The wide array of disease-modifying therapies (DMTs) now available for the treatment of multiple sclerosis (MS) in the major European markets (EU5; France, Germany, Italy, Spain, and the United Kingdom) has greatly expanded neurologists’ MS armamentarium and made treatment decisions increasingly complex. New oral DMTs (i.e., Genzyme/Sanofi’s Aubagio and Biogen’s Tecfidera) are available in all five countries, and the EMA has approved updates of two mainstays of MS treatment that offer more-convenient dosing (i.e., Biogen’s Plegridy and Teva’s Copaxone 40 mg three time weekly [3TW]), as well as a high-potency DMT (Genzyme/Sanofi’s Lemtrada). Furthermore, recent cases of progressive multifocal leukoencephalopathy (PML) in Gilenya- (Novartis) and Tecfidera-treated patients have changed the way neurologists approach treatment with these DMTs and affected prescribing decisions following anti-John Cunningham (JC) virus antibody assay results. TreatmentTrends: Multiple Sclerosis 2015 (EU) is the fourth fielding of a syndicated report that offers a snapshot of market dynamics and the competitive landscape of the MS space through comprehensive primary research with neurologists across the EU5. This report covers the current and anticipated use of approved DMT brands for the treatment of MS, as well as neurologists’ perceptions of these products—e.g., their advantages and disadvantages, ideal patient types, anticipated use, barriers to growth—and current detailing and message efforts for these brands. Finally, we asked neurologists about their awareness of and interest in select DMTs in development.

Questions Answered in This Report:

  • The majority of DMTs available are approved for relapsing forms of MS; indeed, no DMTs are approved for progressive forms of MS, although some emerging therapies promise efficacy in these subpopulations. What percentage of patients in each of the EU5 countries is diagnosed with each of the four disease classifications (CIS, relapsing-remitting MS [RR-MS], secondary-progressive MS [SP-MS], primary-progressive MS [PP-MS])? How does the current DMT treatment rate differ, if at all, by MS disease classification and across the EU5? How does disease classification influence neurologists’ choice of DMT across lines of therapy? Will current treatment rates change over the next six months?

  • Use of oral DMTs has increased over the past several years at the expense of injectable therapies; the recent and forthcoming launches of new DMTs may further alter traditional class allocations. Which injectable therapies have experienced the largest declines in patient share, and which oral therapies have experienced the largest increases? How have the launches of Copaxone 40 mg 3TW and Plegridy influenced the use of other injectable therapies? How is Lemtrada, a new high-potency infusion DMT, competing with Tysabri? Where have new DMTs been incorporated into the MS treatment algorithm; does it vary across the EU5; and how will it change over the next six months?

  • Many recent additions to the MS armamentarium offer more convenience (e.g., oral formulation, less-frequent dosing); however, efficacy and safety/tolerability attributes continue to be the most important factors influencing neurologists’ prescribing decisions. Which specific attributes are the most, and least, important to neurologists when making prescribing decisions? How do different DMTs perform on these attributes? What key attributes do neurologists overlook or, conversely, erroneously deem to be influential? What are the main messages being communicated about brands during recent face-to-face detailing, and how do they compare with the attributes driving brand choice decisions?

  • Numerous emerging therapies, including injectable, oral, and infusion DMTs, are in late-stage development for relapsing and/or progressive forms of MS. How familiar are physicians in each of the EU5 countries with emerging DMTs? Which products do they perceive as offering the most value for treating relapsing MS, and which products do they perceive as offering the most value for treating progressive MS? What characteristics drive value? Will emerging products replace current DMTs in the treatment algorithm, or will they expand the DMT-treated patient pool?

Scope:

Markets covered: Europe (France, Germany, Italy, Spain, and the United Kingdom).

Primary research: 228 neurologists (52 from France, 50 from Germany, 50 from Italy, 51 from Spain, and 25 from the United Kingdom).

Indication coverage: CIS, RR-MS, SP-MS, PP-MS.

Emerging therapies: Phase III: 7 drugs.

Author(s): Andrea (Buurma) Kravit

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