Device choice has long been a driver of sales of certain inhaled therapies, especially those available in multiple inhalers. With generic LAMAs and LABA/ICS FDCs anticipated to launch in the United States, devices may become an even more important driver of physician choice among respiratory therapies. Surveyed and interviewed practitioners note that while insurance often constrains their prescribing options, the device used with a therapy is an important driver and will become even more important as generic drug/device combinations become available. Unmet needs in the device market remain, especially for simpler devices and improved lung deposition.

Questions Answered:

  • What are the treatment drivers and goals for asthma and COPD?
  • What drug/device attributes are key influencers, which have limited impact, and which are hidden opportunities?
  • How do current drug/device combinations perform on key treatment drivers and goals for asthma and COPD?
  • What are the prevailing areas of unmet need and opportunity in drug/device combinations for asthma and COPD?
  • What trade-offs across different clinical attributes and price are acceptable to U.S. pulmonologists for a hypothetical new drug/device combination for asthma and COPD?

Markets covered: United States

Primary research: Survey of 60 U.S. pulmonologists fielded in March 2017

Key companies: GlaxoSmithKline, Boehringer Ingelheim, AstraZeneca, Novartis, Teva, Mylan, Propeller Health

Key drugs: Spiriva HandiHaler, Spiriva Respimat, Anoro Ellipta, Brovana, Symbicort HFA, Advair HFA, Advair Diskus

Table of contents

  • Asthma - Unmet Need - Special Topics: Devices (US)
    • Introduction
      • Overview
      • Key Findings
      • Handheld Device Types Available for Asthma and COPD
    • Current Devices and Clinical Practice
      • Current Device Training and Selection
      • Expert Insight: Device Training and Selection in Clinical Practice
      • Expert Insight: Common Errors
      • Currently Available Drug/Device Combinations
        • Major MDIs in the United States
        • Major DPIs in the United States
        • Major SMIs in the United States
    • Treatment Drivers and Goals
      • Overview
      • Rationale for Treatment Drivers and Goals Selection
        • Clinical Factors
        • Device Features
        • Device/Molecule Franchise
        • Patient-Related Factors
      • Physician Rating of Treatment Drivers and Goals in Asthma and COPD
        • Importance of Clinical Factors to Prescribing Decisions for Drug/Device Combinations in Asthma and COPD
        • Importance of Device Features to Prescribing Decisions for Drug/Device Combinations in Asthma and COPD
        • Importance of Device and Molecule Franchise to Prescribing Decisions for Drug/Device Combinations in Asthma and COPD
        • Importance of Patient-Related Factors to Prescribing Decisions for Drug/Device Combinations in Asthma and COPD
    • Product Performance Against Treatment Drivers and Goals
      • Overview
      • Drug/Device Profiles
        • Expert Insight on Spiriva HandiHaler
        • Expert Insight on Spiriva Respimat
        • Expert Insight on Anoro Ellipta
        • Expert Insight on Brovana Nebulizer
        • Expert Insight on Symbicort HFA
        • Expert Insight on Advair HFA
        • Expert Insight on Advair Diskus
      • Current Brand Performance on Key Treatment Drivers and Goals
        • Overall Performance of Key Drug/Device Combinations for Asthma and COPD Devices
        • Expert Insight: Clinical Factors
        • Relative Performance of Key Drug/Device Combinations for Asthma and COPD Across Select Clinical Factors
        • Expert Insight: Device Features
        • Relative Performance of Key Drug/Device Combinations for Asthma and COPD Across Select Device Features
        • Expert Insight: Device and Molecule Franchise
        • Relative Performance of Key Drug/Device Combinations for Asthma and COPD Across Select Device and Molecule Franchise Attributes
        • Expert Insight: Patient-Related Factors
        • Relative Performance of Key Drug/Device Combinations for Asthma and COPD Across Select Patient-Related Factors
    • Target Product Profiles
      • Stated vs. Derived Importance of Treatment Drivers and Goals
        • Stated vs. Derived Importance of Key Clinical Factors, Device Features, Device/Molecule Franchise, and Patient-Related Factors to Prescribing Decisions in Asthma and COPD: United States
      • Assessing Drug Development Opportunities
      • Target Product Profile Methodology
        • Attributes and Attribute Levels
        • Assigned Prohibitions for the Conjoint Module
      • Attribute Importance and Part-Worth Utilities
        • Asthma and COPD Devices Target Product Profile: Attribute Importance
        • Device Type
        • Molecule Choice
        • Availability of Alternative Devices with Same Molecule
        • Inhaler Captures and Uses Health Information
        • Number of Steps Required for Optimal Use
        • Patient Feedback on Dosing
        • Price Per Day
      • Conjoint Analysis-Based Simulations of Market Scenarios
        • Expert Insight
        • Expert Insight
        • Scenario Analysis: Generic LABA/ICS FDCs
        • Asthma and COPD Market Simulations: Share of Preference of Branded-Generics and AB-Rated Generics
        • Asthma and COPD Market Simulations: Likelihood to Prescribe Branded-Generics and AB-Rated Generics
        • Asthma and COPD Market Simulations: Target Product Profiles Included in Scenario on Generic LABA/ICS FDCs
        • Expert Insight
        • Expert Insight
        • Scenario Analysis: LABA/LAMA/ICS FDCs
        • Asthma and COPD Market Simulations: Share of Preference of Triple Therapies
        • Asthma and COPD Market Simulations: Likelihood to Prescribe Triple Therapies
        • Asthma and COPD Market Simulations: Target Product Profiles Included in Scenario on Triple Therapies
    • Assessment of Unmet Need
      • Overview
      • Overall Satisfaction with Current Treatment Drug/Device Combinations
        • Surveyed Pulmonologists’ Satisfaction with the Performance of Key Drug/Device Combinations for Asthma and COPD on Various Factors
      • Physician Rating of Unmet Need in Asthma and COPD Devices
        • Expert Insight: Unmet Needs
        • Surveyed Pulmonologists' Ascribed Level of Unmet Need Across Key Clinical Factors in Asthma and COPD
        • Surveyed Pulmonologists' Ascribed Level of Unmet Need Across Key Device Features in Asthma and COPD
        • Surveyed Pulmonologists' Ascribed Level of Unmet Need Across Key Device and Molecule Franchise Attributes in Asthma and COPD
        • Surveyed Pulmonologists' Ascribed Level of Unmet Need Across Key Patient-Related Factors in Asthma and COPD
      • Unmet Need in Asthma and COPD Devices
        • Surveyed Pulmonologists' Ascribed Level of Unmet Need in Asthma and COPD Devices
    • Opportunity Analysis
      • Areas of Opportunity in the Asthma and COPD Drug/Device Market and Emerging Therapy Insights
        • Opportunity: Smart Devices
        • Expert Insight: Smart Devices
        • Opportunity: Generic Inhaled Therapies
        • Expert Insight: Generic Inhaled Therapies
        • Opportunity: Nebulized Therapies
        • Expert Insight: Nebulized Therapies
    • Appendix
      • Experts Interviewed
      • Bibliography
      • Number of Patients Treated
      • Therapies Used to Treat Asthma and/or COPD
      • Willingness to Use LABA/LAMA FDCs for Asthma and COPD
      • Willingness to Use LABA/LAMA/ICS FDCs for Asthma and COPD
      • Preferred LAMA Therapy for Asthma and COPD
      • Preferred LABA/ICS FDC for Asthma and COPD

Author(s): Kristine Mackin, Ph.D.

Kristine Mackin, Ph.D., is a principal analyst on the Immune and Inflammatory Disorders team at Clarivate. Her expertise includes emerging microbiome-based therapies, psoriatic arthritis, chronic obstructive pulmonary disease, and asthma. Previously, Dr. Mackin was involved with a new company pitch focusing on the infant microbiome, now realized as Commense, during an internship at Puretech Ventures in Boston. She holds a doctorate in biochemistry from Brandeis University, where she studied the evolution of bacteriorhodopsin and the relationship between type I and type II rhodopsins.


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