Will impressive uptake of Novartis’ Mayzent in the active secondary progressive multiple sclerosis market over the past two years be enough to unseat Ocrevus in the US?
EXTON, Pa., October 27, 2020/PRNewswire/ — While the segment of multiple sclerosis (MS) patients with progressive disease remains underserved, numerous recent approvals for relapsing MS (RMS)—including active secondary progressive MS (SPMS)—have enhanced neurologists’ ability to treat active SPMS patients. Data from 764 charts of disease-modifying therapy (DMT)-treated patients with progressive forms of MS (PfMS), provided by 169 neurologists as part of Spherix’s RealWorld Dynamix™: Progressive Forms of Multiple Sclerosis (US) service, indicate that, although Genentech’s Ocrevus scores the top share position among active SPMS patients for the third year in a row, Novartis’ Mayzent is beginning to close the gap.
Mayzent, approved in March 2019, is now prescribed to nearly one in six active SPMS patients. While most MS DMTs are now indicated for all forms of RMS (clinically isolated syndrome, relapsing remitting MS, and active SPMS), Mayzent’s unique pivotal trial data from the EXPAND study in SPMS patients compels neurologists to consider it a top contender for active SPMS. Among patients currently prescribed Ocrevus, the treating neurologists frequently contemplated Mayzent as the most likely alternative choice (aside from another monoclonal antibody [mAb] DMT). While delaying disability progression is equally influential in brand selection decisions for both Mayzent and Ocrevus, the Spherix study found that approval for active SPMS is four times more influential in decisions to prescribe Mayzent than Ocrevus.
However, evidence suggests that Ocrevus will likely maintain its status as the most preferred and most commonly prescribed DMT in active SPMS. Surveyed neurologists are highly satisfied with the majority of their active SPMS patients’ responses to Ocrevus so far (among patients for whom neurologists have already evaluated success of the current DMT), and approximately two-thirds of active SPMS patients currently prescribed Ocrevus are very unlikely to switch DMTs within the next six months. Although well-equipped with clinical trial data, Mayzent faces an uphill battle to meaningfully challenge Genentech’s brand.
In primary progressive MS (PPMS), Ocrevus stands out even further, as no other DMTs appear close to competing with the only FDA-approved option. Owing to neurologist expectations of efficacy in delaying disability progression and reducing inflammatory disease activity, as well as Ocrevus’ indication for PPMS, neurologists turn to the mAb DMT for nearly three out of five of their PPMS patients. Ocrevus is a common choice across lines of therapy, including DMT-naïve PPMS patients. Furthermore, among patients diagnosed with PPMS who are not currently prescribed Ocrevus, nearly one-third would switch to the brand if their current DMT proves unsuccessful.
While options currently approved for RMS stand little chance of rivaling Ocrevus’ dominance in PPMS, numerous pipeline agents have potential to test the DMT giant. Novartis’ recently approved Kesimpta is best positioned for direct competition, with its similar mechanism of action to Ocrevus coupled with subcutaneous dosing (allowing for at-home administration). In concordance with Kesimpta’s RMS indication, audit data indicate that half of the very-likely PfMS candidates for Kesimpta (assuming failure of their current DMT) are diagnosed with active SPMS. However, more than one-third of Kesimpta candidates are diagnosed with PPMS, suggesting at least some uptake in this segment (assuming minimal payer restrictions on this off-label use) centered on belief in the utility of the anti-CD20 mechanism for delaying disability progression.
Looking further down the pipeline, AB Science’s orally-dosed masitinib, which is in development specifically for non-relapsing SPMS and PPMS, has an even higher candidacy rate among PPMS patients than Kesimpta. Additionally, BTK inhibitors, such as Sanofi Genzyme’s tolebrutinib and Genentech’s fenebrutinib, will undergo assessment in progressive MS; in fact, fenebrutinib will be studied in PPMS using Ocrevus as the active comparator. Although Ocrevus may continue to monopolize the PPMS market in the near future, the numerous ongoing clinical development programs for the treatment of PPMS will begin to open the door for future competition.
About RealWorld Dynamix™
RealWorld Dynamix™ is an independent, data-driven service unveiling real patient management patterns through rigorous analysis of large-scale patient chart audits. Insights reveal the “why” behind treatment decisions, include year over year trending to quantify key aspects of market evolution, and integrate specialists’ attitudinal & demographic data to highlight differences between stated and actual treatment patterns.
The third annual audit of RealWorld Dynamix™: Progressive Forms of Multiple Sclerosis (US) published last week, the fifth annual audit of RealWorld Dynamix™: DMT Switching in Multiple Sclerosis (US) published in April, and the fourth annual audit of RealWorld Dynamix™: DMT New Starts in Multiple Sclerosis (US) published in February.
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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