The Current Treatment 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, and drivers and obstacles to the use 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) Q3 2016
    • Physician Prescribing Practices
      • Key Findings
      • Patient Characteristics
        • Prevalence of BMM Disorders Increases as CKD Worsens
        • Primary Cause of Kidney Disease in CKD-ND and Dialysis
        • Percentage of CKD Patients Diagnosed with BMM Disorders by Stage
      • Treatment Practices
        • Use of AVD, Sensipar, and Phosphate Binders Increases as CKD Becomes More Severe
        • Patients on Dialysis Receive Treatment Sooner than Nondialysis Patients
        • Time to Start Treatment in BMM Disorders by Stage
        • SHPT and Hyperphosphatemia Treatment Rate Higher in Dialysis than in CKD-ND Patients
        • Treatment Rates in BMM Disorders by Stage
        • BMM Treatment Increases with CKD Severity Except for the Use of NVD and Potassium Binders
        • Patient Share of SHPT Therapies by Stage
        • Patient Share of AVD Therapies by Stage
        • Patient Share of Hyperphosphatemia Therapies by Stage
        • Patient Share of Phosphate Binder Therapies by Stage
        • Patient Share of Hyperkalemia Therapies by Stage
        • Patient Share of Hyperkalemia Therapies by Potassium Levels
        • Treatment Duration Varies Between Dialysis and CKD-ND
        • Treatment Duration of SHPT Therapies by Stage
        • Treatment Duration of Hyperphosphatemia Therapies by Stage
        • Treatment Duration of Hyperkalemia Therapies by Stage
        • Calcium-Based Binders and Calcitriol/Calcijex Are First-Line Therapies for Hyperphosphatemia and SHPT, Respectively
        • Physicians Opt for More-Efficacious BMM Therapies in the Dialysis vs. CKD-ND Setting
        • Treatment Rates of BMM Disorders by Line of Therapy: CKD-ND
        • Treatment Rates of BMM Disorders by Line of Therapy: Dialysis
        • Majority of BMM Patients Do Not Progress from First-Line Treatment
        • Progression Between Lines of Therapy in Hyperphosphatemia
        • Progression Between Lines of Therapy in SHPT
        • Iron-Based Phosphate Binders Are Relegated to Later Lines of Hyperphosphatemia Therapy
        • AVD Patient Share by Line of Therapy
        • Phosphate Binder Patient Share by Line of Therapy
        • Combination Therapy in Hyperphosphatemia Increases with CKD Severity
        • Combination Therapy in Hyperphosphatemia
        • Comedication in BMM Disorders
      • Persistency and Compliance
        • Dialysis Patients Spend Significantly More Time than CKD-ND Patients on BMM Therapies
        • Persistency with Therapies for BMM Disorders by Stage
        • Compliance with Therapies for BMM Disorders by Stage
      • Sequence of Treatment
        • Sevelamer-Based Binders Are the Preferred Hyperphosphatemia Treatment
        • Previous Phosphate Binder-Treated Patients and Switches
        • Current Phosphate Binder-Treated Patients and Switches
      • Recent/Anticipated Changes in Brand Usage/Treatment Approach
        • Overall, Nephrologists Do Not Anticipate Significant Changes in BMM Disorder Therapy
        • Anticipated SHPT Patient Share by Stage
        • Anticipated AVD Patient Share by Stage
        • Anticipated Hyperphosphatemia Patient Share by Stage
        • Anticipated Phosphate Binder Patient Share by Stage
        • Likely Candidates for Veltassa
        • Anticipated Veltassa Patient Share by Stage
        • Likely Candidates for ZS-9
        • Recent Changes in the Management of BMM Disorders by Stage
    • Physician Insight on Medical Practice
      • Key Findings
      • Drivers of Treatment Selection
        • Clinical Parameters, Cost, and Efficacy Drive Treatment of BMM Disorders
        • Disease Severity and Brand Satisfaction Influence Treatment of BMM Disorders
        • Overall Satisfaction with SHPT Brands
        • Intact PTH Values at Which Sensipar Is Initiated
        • Overall Satisfaction with Phosphate Binders
        • Phosphorus Levels at Which Phosphate Binders Are Initiated in CKD-ND
        • Phosphorus Levels at Which Phosphate Binders Are Initiated in Dialysis
        • Mean Phosphorus Levels at Which Phosphate Binders Are Initiated in Dialysis and CKD-ND
        • Overall Satisfaction with Potassium Binders
        • Potassium Levels at Which Potassium Binders Are Initiated
        • Cost and Efficacy Tend to Drive Treatment Selection
        • Factors Driving Phosphate Binder Use
        • Factors Driving NVD Use
        • Factors Driving AVD Use
        • Factors Driving Sensipar Use
        • Factors Driving Veltassa Use
        • More than 50% of Surveyed Nephrologists Face No Obstacles When Prescribing SHPT and Hyperphosphatemia Therapies
        • Factors Constraining Phosphate Binder Use
        • Factors Constraining NVD Use
        • Factors Constraining AVD Use
        • Factors Constraining Sensipar Use
        • Factors Constraining Veltassa Use
        • Physicians Switch Phosphate Binders for Efficacy Reasons
        • Rationale for Phosphate Binder Discontinuation
      • Effectiveness of Face-to-Face Product Detailing
        • Sales Representatives for Sensipar, Auryxia, and Veltassa Have Been Effective
        • Contact Rates for SHPT and Hyperphosphatemia Have Remained Unchanged over the Past Year
        • Sales Representative Contact Rates for PTH Modifiers
        • Sales Representative Contact Rates for Phosphate Binders
        • Sales Representative Contact Rates for Veltassa
        • Nephrologists' Satisfaction with Performance of Sales Representatives for SHPT and Hyperphosphatemia Agents Has Not Changed
        • Physician Satisfaction with Sales Representatives’ Performance for AVD Therapies
        • Physician Satisfaction with Sales Representatives’ Performance for AVD Therapies over Time
        • Physician Satisfaction with Sales Representatives’ Performance for Phosphate Binders
        • Physician Satisfaction with Sales Representatives’ Performance for Phosphate Binders over Time
        • Physician Satisfaction with Sales Representatives’ Performance for Veltassa
        • Sales Messages Focus on BMM Therapies' Efficacy
        • Sales Representatives’ Messages for PTH Modifiers in Past Three Months
        • Sales Representatives’ Messages for Phosphate Binders in Past Three Months
        • Sales Representatives’ Messages for Veltassa in Past Three Months
    • Methodology
      • Primary Market Research Methodology
      • Physician Length of Practice
      • Physician Medical Background
      • Physician Location by Region
      • Physician Location by State
      • CKD-ND and Dialysis Patient Load
      • Physician Dialysis Affiliations

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.