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RealWorld Dynamix: DMT New Starts in Multiple Sclerosis US

The US multiple sclerosis (MS) market has become fiercely competitive with the introduction of multiple disease-modifying therapies (DMTs) over the past several years, including generic glatiramer acetate (GA) agents and Genentech’s Ocrevus, the first DMT indicated for primary progressive MS (PPMS). As physicians, patients, and industry adapt to these changes, brand choice for the coveted firstline position will be influenced by a multitude of clinical variables, such as patient demographics/characteristics, prognostic profiles, biomarkers, comorbidities, and QOL metrics, as well as anticipated brand performance and breadth of therapy choice for patients’ diagnosed MS subtype.

RealWorld Dynamix™: DMT New Starts in MS (US) blends attitudinal and demographic physician survey data with patient record data to uncover how neurologists’ practice type and setting and certain beliefs influence the treatment pathway and to understand how marketed DMTs are being used by physicians and for what patient types. The report also captures physician’s perspectives about products in development and the impact they will have on the current treatment paradigm among new start patients.

Spherix Global Insights conducts an online survey with ~200 US neurologists combined with a large-scale patient record audit of over 1,000 of their MS patients recently started on their first-line DMT. Each neurologist completes an in-depth retrospective review of their last three to seven patients who meet specific study criteria. Respondents are recruited from the Spherix Network, a proprietary group of clinical neurologists meeting our strict screening criteria. Our relationship with this network leads to more engaged respondents resulting in higher quality output. Additionally, this gives us the opportunity to more easily revisit physicians to uncover even more insight on strategically important findings.

This is the third wave of the report (first published in 2017).

Learn more about RealWorld Dynamix™ reports here.

  • What are the key drivers (e.g., efficacy/safety/tolerability/patient/payer) for first-line DMT selection? To what extent do patient requests influence each brand? How much influence do payers exert on the final choice?
  • What is the profile of a previously treatment-naïve patient being started on an interferon vs. GA agent vs. oral vs. monoclonal antibody DMT?
  • How does first-line use differ between RRMS and PPMS patients?
  • What is the opportunity cost for the brands (e.g., where would their brand have been selected if the first-line DMT was not available)?
  • How is the availability of generic glatiramer acetate impacting overall share of the glatiramer acetate class? When prescribing Copaxone, do neurologists make a conscious effort to avoid generics? When prescribing generic glatiramer acetate, do neurologists specifically prescribe the generic or is it payer driven?
  • Are neurologists willing to sacrifice safety for more efficacy in certain populations of MS patients (i.e., based upon their prognostic profile)?
  • How frequently are neurologists using various biomarkers (i.e., JCV serostatus, sNfL, oligoclonal bands) and does the result shape the patient pathway?
  • How long do neurologists plan to treat patients with the first-line DMT (i.e., finite treatment or for suboptimal response) and how does it differ between brands or by patient type?
  • What will be the impact of pipeline DMTs on the current first-line treatment algorithm? What are the most likely patient profiles for the pipeline DMTs?

Commercial Products
Bayer (Betaseron), Biogen (Avonex, Plegridy, Tecfidera, Tysabri), EMD Serono (Rebif), Genzyme (Aubagio, Lemtrada), Genentech (Ocrevus, Rituxan), Mylan (generic glatiramer acetate), Novartis (Gilenya, Extavia), Sandoz (Glatopa), Teva (Copaxone)

Pipeline Agents
AB Science (masitinib), Biogen/Alkermes (diroximel fumarate), Celgene (ozanimod), EMD Serono (Mavenclad), J&J/Actelion (ponesimod), MedDay (MD-1003), MediciNova (ibudilast), Novartis (siponimod, ofatumumab), TG Therapeutics (ublituximab)


Bristol Myers Squibb’s Zeposia and Janssen’s Ponesimod Could Be Early-Line Winners, While Biogen’s Vumerity Appears Relegated to Tolerability Switches Within the Fumarate Class – June 16, 2020

Overall Share of Ocrevus Remains Stable Among Recent New Start Patients, Yet Genentech’s Efforts to Increase First-Line Use Appears to be Paying Off in the Dominant Relapsing-Remitting Multiple Sclerosis Subgroup – February 11, 2020