As the term implies, levodopa-induced dyskinesia (LID) is a complication of chronic use of levodopa, the gold standard of Parkinson’s disease (PD) treatment. Surveyed neurologists estimate that 40% of their patients suffer from LID, which is often disabling and painful, impacting quality of life and increasing fall risk. For decades, the only drug for LID has been immediate-release amantadine—now long generic—but it is not specifically approved for LID and has an unfavorable side-effect profile. Now, the treatment of PD-LID is evolving, thanks to the recent FDA approval of Gocovri for LID and research suggesting Xadago may have a positive impact. Understanding prescriber perceptions of available options and the drivers of clinical decision-making in PD-LID will help drug developers identify levers for new product positioning and differentiation and gauge unmet clinical need for further innovations in this arena.

Questions Answered

  • What clinical end points and drug attributes are most influential in prescribing for PD-LID? How do amantadine, Gocovri, and Xadago perform on these attributes?
  • What are the prevailing areas of unmet need and opportunity in the treatment of PD-LID?
  • Based on conjoint analysis and TPP simulation, what trade-offs between efficacy, safety, and price are neurologists willing to make for a hypothetical new PD-LID drug?

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

Primary research: Survey of 62 U.S. and 30 European neurologists fielded in December 2018.

Key drugs covered: Amantadine, Gocovri, Xadago.

Key metrics included:

  • Target Product Profile (TPP) simulator based on conjoint analysis methodology.
  • Stated versus derived importance of product attributes on prescribing behavior.
  • Assessment of current drug performance against treatment drivers and goals.
  • Physician perceptions of unmet needs in PD-LID and related PD subpopulations.
  • Analysis of remaining drug development opportunities.

Product Description

Unmet Need supports clinical development decisions by identifying key attributes and assessing areas of unmet need for a specific disease or subpopulation. Based on surveys with U.S. and European physicians, this report provides insight into key treatment drivers and goals, the performance of current therapies, and the remaining commercial opportunities. Two market scenarios are profiled in detail by DRG experts, and additional customized market scenarios can be evaluated with the corresponding TPP simulator.

Table of contents

  • Parkinson's Disease - Unmet Need - Detailed, Expanded Analysis - Levodopa-Induced Dyskinesia (US&EU)
    • Introduction
      • Overview
      • Methodology
      • Rationale for Treatment Drivers and Goals Selection
        • Efficacy
        • Safety and Tolerability
        • Convenience of Administration
      • Rationale for Drug Selection
        • Products for PD-LID
    • 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 in PD-LID
      • Importance of Efficacy Attributes to Prescribing Decisions in PD-LID: United States
      • Importance of Efficacy Attributes to Prescribing Decisions in PD-LID: Europe
      • Importance of Safety and Tolerability Attributes to Prescribing Decisions in PD-LID: United States
      • Importance of Safety and Tolerability Attributes to Prescribing Decisions in PD-LID: Europe
      • Importance of Convenience of Administration Attributes to Prescribing Decisions in PD-LID: United States
      • Importance of Convenience of Administration Attributes to Prescribing Decisions in PD-LID: Europe
      • Key Findings: Stated vs. Derived Importance
      • Stated vs. Derived Importance of Key Efficacy, Safety and Tolerability, and Convenience of Administration Attributes to Prescribing Decisions in PD-LID: United States
      • Stated vs. Derived Importance of Key Efficacy, Safety and Tolerability, and Convenience of Administration Attributes to Prescribing Decisions in PD-LID: Europe
    • Product Performance Against Treatment Drivers and Goals
      • Key Findings
      • Overall Performance of Key Therapies for PD-LID: United States
      • Overall Performance of Key Therapies for PD-LID: Europe
      • Mean Overall Performance of Key Therapies for PD-LID: United States and Europe
      • Relative Performance of Key Therapies for PD-LID Across Select Efficacy Attributes: United States
      • Relative Performance of Key Therapies for PD-LID Across Select Efficacy Attributes: Europe
      • Relative Performance of Key Therapies for PD-LID Across Select Safety and Tolerability Attributes: United States
      • Relative Performance of Key Therapies for PD-LID Across Select Safety and Tolerability Attributes: Europe
      • Relative Performance of Key Therapies for PD-LID Across Select Convenience of Administration Attributes: United States
      • Relative Performance of Key Therapies for PD-LID Across Select Convenience of Administration Attributes: Europe
    • Assessment of Unmet Need
      • Key Findings: Unmet Need in PD-LID
      • Surveyed Neurologists’ Satisfaction with the Performance of Key Therapies for PD-LID on Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Factors: United States
      • Surveyed Neurologists’ Satisfaction with the Performance of Key Therapies for PD-LID on Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Factors: Europe
      • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Efficacy Attributes in PD-LID: United States
      • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Efficacy Attributes in PD-LID: Europe
      • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Safety and Tolerability Attributes in PD-LID: United States
      • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Safety and Tolerability Attributes in PD-LID: Europe
      • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Convenience of Administration Attributes in PD-LID: United States
      • Surveyed Neurologists' Ascribed Level of Unmet Need Across Key Convenience of Administration Attributes in PD-LID: Europe
      • Key Findings: Unmet Need in LID and Other PD Symptoms
      • Surveyed Neurologists' Ascribed Level of Unmet Need in LID and Other PD Symptoms: United States
      • Surveyed Neurologists' Ascribed Level of Unmet Need in LID and Other PD Symptoms: Europe
    • Opportunity Analysis
      • Areas of Opportunity in the PD-LID Market and Emerging Therapy Insights
        • Opportunity: An Antidyskinetic Agent with a Demonstrably Superior Efficacy Profile to Amantadine
        • Opportunity: An Antidyskinetic Agent with a Better Safety/Tolerability Profile Than Amantadine
        • Opportunity: A PD Motor Therapy with a Secondary Effect on LID
    • Target Product Profiles
      • Assessing Drug Development Opportunities
      • Target Product Profile Methodology
        • Attributes and Attribute Levels
        • Attributes of Current Therapies for PD-LID
      • Attribute Importance and Part-Worth Utilities
        • PD-LID Target Product Profile: Attribute Importance
        • Mean Increase in Total Daily "On" Time Without Troublesome LID vs. Placebo: United States
        • Mean Increase in Total Daily "On" Time Without Troublesome LID vs. Placebo: Europe
        • Mean Improvement in Total UDysRS Score vs. Placebo: United States
        • Mean Improvement in Total UDysRS Score vs. Placebo: Europe
        • Incidence of Hallucinations vs. Placebo (% of Patients): United States
        • Incidence of Hallucinations vs. Placebo (% of Patients): Europe
        • Incidence of Peripheral Edema vs. Placebo (% of Patients): United States
        • Incidence of Peripheral Edema vs. Placebo (% of Patients): Europe
        • Incidence of Dizziness vs. Placebo (% of Patients): United States
        • Incidence of Dizziness vs. Placebo (% of Patients): Europe
        • Delivery Profile: United States
        • Delivery Profile: Europe
        • Price Per Day: United States
        • Price Per Day: Europe
      • Conjoint Analysis-Based Simulations of Market Scenarios
        • PD-LID Market Simulations: Share of Preference of Target Product Profiles Included in Scenario 1
        • PD-LID Market Simulations: Likelihood to Prescribe Target Product Profiles Included in Scenario 1
        • PD-LID Market Simulations: Target Product Profiles Included in Scenario 1
        • PD-LID Market Simulations: Share of Preference of Target Product Profiles Included in Scenario 2
        • PD-LID Market Simulations: Likelihood to Prescribe Target Product Profiles Included in Scenario 2
        • PD-LID 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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