DRG estimates that 60% of epilepsy patients experience partial-onset seizures (POS). More than two dozen antiepileptic drugs (AEDs) are available in the United States and Europe—the majority of which are approved to treat POS—yet 20-30% of all epilepsy patients are refractory to AED treatment. While the treatment algorithm in early lines of therapy is generally well understood, later-line prescribing for refractory POS is highly variable, in part because seizures in epilepsy are diverse and newer therapies lack clear clinical differentiation. As such, treatment choice is often based on neurologists’ personal experience. Understanding the drivers of clinical decision-making for treating refractory POS and prescriber perceptions of third-generation brands will help innovators identify levers for new product positioning and differentiation in this crowded yet underserved market.

Questions Answered

  • What clinical end points and drug attributes are most influential in prescribing for refractory POS? How do recently launched brands such as Vimpat, Briviact, and Fycompa perform on these attributes?
  • What are the prevailing areas of unmet need and opportunity in the treatment of refractory POS in epilepsy?
  • Based on conjoint analysis and TPP simulation, what trade-offs between efficacy, safety, and price are neurologists willing to make for a hypothetical new AED for refractory POS?

Product Description

Unmet Need: Provides quantitative insight into U.S. and European physician perceptions of key treatment drivers and goals and the current level of unmet need for a specific disease. Commercial opportunities are analyzed, and the extent to which emerging therapies may capitalize on these opportunities is evaluated.

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

Primary research: Survey of 61 neurologists in United States and 30 neurologists in Europe.

Key companies: Sunovion Pharmaceuticals, Eisai, UCB, Pfizer, Janssen, and Concordia Pharmaceuticals.

Key drugs: Aptiom/Zebinix, Briviact, Fycompa, Lyrica, topiramate, Vimpat, and zonisamide.

Key metrics included:

  • Stated versus derived analysis of U.S. and European physician prescribing behavior.
  • Conjoint analysis with U.S. and European physicians includes market simulator.
  • Assessment of current drug performance against treatment drivers and goals.
  • Physician perceptions of unmet need in subpopulation covered and related subpopulations.
  • Analysis of remaining drug development opportunities.

Table of contents

  • Epilepsy - Unmet Need - Detailed, Expanded Analysis - Treatment Refractory Epilepsy (Partial Onset) - US/EU
    • Introduction
      • Overview
      • Methodology
      • Rationale for Treatment Drivers and Goals Selection
        • Efficacy
        • Safety and Tolerability
        • Convenience of Administration
        • Nonclinical Factors
      • Rationale for Drug Selection
        • Products for Treatment-Refractory Partial-Onset Seizures in Epilepsy
    • Treatment Drivers and Goals
      • Key Findings: Attribute Importance
      • Relative Importance of Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Attributes to Surveyed Neurologists' Prescribing Decisions for Treatment-Refractory Partial-Onset Seizures in Epilepsy
      • Importance of Efficacy Attributes to Prescribing Decisions for Treatment-Refractory Partial-Onset Seizures in Epilepsy: United States
      • Importance of Efficacy Attributes to Prescribing Decisions for Treatment-Refractory Partial-Onset Seizures in Epilepsy: Europe
      • Importance of Safety and Tolerability Attributes to Prescribing Decisions for Treatment-Refractory Partial-Onset Seizures in Epilepsy: United States
      • Importance of Safety and Tolerability Attributes to Prescribing Decisions for Treatment-Refractory Partial-Onset Seizures in Epilepsy: Europe
      • Importance of Convenience of Administration Attributes to Prescribing Decisions for Treatment-Refractory Partial-Onset Seizures in Epilepsy: United States
      • Importance of Convenience of Administration Attributes to Prescribing Decisions for Treatment-Refractory Partial-Onset Seizures in Epilepsy: Europe
      • Importance of Nonclinical Factors to Prescribing Decisions for Treatment-Refractory Partial-Onset Seizures in Epilepsy: United States
      • Importance of Nonclinical Factors to Prescribing Decisions for Treatment-Refractory Partial-Onset Seizures in Epilepsy: Europe
      • Key Findings: Stated vs. Derived Importance
      • Stated vs. Derived Importance of Key Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Attributes to Prescribing Decisions for Treatment-Refractory Partial-Onset Seizures in Epilepsy: United States
      • Stated vs. Derived Importance of Key Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Attributes to Prescribing Decisions for Treatment-Refractory Partial-Onset Seizures in Epilepsy: Europe
    • Product Performance Against Treatment Drivers and Goals
      • Key Findings
      • Overall Performance of Key Therapies for Treatment-Refractory Partial-Onset Seizures in Epilepsy: United States
      • Overall Performance of Key Therapies for Treatment-Refractory Partial-Onset Seizures in Epilepsy: Europe
      • Relative Performance of Key Therapies for Treatment-Refractory Partial-Onset Seizures in Epilepsy Across Select Efficacy Attributes: United States
      • Relative Performance of Key Therapies for Treatment-Refractory Partial-Onset Seizures in Epilepsy Across Select Efficacy Attributes: Europe
      • Relative Performance of Key Therapies for Treatment-Refractory Partial-Onset Seizures in Epilepsy Across Select Safety and Tolerability Attributes: United States
      • Relative Performance of Key Therapies for Treatment-Refractory Partial-Onset Seizures in Epilepsy Across Select Safety and Tolerability Attributes: Europe
      • Relative Performance of Key Therapies for Treatment-Refractory Partial-Onset Seizures in Epilepsy Across Select Convenience of Administration Attributes: United States
      • Relative Performance of Key Therapies for Treatment-Refractory Partial-Onset Seizures in Epilepsy Across Select Convenience of Administration Attributes: Europe
      • Relative Performance of Key Therapies for Treatment-Refractory Partial-Onset Seizures in Epilepsy Across Select Nonclinical Attributes: United States
      • Relative Performance of Key Therapies for Treatment-Refractory Partial-Onset Seizures in Epilepsy Across Select Nonclinical Attributes: Europe
    • Assessment of Unmet Need
      • Key Findings: Unmet Need for Treatment-Refractory Partial-Onset Seizures in Epilepsy
      • Surveyed Neurologists’ Satisfaction with the Performance of Key Therapies for Treatment-Refractory Partial-Onset Seizures in Epilepsy on Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Factors: United States
      • Surveyed Neurologists’ Satisfaction with the Performance of Key Therapies for Treatment-Refractory Partial-Onset Seizures in Epilepsy on Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Factors: Europe
      • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Efficacy Attributes for Treatment-Refractory Partial-Onset Seizures in Epilepsy: United States
      • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Efficacy Attributes for Treatment-Refractory Partial-Onset Seizures in Epilepsy: Europe
      • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Safety and Tolerability Attributes for Treatment-Refractory Partial-Onset Seizures in Epilepsy: United States
      • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Safety and Tolerability Attributes for Treatment-Refractory Partial-Onset Seizures in Epilepsy: Europe
      • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Convenience of Administration Attributes for Treatment-Refractory Partial-Onset Seizures in Epilepsy: United States
      • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Convenience of Administration Attributes for Treatment-Refractory Partial-Onset Seizures in Epilepsy: Europe
      • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Nonclinical Factors for Treatment-Refractory Partial-Onset Seizures in Epilepsy: United States
      • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Nonclinical Factors in Treatment-Refractory Partial-Onset Seizures in Epilepsy: Europe
      • Key Findings: Unmet Need for Treatment-Refractory Partial-Onset Seizures and Related Seizure Syndromes
      • Surveyed Neurologists' Ascribed Level of Unmet Need for Treatment-Refractory Partial-Onset Seizures and Related Seizure Syndromes: United States
      • Surveyed Neurologists' Ascribed Level of Unmet Need for Treatment-Refractory Partial-Onset Seizures and Related Seizure Syndromes: Europe
    • Opportunity Analysis
      • Areas of Opportunity for Treatment-Refractory Partial-Onset Seizures in the Epilepsy Market and Emerging Therapy Insights
        • Opportunity: A Novel Agent with Greater Efficacy in Preventing Partial-Onset Seizures
        • Opportunity: An Effective Agent That Is Better Tolerated Than Current Options
        • Opportunity: A Rescue Therapy for the Acute Suppression of Breakthrough Seizures
    • Target Product Profiles
      • Assessing Drug Development Opportunities
      • Target Product Profile Methodology
        • Attributes and Attribute Levels
      • Attribute Importance and Part-Worth Utilities
        • Treatment-Refractory Partial-Onset Seizures in Epilepsy Target Product Profile: Attribute Importance
        • Median Reduction in Partial-Onset Seizure Frequency vs. Placebo
        • 50% Responder Rate for Partial-Onset Seizures vs. Placebo
        • Incidence of Aggression/Irritability-Related Side Effects vs. Placebo
        • Incidence of Somnolence vs. Placebo
        • Incidence of Dizziness vs. Placebo
        • Delivery Profile
        • Price per Day
      • Conjoint Analysis-Based Simulations of Market Scenarios
        • Treatment-Refractory Partial-Onset Seizures in Epilepsy Market Simulations: Share of Preference of Target Product Profiles Included in Scenario 1
        • Treatment-Refractory Partial-Onset Seizures in Epilepsy Market Simulations: Likelihood to Prescribe Target Product Profiles Included in Scenario 1
        • Treatment-Refractory Partial-Onset Seizures in Epilepsy Market Simulations: Target Product Profiles Included in Scenario 1
        • Treatment-Refractory Partial-Onset Seizures in Epilepsy Market Simulations: Share of Preference of Target Product Profiles Included in Scenario 2
        • Treatment-Refractory Partial-Onset Seizures in Epilepsy Market Simulations: Likelihood to Prescribe Target Product Profiles Included in Scenario 2
        • Treatment-Refractory Partial-Onset Seizures in Epilepsy Market Simulations: Target Product Profiles Included in Scenario 2
    • Appendix
      • Key Abbreviations
      • 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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