Use in treatment-naïve patients drives recent growth of Biogen’s Tecfidera and Genzyme’s Aubagio in Canada, as reported switch share has remained flat over the past year – reflecting the continued shift in using established oral agents earlier in the multiple sclerosis treatment algorithm
EXTON, Pa., May 27, 2020 /PRNewswire/ — The COVID-19 pandemic has (at least temporarily) transformed neurology practices and multiple sclerosis (MS) patient management patterns across Canada, according to the most recent report included in Spherix’s RealTime Dynamix™: Multiple Sclerosis (Canada) service. The report, which collected the responses of 50 Canadian neurologists surveyed between April 6th and May 2nd, found that 90% of respondents indicate the novel coronavirus outbreak has had a high impact on their practice. While preference for induction versus escalation treatment was clearly on the rise prior to the pandemic, new data suggest a potentially transient reversion to more conservative disease-modifying therapy (DMT) treatment patterns.
Neurologists express hesitation to prescribe or re-dose patients with immunosuppressive DMTs, namely Roche’s Ocrevus, Sanofi Genzyme’s Lemtrada, and EMD Serono’s Mavenclad, due to increased risk of complications or death among MS patients infected with the novel coronavirus. One surveyed neurologist states “becoming more aggressive in [the] treatment of highly active MS” prior to the COVID-19 pandemic, which has now resulted in “more caution with immune-suppressing therapies.” This mindset has resulted in a leveling off of reported shares for the immunosuppressant DMTs.
Along with the trajectory of COVID-19 spread, the permanency of COVID-19-related impacts on high-efficacy DMT use remains uncertain. Neurologists anticipate Mavenclad and Ocrevus use to rebound over the next six months, suggesting optimism that MS patient management may soon return to normal. Conversely, Lemtrada share has declined and is projected to remain depressed in the future, bringing into question whether COVID-19 has simply hastened shrinking use of the DMT that may have already occurred as a result of new reports of vascular and immune-related safety concerns.
Regardless, strong preference for Ocrevus, as well as continued uptake among patients recently started on or switched to a new DMT, hints at potential resiliency to COVID-19-related disruption for Roche’s brand. The DMT has now established a clear lead within the recently switched segment, following a 60% increase in reported share of recent switches compared to one year ago. Moreover, Ocrevus use among recent new starts has also grown over the same time period, despite caution in early-line DMT treatment paradigms with respect to DMTs that could impact immune response.
Among DMTs considered to be less/not immunosuppressive, uptake of Biogen’s Tecfidera and Sanofi Genzyme’s Aubagio for MS patients starting on their first DMT has propelled overall oral DMT class share of first-line prescribing to more than twice that of the interferon, glatiramer acetate (GA), and monoclonal antibody (mAb) DMT classes. Aubagio and Tecfidera alone currently account for more than half of recent DMT initiations. In fact, neurologists are more likely to prefer Aubagio than other agents for treatment-naïve patients diagnosed with relapsing remitting MS (RRMS) presenting with less active disease. Amid considerable success within the new start patient segment, shares for Aubagio and Tecfidera among recently switched patients have remained relatively stable, resulting in moderate overall growth in use of these established oral DMTs which is being driven by a shift to earlier use in the treatment algorithm.
While COVID-19 remains a concern, neurologist conservatism may limit uptake of any new DMTs. Nearly two thirds of respondents claim they are currently less likely than normal to prescribe any DMT recently approved or that may be approved in the coming months. Novartis’ Mayzent, which received Health Canada approval in March, may be somewhat insulated from this apprehension as the first non-injectable DMT indicated to treat active secondary progressive MS (SPMS). Neurologists agree that Mayzent could become their preferred option in active SPMS, and some already say they would choose the agent over other DMTs for patients with active SPMS or disease transitioning from RRMS to SPMS. Nevertheless, with many neurologists believing that DMTs approved for RRMS are also effective in SPMS, the new market entrant will face considerable competition from high-efficacy DMTs indicated for RRMS, especially Ocrevus, upon expansion of market access and provincial formulary coverage.
Bristol Myers Squibb’s Zeposia (ozanimod) and Janssen’s ponesimod, late-stage pipeline S1P receptor modulators, will most likely be classified as immunomodulators that may impact immune response. Thus, as with Novartis’ Gilenya and Mayzent, both agents, if approved, may face a suboptimal environment upon launch depending upon the length of the COVID-19 pandemic. Few neurologists express high interest in either Zeposia or ponesimod compared to other assessed pre-market DMTs, even those with immunosuppressive mode of action, such as Novartis’ ofatumumab.
The next wave of the RealTime Dynamix™ series will continue to closely track Mayzent’s launch, as well as provide a prelaunch assessment of ofatumumab. Spherix’s assessment of unmet needs, along with analysis of DMT preferences by MS subtype, will further illustrate which pre-market DMTs have the most potential and likely confirm Aubagio’s dominance in early RRMS and Ocrevus’ sway in primary progressive MS.
About RealTime Dynamix™
RealTime Dynamix™: Multiple Sclerosis (Canada) is an independent service providing strategic guidance through rapid and comprehensive semiannual reports, which include market trending, launch tracking, and a fresh infusion of unique content with each wave. The next semiannual report publishes in November.
About Spherix Global Insights
Spherix Global Insights is a hyper-focused market intelligence firm that leverages our own independent data and expertise to provide strategic guidance, so biopharma stakeholders make decisions with confidence. We specialize in select immunology, nephrology, and neurology markets.
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