ZUG, Switzerland, Jan. 17, 2017 /PRNewswire/ — The MS market has shifted over the course of 2016 according to the Q4 update of RealTime Dynamix™, an independent report based on survey responses of 100 US neurologists who actively manage patients with MS.

According to the study, oral DMTs captured a significantly higher share at the end of 2016 compared to 2015 and while Biogen’s Tecfidera leads the category, future projections are more favorable for Sanofi-Genzyme’s Aubagio which has steadily been gaining share. However, not all orals are created equal and neurologists have varied preferences based on certain patient characteristics.

The expanding use of orals into first-line position is putting pressure on nearly all of the platform injectables, but most notably on Teva’s Copaxone, for which surveyed neurologists have reported consecutive quarterly declines throughout 2016. Copaxone also faces a challenge from the first generic DMT to hit the market, Sandoz’s Glatopa. The user base for Glatopa has been slowly expanding, driven largely by managed care mandates and although some neurologists (and their patients) are still reluctant to use Glatopa over Copaxone, willingness is higher to use Glatopa in the DMT-naïve patient as opposed to switching from Copaxone or other agents.

These findings were further validated in RealWorld Dynamix™: DMT New Starts in Multiple Sclerosis, a large-scale patient chart audit of 1,020 DMT-naïve patients with all forms of MS who were initiated on a DMT for the first time in the past three months. The analysis of the patient records, submitted by 242 neurologists, showcases the drivers behind category and brand selection including clinical drivers such as safety and efficacy as well as non-clinical drivers including patient request and payer policies. Importantly, the study also digs deep into the competitive position for each brand, further highlighting just how vulnerable Copaxone is to first-line oral agent use – had Copaxone not been available, more than one third of the patients would have been started on an oral agent instead.

Both studies also point to a growing comfort with earlier use of high efficacy DMTs for patients with more aggressive disease, a trend expected to be further fueled by the approval of Roche’s ocrelizumab. Although the highly anticipated product approval was delayed in December 2016, neurologists are very familiar with the drug and many intend to use it as soon as it is approved. Although the greatest excitement for the drug is around the PPMS indication, many neurologists see a role for it in the larger RRMS population as well, primarily challenging other infused agents such as Biogen’s Tysabri and Sanofi-Genyzme’s Lemtrada. Indeed, neurologists reported that in more than onethird of the newly initiated Tysabri patients they would have been likely to use ocrelizumab instead had it been available. Considering the unmet need in the PPMS space and the high percent of RRMS patients not achieving optimal results, we expect ocrelizumab to be a disruptive force in the MS space in 2017 assuming the FDA clears it for marketing.

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