The availability of novel disease-modifying therapies (DMTs)—Copaxone 40 mg 3TW, oral DMTs, Plegridy, and Lemtrada—has complicated clinical decision-making and treatment choice in the management of multiple sclerosis (MS) in the United States. Glatopa (glatiramer acetate 20 mg), the first generic DMT, entered the U.S. market in June 2015. Further, recent cases of progressive multifocal leukoencephalopathy (PML) in Gilenya- and Tecfidera-treated patients have changed the way neurologists approach treatment with these DMTs and prescribing decisions following anti-John Cunningham (JC) virus antibody assay results. TreatmentTrends: Multiple Sclerosis (US) is an annual syndicated report that provides a comprehensive view of the current and anticipated market dynamics and competitive landscape through comprehensive primary research with U.S. neurologists. These reports cover the use of DMTs for the treatment of MS as well as attitudes and perceptions toward these products, advantages and disadvantages, ideal patient types, barriers to growth, promotional messaging, and anticipated use. In addition, respondents are queried about their awareness of and interest in DMTs in development.

Questions Answered in This Report:

  • No DMTs are approved for progressive forms of MS, but some emerging therapies promise efficacy in these subpopulations. What percentage of patients is diagnosed with each of the four disease classifications (clinically isolated syndrome [CIS], relapsing-remitting MS [RR-MS], secondary-progressive MS [SP-MS], and primary-progressive MS [PP-MS])? Do physicians consider SP-MS to be a form of relapsing MS? How does the current DMT treatment rate differ, if at all, across the four MS disease classifications? Is a neurologist’s preferred first-, second-, or third-line DMT impacted by a diagnosis of relapsing versus progressive MS? How will current treatment rates and patient share allocations change over the next six months?

  • Use of oral DMTs has been increasing over the past two years at the expense of injectable therapies; the recent and impending launches of new infusion DMTs may further alter traditional class allocations. Which injectable therapies have experienced the largest decreases, and which oral therapies have experienced the largest increases, in patient share? 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? What is the impact of the MS market’s first generic product, Glatopa? Where have new DMTs been incorporated into the MS treatment algorithm, and how will this change over the next six months?

  • Although many of the recent launches have offered more convenient dosing profiles, efficacy attributes, followed by safety and tolerability, continue to be the most important factors in prescribing decisions. Which specific efficacy attributes are the most important to neurologists when making prescribing decisions? Which attributes are NOT important? How do different DMTs and classes of DMTs perform on efficacy, safety/tolerability, patient benefit, and physician benefit attributes? Are there important attributes that neurologists tend to overlook or, conversely, ones that neurologists 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 to the attributes driving brand choice decisions?

  • Numerous emerging therapies, including injectable, oral, and infusion DMTs, are in late-stage development for relapsing or progressive forms of MS. How receptive are neurologists to emerging therapies, and do any agents stand out as having the greatest potential value for the treatment of relapsing or progressive MS? Will emerging products replace current DMTs in the treatment algorithm, or will they grow the DMT-treated patient pool, upon launch? What are the main value drivers for emerging therapies, and how do they compare with attribute performance of current products?

Scope:

Markets covered: United States.

Primary research: 100 neurologists.

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

Emerging therapies: Phase III: 7 drugs.

Author(s): Meg Weigel

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