Even with the recent favorable conclusion to pan-Canadian Pharmaceutical Alliance negotiations, the prescriber base for Roche’s Ocrevus may be nearing a plateau requiring existing prescribers to fuel the majority of anticipated brand growth, according to the inaugural Canada report from Spherix Global Insights
EXTON, Pa., May 28, 2019 ― Therapeutic choice for multiple sclerosis (MS) in Canada has expanded substantially over the past two years with Health Canada’s November 2017 approval of EMD Serono’s Mavenclad for relapsing-remitting MS (RRMS) and August 2017 and February 2018 approvals of Roche’s Ocrevus for RRMS and early primary progressive MS (PPMS), respectively. In the inaugural wave of the ongoing biannual RealTime Dynamix™: Multiple Sclerosis (Canada) series, neurologists (n=50) are most likely to select Ocrevus, as well as Teva’s Copaxone and Novartis’ Gilenya, as their most preferred disease-modifying therapies (DMTs) for the treatment of MS. Mavenclad, restricted to a second line or later position, trails Gilenya among the oral DMTs in preference, but captures an oral DMT class-leading share of recent switch business. Mavenclad switches are typically occurring in RRMS and active secondary progressive MS (SPMS) patients, pulling from common first-line DMTs, including interferons, Sanofi Genzyme’s Aubagio, and Biogen’s Tecfidera. Most of the competitive pressure from Mavenclad switches is being felt by Gilenya due to perceptions of Mavenclad superiority on PML risk, convenient administration, required monitoring, and efficacy in relapsing MS. Mavenclad could be even more competitive if supported by broader physician and patient educational outreach, as both detailing rate and patient request frequency lag that of Ocrevus, contributing to familiarity being a common obstacle to greater uptake.
Along with disability progression risk reduction and reduced relapse rate, favorable overall risk-benefit is among the most important attributes driving DMT selection in Canada. Ocrevus’ strong performances across these attributes, as well as the March 2019 pan-Canadian Pharmaceutical Alliance (pCPA) recommendation for provincial drug formulary inclusion, bodes well for continued robust uptake in Canada. However, share gains will likely need to rely predominantly on expanded use among existing prescribers, as Spherix data suggest that the Ocrevus prescriber base may be nearing a plateau. While the early PPMS segment would represent a less competitive position for Ocrevus, less than one in five PPMS patients are currently treated with a DMT and Ocrevus is restricted to just those patients diagnosed with early PPMS, as defined by disease duration and level of disability, who have imaging evidence of inflammation. Instead, neurologists’ recall of recent sales representative interactions suggests that Roche is focused on competing within the RRMS segment ― a strategy that appears to be resonating with Canadian neurologists based upon current Ocrevus use patterns. With patient refusal the most common impediment to a higher RRMS treatment rate, uptake of frequently-requested Ocrevus could potentially help to boost both the RRMS and PPMS treatment rates over the next few years ― a metric that will be trended on a biannual basis by Spherix.
Looking to future drivers of MS market shifts in Canada, neurologists are most interested in the potential availability of Mayzent, Novartis’ S1P receptor modulator, due to its potential as a treatment for SPMS. Canadian neurologists are highly aware of the March 2019 Mayzent approval in the US where, while submitted for a broad SPMS indication, approval was instead granted for relapsing forms of MS ― limiting use to SPMS patients with inflammatory disease activity. In Canada, where most interferons are already approved for the treatment of SPMS with relapses, not active SPMS would represent the greatest differentiation opportunity for Mayzent based upon the extremely low current treatment rate. However, only one-third of neurologists agree that they would consider a DMT switch in a patient displaying evidence of secondary neurodegeneration in the absence of new MRI activity or clinical signs or symptoms of a relapse ― the definition of not active SPMS presentation. If granted a broad SPMS label in Canada, such data highlight the substantial educational push that would be required of Novartis to truly shift the treatment paradigm.
About RealTime Dynamix™
RealTime Dynamix™: Multiple Sclerosis (Canada) provides a twice-yearly analysis of key performance metrics, focusing on brand gains and losses, industry contact rates, familiarity and adoption rates of recently launched products, and awareness of products in development. Product perceptions, disease awareness and attitudes, practice management and other topics are rotated throughout the year to provide an ongoing probe of the crucial drivers of change. The next wave of research in Canada will be published in November 2019.
About Spherix Global Insights
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