Although motor fluctuations in Parkinson’s disease (PD) can be managed effectively in the early stages of the disease, today’s treatment paradigm is suboptimal owing to the considerable pill burden, a risk of motor and nonmotor complications associated with dopaminergic therapy, and a progressive loss of efficacy. In response, the pipeline for adjunctive therapies targeting motor fluctuations has swelled. With the recent launches of Xadago and Ongentys and with Nouriast and tozadenant in late-phase development, understanding the drivers of clinical decision-making for treating motor fluctuations and prescriber perceptions of approved options will help innovators identify levers for new product positioning and differentiation in this evolving market niche.

Questions Answered:

  • What are the treatment drivers and goals for motor fluctuations in PD?
  • What attributes are key influences, which have limited impact, and which are hidden opportunities?
  • How do current therapies perform on key treatment drivers and goals for motor fluctuations in PD?
  • What are the prevailing areas of unmet need and opportunity in the treatment of motor fluctuations in PD?
  • What trade-offs across different clinical attributes and price are acceptable to U.S. and European neurologists for a hypothetical new adjunctive drug for the treatment of motor fluctuations in PD?

Markets covered: United States, France, Germany, United Kingdom

Primary research: Survey of 60 U.S. and 31 European neurologists fielded in February 2017

Key companies: Teva, UCB, Newron, Zambon, US WorldMeds, Bial, Neurocrine, Kyowa Hakko Kirin, Acorda

Key drugs: oral dopamine agonists, rotigotine (Neupro), rasagiline (Azilect), selegiline, safinamide (Xadago), entacapone, Ongentys (opicapone), tozadenant, Nouriast (istradefylline)

Table of contents

  • Parkinson's Disease - Unmet Need - Detailed, Expanded Analysis: Adjunctive Therapies For Motor Fluctuations
    • Key Updates
      • October 2017
      • July 2017
      • April 2017
    • Treatment Drivers and Goals
      • Overview
      • Rationale for Treatment Drivers and Goals Selection
        • Efficacy
        • Safety and Tolerability
        • Convenience of Administration
        • Nonclinical Factors
      • Physician Rating of Treatment Drivers and Goals for Motor Fluctuations in Parkinson's Disease
        • Importance of Efficacy Attributes to Prescribing Decisions for Motor Fluctuations in Parkinson's Disease: United States
        • Importance of Efficacy Attributes to Prescribing Decisions for Motor Fluctuations in Parkinson's Disease: Europe
        • Importance of Safety and Tolerability Attributes to Prescribing Decisions for Motor Fluctuations in Parkinson's Disease: United States
        • Importance of Safety and Tolerability Attributes to Prescribing Decisions for Motor Fluctuations in Parkinson's Disease: Europe
        • Importance of Convenience of Administration Attributes to Prescribing Decisions for Motor Fluctuations in Parkinson's Disease: United States
        • Importance of Convenience of Administration Attributes to Prescribing Decisions for Motor Fluctuations in Parkinson's Disease: Europe
        • Importance of Nonclinical Factors to Prescribing Decisions for Motor Fluctuations in Parkinson's Disease: United States
        • Importance of Nonclinical Factors to Prescribing Decisions for Motor Fluctuations in Parkinson's Disease: Europe
      • Stated vs. Derived Importance of Treatment Drivers and Goals
        • Stated vs. Derived Importance of Key Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Attributes to Prescribing Decisions for Motor Fluctuations in Parkinson's Disease: United States
        • Stated vs. Derived Importance of Key Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Attributes to Prescribing Decisions for Motor Fluctuations in Parkinson's Disease: Europe
    • Product Performance Against Treatment Drivers and Goals
      • Overview
      • Rationale for Drug Selection
        • Products for Motor Fluctuations in Parkinson's Disease
      • Current Brand Performance on Key Treatment Drivers and Goals
        • Overall Performance of Key Therapies for Motor Fluctuations in Parkinson's Disease: United States
        • Overall Performance of Key Therapies for Motor Fluctuations in Parkinson's Disease: Europe
        • Relative Performance of Key Therapies for Motor Fluctuations in Parkinson's Disease Across Select Efficacy Attributes: United States
        • Relative Performance of Key Therapies for Motor Fluctuations in Parkinson's Disease Across Select Efficacy Attributes: Europe
        • Relative Performance of Key Therapies for Motor Fluctuations in Parkinson's Disease Across Select Safety and Tolerability Attributes: United States
        • Relative Performance of Key Therapies for Motor Fluctuations in Parkinson's Disease Across Select Safety and Tolerability Attributes: Europe
        • Relative Performance of Key Therapies for Motor Fluctuations in Parkinson's Disease Across Select Convenience of Administration Attributes: United States
        • Relative Performance of Key Therapies for Motor Fluctuations in Parkinson's Disease Across Select Convenience of Administration Attributes: Europe
        • Relative Performance of Key Therapies for Motor Fluctuations in Parkinson's Disease Across Select Nonclinical Attributes: United States
        • Relative Performance of Key Therapies for Motor Fluctuations in Parkinson's Disease Across Select Nonclinical Attributes: Europe
    • Assessment of Unmet Need
      • Overview
      • Overall Satisfaction with Current Treatment
        • Surveyed Neurologists’ Satisfaction with the Performance of Key Therapies for Motor Fluctuations in Parkinson's Disease on Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Factors: United States
        • Surveyed Neurologists’ Satisfaction with the Performance of Key Therapies for Motor Fluctuations in Parkinson's Disease on Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Factors: Europe
      • Physician Rating of Unmet Need for Motor Fluctuations in Parkinson's Disease
        • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Efficacy Attributes for Motor Fluctuations in Parkinson's Disease: United States
        • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Efficacy Attributes for Motor Fluctuations in Parkinson's Disease: Europe
        • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Safety and Tolerability Attributes for Motor Fluctuations in Parkinson's Disease: United States
        • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Safety and Tolerability Attributes for Motor Fluctuations in Parkinson's Disease: Europe
        • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Convenience of Administration Attributes for Motor Fluctuations in Parkinson's Disease: United States
        • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Convenience of Administration Attributes for Motor Fluctuations in Parkinson's Disease: Europe
        • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Nonclinical Factors for Motor Fluctuations in Parkinson's Disease: United States
        • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Nonclinical Factors for Motor Fluctuations in Parkinson's Disease: Europe
      • Unmet Need in the Treatment of Motor Fluctuations in PD and Related Indications
        • Surveyed Neurologists' Ascribed Level of Unmet Need in Parkinson's Disease and Related Indications: United States
        • Surveyed Neurologists' Ascribed Level of Unmet Need in Parkinson's Disease and Related Indications: Europe
    • Opportunity Analysis
      • Areas of Opportunity and Emerging Therapy Insights
        • Opportunity: A Therapy with Greater Efficacy in Preventing Motor Fluctuations
        • Opportunity: A Novel Agent with Low Risk of Motor and Nonmotor Complications
        • Opportunity: A Rescue Therapy for the Acute Treatment of "Off" Episodes
      • Lack of Opportunity and Emerging Therapy Insights
      • Target Product Profiles
        • Assessing Drug Development Opportunities
        • Target Product Profile Methodology
          • Attributes and Attribute Levels
        • Attribute Importance and Part-Worth Utilities
          • Motor Fluctuations in Parkinson's Disease Target Product Profile: Attribute Importance
          • Mean Reduction in Total "Off" Time vs. Placebo, Adjunct to Levodopa
          • Mean Improvement in UPDRS Part III Score vs. Placebo, Adjunct to Levodopa
          • Mean Improvement in UPDRS Part II Score vs. Placebo, Adjunct to Levodopa
          • Incidence of Dyskinesia vs. Placebo
          • Incidence of Psychosis vs. Placebo
          • Delivery Profile
          • Price per Day
        • Conjoint Analysis-Based Simulations of Market Scenarios
          • Market Simulations for Motor Fluctuations in PD: Share of Preference of Target Product Profiles Included in Scenario 1
          • Market Simulations for Motor Fluctuations in PD: Likelihood to Prescribe Target Product Profiles Included in Scenario 1
          • Market Simulations for Motor Fluctuations in PD: Target Product Profiles Included in Scenario 1
          • Market Simulations for Motor Fluctuations in PD: Share of Preference of Target Product Profiles Included in Scenario 2
          • Market Simulations for Motor Fluctuations in PD: Likelihood to Prescribe Target Product Profiles Included in Scenario 2
          • Market Simulations for Motor Fluctuations in PD: Target Product Profiles Included in Scenario 2
      • Appendix
        • Key Abbreviations
        • Experts Interviewed
        • Bibliography

    Author(s): Bethany Christmann, PhD

    Bethany Christmann, Ph.D., has been with DRG since 2015, and is a Senior Business Insights Analyst with the Central Nervous System/Ophthalmology team. In this role, she covers the neurology space, specializing in Parkinson’s disease and epilepsy; she provides expert insight and authors primary market research and forecasting content focused on these and other neurology indications. Prior to joining DRG, Bethany earned her Ph.D. in neuroscience from Brandeis University, where she studied the cellular interactions involved in memory consolidation and their link to sleep behavior.


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