient Share: CKD-ND
        • Key Findings: Patient Share for Hyperphosphatemia Treatment (Phosphate Binders)
        • Phosphate Binder Patient Share–HD
        • Phosphate Binder Patient Share–PD
        • Phosphate Binder Patient Share–CKD-ND
        • Sevelamer Patient Share
        • Key Findings: Treatment Duration by Product
        • Average Duration of AVD Treatment in SHPT Patients
        • Sensipar Treatment Duration for SHPT Patients
        • Average Duration of Phosphate-Binder Treatment in Hyperphosphatemia Patients
        • Key Findings: Treatment Rates by Line of Therapy
        • Initiation of Therapy for CKD Patients with BMM
        • Key Findings: Progression Between Lines of Therapy
        • Preferred First-Line Agent: Dialysis
        • Preferred First-Line Agent: CKD-ND
        • Previous Phosphate Binder-Treated Patients and Switches
        • Current Phosphate Binder-Treated Patients and Switches
        • Preferred First-Line Phosphate Binders: Dialysis Over Time
        • Preferred First-Line Phosphate Binders: CKD-ND Over Time
        • First- and Second-Line Phosphate Binder Choice in Dialysis
        • First- and Second-Line Phosphate Binder Choice in CKD-ND
        • Key Findings: Product Patient Share by Line of Therapy
        • SHPT Patients Treated with AVD Therapies
        • Hyperphosphatemia Patients Treated with Phosphate Binders
        • Average Duration of AVD Treatment in SHPT Patients
        • Average Duration of Phosphate-Binder Treatment in Hyperphosphatemia Patients
        • Key Findings: Combination/Regimen/Comedication Analysis
        • Percentage of Patients on More Than One Phosphate Binder (Combination Therapy) Over Time
        • Phosphate-Binder Combination Therapy
      • Persistency and Compliance
        • Key Findings: Persistency/Compliance
        • CKD-ND and Dialysis Patients on BMM Therapies from One Year Ago
        • Current CKD-ND and Dialysis Patient Compliance with BMM Therapies
      • Sequencing of Treatment
        • Key Findings: Treatment Rates by Line of Therapy
        • Initiation of Therapy for CKD Patients with BMM
      • Recent/Anticipated Changes in Brand Usage/Treatment Approach
        • Key Findings: Recent/Anticipated Changes in Brand Usage/Treatment Approach (SHPT)
        • Percentage of Patients on NVD (Current)
        • Percentage of Patients on NVD (Current and Anticipated)
        • Percentage of Patients on AVD (Current)
        • Percentage of Patients on AVD (Current and Anticipated)
        • AVD Patient Share: HD—Current
        • AVD Patient Share: HD—Current and Anticipated
        • AVD Patient Share: PD—Current
        • AVD Patient Share: PD—Current and Anticipated
        • AVD Patient Share: CKD-ND—Current
        • AVD Patient Share: CKD-ND—Current and Anticipated
        • Percentage of Patients on Sensipar (Current Use)
        • Percentage of Patients on Sensipar (Current and Anticipated)
        • Key Findings: Recent/Anticipated Changes in Brand Usage/Treatment Approach (Phosphate Binders)
        • Percentage of Patients on Phosphate Binders—Current
        • Percentage of Patients on Phosphate Binders—Current and Anticipated
        • Phosphate Binder HD Patient Share (Current)
        • Anticipated Change in Use of Phosphate Binders
        • Phosphate Binder Patient Share: HD—Current and Anticipated
        • Sevelamer Patient Share—Current
        • Phosphate Binder Patient Share: PD—Current
        • Phosphate Binder Patient Share: PD—Current and Anticipated
        • Phosphate Binder Patient Share: CKD-ND—Current
        • Phosphate Binder CKD-ND Patient Share (Current and Anticipated)
        • Velphoro and Auryxia Use
        • Key Findings: Anticipated Changes in Treatment Approach
        • Tenapanor Familiarity (Prior to Product Profile)
        • Percentage of Patients Who Are Likely Tenapanor Candidates After Review of Product Profile
        • Etelcalcetide Familiarity (Prior to Product Profile)
        • Percentage of Likely Patient Candidates After Review of Product Profile
        • Familiarity of Veltassa and ZS-9 (Prior to Product Profile)
        • Percentage of Patient Likely Candidates for Veltassa
        • Percentage of Patient Likely Candidates for ZS-9
    • Physician Insight on Medical Practice
      • Drivers of Treatment Selection
        • Drivers of Treatment Selection (SHPT)
        • Use of Nutritional Vitamin D in Dialysis
        • Reason for Increase
        • Reason for Decrease
        • Use of Nutritional Vitamin D in CKD-ND
        • Reason for Increase
        • Reason for Decrease
        • Use of Active Vitamin D in Dialysis
        • Reason for Increase
        • Reason for Decrease
        • Use of Active Vitamin D in CKD-ND
        • Reason for Increase
        • Reason for Decrease
        • AVDs Available on Formulary Over Time
        • Use of Sensipar in Dialysis
        • Use of Sensipar in CKD-ND
        • Use of Phosphate Binders in Dialysis
        • Phosphorus Lab Value at Phosphate Binder Initiation in CKD-ND
        • Phosphorus Lab Value at Phosphate Binder Initiation in Dialysis
        • Factors Influencing Treatment and Disease Management (SHPT)
        • Percentage of HD Patients on NVD, by Chain
        • Percentage of HD Patients on AVD, by Chain
        • AVD HD Patient Share, by Dialysis Chain
        • Percentage of HD Patients on Sensipar, by Chain
        • Percentage of HD Patients on Sensipar, by Chain
        • Factors Influencing Treatment and Disease Management (Hyperphosphatemia)
        • Percentage of HD Patients on Phosphate Binders, by Chain
        • Current HD Patient Share, by Chain
        • Factors Influencing Treatment and Disease Management (Hyperkalemia)
        • Treatment of Hyperkalemia Patients with Different Levels of Severity
        • Overall Physician Satisfaction with PTH Modifiers
        • Overall Physician Satisfaction with Phosphate Binders
        • Phosphate Binders: Patients Most Likely to Benefit
        • Sensipar Patients’ PTH Levels
        • Potassium Level for Pharmacological Hyperkalemia Treatment
        • Overall Physician Satisfaction with Phosphate Binders
        • Top Challenges in the Treatment of Hyperkalemia
        • Overall Satisfaction with PTH Modifiers
        • Previous Phosphate Binder-Treated Patients and Switches
        • Current Phosphate Binder-Treated Patients and Switches
        • CKD-ND and Dialysis Patient Discontinuation of BMM Therapies Within First Year
      • Face-to-Face Product Detailing Effectiveness
        • Percentage of Nephrologists Seen by a Sales Representative in Past Month (Over Time)
        • PTH Modifiers: Sales Representative Contact Rates
        • Percentage of Surveyed Nephrologists Seen by a Sales Rep in Past Month (Over Time)
        • Phosphate Binders: Sales Representative Contact Rates
        • Physician Satisfaction with Sales Representatives’ Performance
        • Sales Representatives’ Performance: PTH Modifiers
        • Sales Representatives’ Performance: Phosphate Binders
        • Sales Representatives’ Messages for PTH Modifiers in Past Three Months
        • Sales Representatives’ Messages for Phosphate Binders in Past Three Months
    • Methodology
      • Primary Market Research Methodology
      • Physician Background
      • Significance Testing in This Study
      • Physician Practice Type
      • Dialysis Affiliations
      • Regional Distribution of Practices
      • CKD-ND and Dialysis Patient Load
      • Percentage of Patients with Hyperkalemia in the Past Year
    • Appendix
      • Background
      • Research Objectives
      • Report Abbreviations
      • Current and Future Market: SHPT (AVD)
      • Current and Future Market: SHPT (NVD and Sensipar)
      • Current and Future Market: Hyperphosphatemia
      • Competitive Landscape: SHPT Therapies (AVD Analogues and Sensipar) and Hyperphosphatemia Therapies (Phosphate Binders)
      • Products in Development
      • Tenapanor Product Profile
      • Etelcalcetide Product Profile
      • ZS-9 Product Profile
      • Veltassa Product Profile

Author(s): Jihan Khan, PhD; Caitlin Koris, MSPH; Jihan Khan, PhD

Jihan Khan, Ph.D., is a director in the oncology team at DRG. Dr. Khan manages a team of analysts who conduct extensive primary and secondary market research on several oncology indications across the major pharmaceutical markets. She also provides sales and client support across DRG oncology products.

 

Previously, Dr. Khan was a principal analyst on the cardiometabolic team at DRG. Her specialties were the type 2 diabetes and renal disorders markets. Dr. Khan provided forecasts of these pharmaceutical markets by evaluating the agents in development and the changing clinical behaviors and conducting primary research with payers and physicians. Prior to joining DRG, she worked as a knowledge specialist in a company where she conducted in-depth research on products and processes for commercialization. She obtained her Ph.D. in organic chemistry from Brandeis University and was a postdoctoral fellow at Brigham and Women’s Hospital and Harvard Medical School.

Caitlin Koris, MSPH, is a business insights analyst on the cardiovascular, metabolic, and renal disorders team at Decision Resources Group. She has developed expertise in chronic kidney disease and related disorders such as bone and mineral metabolism, renal anemia, hyperkalemia, diabetic nephropathy, and kidney transplant.

Prior to joining DRG, Caitlin was a clinical research monitor for oncology phase I and II trials. She obtained her M.S. in public health/health services research (MSPH) from Emory University, where she focused on pharmacoeconomics/outcomes research and healthcare policy. She has conducted research at the U.S. Centers for Disease Control and at the Food and Drug Administration.

Jihan Khan, Ph.D., is a director in the oncology team at DRG. Dr. Khan manages a team of analysts who conduct extensive primary and secondary market research on several oncology indications across the major pharmaceutical markets. She also provides sales and client support across DRG oncology products.

 

Previously, Dr. Khan was a principal analyst on the cardiometabolic team at DRG. Her specialties were the type 2 diabetes and renal disorders markets. Dr. Khan provided forecasts of these pharmaceutical markets by evaluating the agents in development and the changing clinical behaviors and conducting primary research with payers and physicians. Prior to joining DRG, she worked as a knowledge specialist in a company where she conducted in-depth research on products and processes for commercialization. She obtained her Ph.D. in organic chemistry from Brandeis University and was a postdoctoral fellow at Brigham and Women’s Hospital and Harvard Medical School.