Is there trouble in paradise for Genentech? US neurologist reevaluation of Ocrevus in PPMS patients, along with competitive pressure from Bristol Myers Squibb’s Zeposia, Novartis’ ofatumumab, and Janssen’s ponesimod, will further test the resiliency of the current leaders in the switch segment
EXTON, Pa., April 30, 2020/PRNewswire/ — Genentech’s Ocrevus, Teva’s Copaxone, and Biogen’s Tecfidera score the top three share positions among patients who recently switched to a different disease-modifying therapy (DMT). The diverse clinical profiles of the current share leaders underscore the importance of each DMT class in this multiple sclerosis (MS) patient segment, with Ocrevus—a monoclonal antibody (mAb)—displacing Novartis’ Gilenya from the top three brands with the highest switch share.
Chart audit data from 1,009 patients switched to a new DMT within the past three months, provided by 204 neurologists in Spherix’s RealWorld Dynamix™: DMT Switches in Multiple Sclerosis (US) service, indicate that the percentage of later-line switches among audit patients continue to decline with the move of higher-efficacy options to the earlier lines of the MS treatment algorithm. However, brewing changes in switching patterns across lines of therapy and MS subtypes portend shifts in the power dynamic within the recently switched segment. Furthermore, profiling of patient candidates for the emerging agents—in particular, Bristol Myers Squibb’s Zeposia (ozanimod) and Novartis’ ofatumumab, as well as Janssen’s ponesimod—suggests future challenges for current mainstays.
At a class level, a “floor effect” for the total use of glatiramer acetate (GA) agents in the switch segment has emerged, as historical declines in GA shares have stabilized over the past year. The use of GA for patients with clinically isolated syndrome (CIS) and relapsing-remitting MS, as well as those for whom safety (including concerns related to pregnancy planning and teratogenicity) is prioritized, maintains the relevance of the GA class.
Despite the widespread availability of generic GA, Copaxone remains a key option for patients switching to a new DMT, with overall switch share second only to Ocrevus. A brand-loyal contingent of neurologists, valuing the predictability and comfort Copaxone provides, protects the brand from substantial generic erosion. Indeed, Copaxone continues to account for the majority of total GA class share among recently switched patients and, among patients switching between GA agents, more move from a generic version to the brand than from the brand to a generic, further confirming the impact of neurologist familiarity with Copaxone.
Although Tecfidera is still a major player in the switch segment, the ever-crowding DMT landscape (including the recent expansion of the oral DMT class with two higher-efficacy options, EMD Serono’s Mavenclad and Novartis’ Mayzent) threatens Tecfidera’s foothold. The years-long decline in Tecfidera’s overall share of DMT switches has accelerated over the past two years, as all established oral DMTs lose switch share to the newer oral options and Ocrevus. As a result, Tecfidera incurs diminishing gains from the switch segment, making the maintenance of its positioning as a strong first-line choice paramount for the brand’s continued success. However, data from Spherix’s RealWorld Dynamix™: DMT New Starts in Multiple Sclerosis (US) audit—showing that shifting competitive patterns have cut into Tecfidera first-line shares—signal a difficult road ahead for the brand.
Much of Tecfidera’s decline may be attributed to the substantial growth of Ocrevus’ share of first-line switches among relapsing MS (RMS) patients. Ocrevus has established itself as a gateway mAb DMT, posing stiff competition for both oral and other mAb DMTs in early switches in RRMS and active secondary progressive MS (SPMS). Especially in active SPMS, even when Ocrevus was not chosen as the switch-to DMT, it was considered the top alternative for patients who went on to switch to Mayzent, Mavenclad, Sanofi’s Lemtrada, or Biogen’s Tysabri.
What Ocrevus has gained in share among RMS patients, it has lost in primary progressive MS (PPMS) business: compared to audit data from 2018 and 2019, Ocrevus share of first switches among PPMS patients has plummeted by over 60%. A similar trend was observed in two recent Spherix audits—RealWorld Dynamix™: Progressive Forms of Multiple Sclerosis (US) as well as the new start audit—where Ocrevus share among PPMS patients has decreased substantially compared to previous years.
Additionally, although Ocrevus is often part of the DMT switching discussion between neurologists and their RMS patients, it was rarely offered as an alternative DMT to PPMS patients who ended up switching to an agent other than Ocrevus. Signs point to uncertainty among neurologists that Ocrevus is the best option for progressive MS, in which disability accumulation is likely to occur independent of active inflammation or relapses. In the upcoming RealTime Dynamix™: Multiple Sclerosis (US) Q2 2020 survey, Spherix will further assess how neurologists’ stated DMT preferences vary by MS subtype, as well as how certain patient characteristics impact which DMT is preferred.
About RealWorld Dynamix™
RealWorld Dynamix™ is an independent, data-driven service unmasking real patient management patterns through annual reports based on chart audits of ~1,000 patients. The report uncovers the “why” behind treatment decisions, includes year over year trending to quantify key aspects of market evolution, and integrates specialists’ attitudinal & demographic data to highlight differences between stated and actual treatment patterns. The fifth annual audit of RealWorld Dynamix™: DMT Switching in Multiple Sclerosis (US) published last week and the fourth annual audit of RealWorld Dynamix™: DMT New Starts in Multiple Sclerosis (US) published in February.
About RealTime Dynamix™
RealTime Dynamix™: Multiple Sclerosis (US) is an independent service providing strategic guidance through rapid and comprehensive quarterly reports, which include market trending, launch tracking, and a fresh infusion of unique content with each wave. The next quarterly report publishes in June.
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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