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RealWorld Dynamix: DMT Switching in Multiple Sclerosis EU

The EU multiple sclerosis (MS) market has become fiercely competitive with the introduction of multiple disease-modifying therapies (DMTs), including Genentech’s Ocrevus and Merck KGaA’s Mavenclad for relapsing forms of MS (RMS) and Ocrevus’ first-in market label for primary progressive MS (PPMS). Pipeline therapies, such a Novartis’ Mayzent, the first potential secondary progressive MS (SPMS) therapy could further transform patient management. While the availability of multiple therapeutic tools is theoretically beneficial to the patient and neurologist, deciphering which treatment is best for which patient and when to switch therapies is a major challenge. With diagnosis occurring earlier in the disease course and guidelines stressing the benefit of timely DMT treatment, the possibility of cycling through multiple therapies is a reality for a substantial subset of MS patients. Understanding when, why, and to which product a neurologist will transition a patient is critical to building an effective commercial strategy for both first-line and later-line therapies.

RealWorld Dynamix™: DMT Switching in MS (EU) blends attitudinal and demographic physician survey data with patient record data to uncover how 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 recently switched patients.

Spherix Global Insights conducts an online survey with ~250 EU neurologists (France, Germany, Italy, Spain, UK) combined with a large-scale patient record audit of over 1,250 of their MS patients that were switched to a different DMT within the past three months. Each neurologist completes an in-depth retrospective review of their last 3-7 patients who meet specific study criteria. Surveys are programmed in the local language.

The 2019 wave is the second wave of the report (first published in 2018)

Learn more about RealWorld Dynamix™ reports here.

  • How do patients’ disease activity metrics and prognostic factors influence brand selection for the most recent switch?
  • How has newcomers, Mavenclad and Ocrevus, been prescribed and which competitors are feeling the greatest impact?
  • What are the most frequently prescribed agents for efficacy/safety/tolerability/patient/payer-driven switches?
  • How do second-line switches differ from third and later line switches? How much time do patients spend on their previous agent before switching?
  • What is the profile of a patient being switched from first-line injectable DMT versus oral DMT? Where do patients go if being switched from first-line induction therapy like Mavenclad or Sanofi’s Lemtrada?
  • How does switching decisions differ between MS subtypes (CIS, RRMS, active SPMS, not active SPMS, PPMS)?
  • What is the opportunity cost for each brand (e.g., where would their brand have been selected if the first choice was not available)?
  • Are neurologists willing to sacrifice safety risk for more efficacy in certain populations of MS patients? How does anti-JC virus antibody serostatus shape the patient pathway?
  • What is the patient profile for switching to Novartis’ Mayzent? Celgene’s ozanimod? Biogen/Alkermes’ diroximel fumarate?

Commercial Products
Bayer (Betaferon), Biogen [Avonex, Plegridy, Tecfidera, Tysabri, (historically) Zinbryta], Merck KGaA (Rebif, Mavenclad*), Novartis (Gilenya, Extavia), Roche (Ocrevus*, MabThera), Sanofi (Aubagio, Lemtrada), Teva (Copaxone), multiple companies (rituximab, generic glatiramer acetate)

*May still be pending reimbursement/pricing in certain EU markets at time of fielding

Pipeline Agents
AB Science (masitinib), Biogen [diroximel fumarate (with Alkermes)], Celgene (ozanimod), J&J/Actelion (ponesimod), MedDay (MD-1003), MediciNova (ibudilast), Novartis (Mayzent*, ofatumumab), TG Therapeutics (ublituximab)

*Could move to commercial products based upon regulatory outcomes


Roche’s Ocrevus Continues to Impress in the EU with Strong Uptake in New Start and Switch Multiple Sclerosis Patient Segments, but Novartis’ Mayzent and Ofatumumab May Threaten the Brand’s Long-Term Dominance – April 9, 2020

Novartis’ Gilenya, Sanofi’s Aubagio, Biogen’s Tysabri and Tecfidera Capture the Majority of Recent Switches in the European Multiple Sclerosis Market Boosted by Frequent Neurologist Endorsement – August 13, 2019