The hospital-treated methicillin-resistant Staphylococcus aureus (MRSA) infection market is dominated by generic vancomycin because of its low cost, physician familiarity and relatively high clinical efficacy. Meanwhile, a number of premium-priced, branded agents (e.g., linezolid [Pfizer’s Zyvox/Zyvoxid] and daptomycin [Cubist/Novartis/Merck’s Cubicin]) compete for limited patient populations requiring later lines of therapy and/or suffering from difficult to treat MRSA infections (e.g., nosocomial pneumonia, bloodstream infections, and osteomyelitis). Therefore, emerging anti-MRSA agents will need to demonstrate improvements across multiple drug attributes including safety, tolerability, efficacy, and delivery in order to gain patient share in this increasingly crowded market landscape. Nevertheless, the MRSA pipeline offers a number of promising emerging therapies that can address areas of unmet need. Cubist’s second-generation oxazolidinone tedizolid (Sivextro) offers a range of improvements over linezolid, including shorter length of therapy, lower drug dosage, once-daily dosing, and the potential for a safer and more tolerable drug profile. In addition, two emerging lipoglycopeptides dalbavancin (Durata’s Dalvance) and oritavancin have the potential to transform the standard-of-care for MRSA infections through once-weekly (dalbavancin), or single-dose (oritavancin) regimens. Infrequent dosing not only provides greater convenience to patients, but can also help facilitate outpatient parenteral antibiotic therapy (OPAT), which in turn can help reduce the overall length and cost of hospitalization.

This report surveys physicians and hospital pharmacy directors (PDs) regarding current practices for hospital-based treatment of bacterial infections due to MRSA. Analysis will be derived from a survey of 140 hospital-based physicians (70 infections disease specialists (ID) and 70 non-ID physicians and 30 hospital PDs. Physician surveys will assess current prescribing practices for marketed anti-MRSA antibiotics, how those practices are evolving due to shifting epidemiology and/or hospital policies, areas of unmet need and expected uptake of emerging anti-MRSA therapies. The survey of hospital-based PDs will provide insight into factors influencing formulary inclusions/positioning for both current and emerging antibiotics. Key anti-MRSA agents to be surveyed include the following current therapies: vancomycin (generics), linezolid, daptomycin, ceftaroline (Forest’s Teflaro/AstraZeneca’s Zinforo/Dainippon Sumitomo), and telavancin (Theravance/Clinigen’s Vibativ). In addition, these surveys will assess physician and payer interest in three emerging MRSA therapies in late-stage clinical development: tedizolid, dalbavancin, and oritavancin.

Questions Answered in This Report:

  • Evolving Prescribing Trends and Formulary Access Considerations for Current Therapies: What are the most prescribed and the preferred antibiotics for the treatment of key MRSA infections and do these differ between ID specialists and non-ID physicians? What are the key drivers and constraints for prescribing current anti-MRSA therapies to hospitalized patients? What specific drug attributes drive and limit physician prescribing of key antibiotic brands and how do physicians expect their prescribing will change over the next year? Which oral and parenteral antibiotics are commonly selected as discharge therapies? What restrictions are placed on the prescribing of current generic and branded therapies, and how are these agents scrutinized for formulary inclusion?

  • Formulary Access and Uptake of Emerging Therapies in the United States: What current therapies do physicians see as the greatest competitors to key emerging antibiotics? Based on available clinical data, how do physicians anticipate emerging antibiotics will be incorporated into medical practice? For emerging therapies, which improvements in drug attributes do physicians consider important differentiators from current therapies? How receptive are hospital PDs to the emerging therapies tedizolid, dalbavancin, and oritavancin on hospital formularies given different pricing scenarios? What hospital-based cost-containment measures will impact formulary inclusion and access to emerging therapies?

  • Challenges and Hurdles for Market Access in the Hospital-Treated MRSA Market: How can marketers with drugs facing unfavorable formulary placement overcome key hurdles/barriers to gain market access? What are physicians’ and hospital PDs’ perceptions of remaining unmet needs in the treatment of MRSA infections?


This U.S. Physician & Payer Forum report contains insights from a survey of 140 physicians (ID specialists and 70 non-ID physicians) and 30 hospital PDs regarding the dynamics that affect prescribing practices and formulary coverage of treatments for hospital-treated MRSA infections in the United States. We explore the factors that shape current and future treatment patterns as well as reimbursement trends in the MRSA space. Additionally, this report reveals physicians’ and hospital PDs’ perceptions of currently marketed anti-MRSA therapies as well as select emerging therapies that are forecasted to launch in the United States within the next year.  

Markets covered: United States.

Primary research: Online survey of 70 infectious disease (ID) and 70 non-ID physicians and 30 hospital PDs.

Author(s): Maria Ascano, Ph.D.

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