March 12, 2019
Two Years After Launch of Genentech’s Ocrevus, US Neurologists Report a Significant and Persistent Increase in the Treatment of Patients with Primary Progressive Multiple Sclerosis
According to a new report from Spherix Global Insights, Novartis’ Mayzent is anticipated to grow the size of the secondary progressive multiple sclerosis segment in the United States, decreasing the influence of the relapsing remitting multiple sclerosis segment on market dynamics
EXTON, Pa., March 12, 2019 ―Expanding adoption of Genentech’s Ocrevus among US neurologists has significantly and persistently increased the rate of disease-modifying therapy (DMT) treatment among patients with primary progressive multiple sclerosis (PPMS) compared to two years ago. In the current wave of the ongoing quarterly RealTime Dynamix™: Multiple Sclerosis (US) report series, neurologists (n=99) report that one-third of Ocrevus-treated patients are diagnosed with PPMS with two out of five PPMS patients being new additions to the DMT-treated patient pool. Indeed, first-line positioning for Ocrevus remains a heavily messaged position during Genentech’s frequent details with surveyed neurologists. Compared to five months after Ocrevus launch, fewer DMT-treated PPMS patients are considered to be nonresponders to their current DMT (predominantly Ocrevus), and the Ocrevus discontinuation rate remains low with PPMS representing less than half of all neurologist-reported discontinuations. Together, these data suggest that Ocrevus uptake may be diminishing the pool of untreated or switch candidates for future PPMS product launches, such as MedDay Pharmaceuticals’ Qizenday (MD-1003), AB Science’s masitinib, and MediciNova’s ibudilast. DMTs that show evidence of efficacy in chronic or advanced PPMS and/or directly address issues underlying patient refusal of therapy (the most commonly reported reasons for PPMS nontreatment) will have the best chance of successfully competing with Ocrevus or winning patient switches away from Ocrevus.
Turning our attention to the next potential DMT launch, Novartis’ Mayzent, under regulatory review for the treatment of SPMS, could transform the MS treatment paradigm through increased SPMS diagnosis and higher DMT treatment rates, especially among not active SPMS patients. While the active secondary progressive multiple sclerosis (SPMS) segment represents the most obvious new business opportunity for Mayzent, neurologists are almost as willing to prescribe Mayzent to patients transitioning from relapsing remitting multiple sclerosis (RRMS). Such a position would represent an early switch opportunity for Mayzent that could moderate the current pattern of switching to monoclonal antibody DMTs at this point in the treatment algorithm. With most neurologists believing that payers will require a SPMS transition chart notation for Mayzent qualification and few hesitant to note such a transition (perhaps due to the already high prelaunch DMT treatment rate among the most likely Mayzent segment of active SPMS patients), the SPMS split of DMT-treated patients should expand along with Mayzent adoption. Consistent with that prediction, neurologists estimate that, two years post-Mayzent approval, significantly more of their MS patients will be diagnosed with SPMS ― decreasing the influence of the DMT-treated RRMS segment on market dynamics and forecasting.
If neurologists and not active SPMS patients are given a persuasive reason to switch or re-enter the treated pool, Mayzent could dominate the not active SPMS segment, similar to that seen with Ocrevus in the PPMS segment. With many not active SPMS patients again not treated due to chronic or advanced disease or patient refusal, as well as a high level of patient attrition, the DMT treatment rate for this segment is roughly that reported for PPMS. Compared to active SPMS, neurologists are significantly less likely to agree that DMTs approved for RMS are effective in not active SPMS and, perhaps as a result, they are also less likely to agree that they typically switch patients when they transition to not active SPMS. Indeed, the switch candidacy rate is lower among DMT-treated not active SPMS patients, who are experiencing less of the active inflammation markers of nonresponse. As such, fewer not active SPMS patients are considered potential Mayzent candidates compared to active SPMS patients. While these current market dynamics may initially limit Mayzent opportunity in this segment, Novartis has the positive disability progression risk reduction and cognition processing speed data in nonrelapsing SPMS patients to drive an increased treatment rate through preferential Mayzent use in a less competitive environment.
Mayzent competitive pressure will be felt across the DMT classes, although Novartis’ own Gilenya is unanimously in the crosshairs due to its similar mechanism of action and position as the only oral high-efficacy DMT. Neurologists believe that Genzyme’s Aubagio and Biogen’s Tecfidera may also feel competitive pressure due to their similar dosing profiles and current broad use among SPMS patients, Ocrevus and Tysabri due to their high-efficacy positioning for active SPMS patients, and Teva’s Copaxone due to its use in the not active SPMS segment when safety and tolerability are valued more than efficacy. In the upcoming RealWorld Dynamix™: DMT Switching in Multiple Sclerosis (US) patient audit, Spherix Global Insights will further analyze the potential for second-line or later competition of DMTs in development, including Mayzent, EMD Serono’s Mavenclad, Celgene’s ozanimod, and Biogen’s Vumerity, with currently marketed DMTs based upon real world patient situations.
About RealTime Dynamix™
RealTime Dynamix™: Multiple Sclerosis (US) is an independent report series published on a quarterly basis. The series provides a close-quarters analysis of key performance metrics, focusing on brand gains and losses, industry contact rates, familiarity and adoption patterns of recently launched products (e.g., Mayzent, Mavenclad, and Vumerity in 2019) 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 will be published in June 2019.
About RealWorld Dynamix™
RealWorld Dynamix™: DMT Switching in Multiple Sclerosis (US) blends physician self-reported data with actual patient chart records from the same physicians to uncover differences in how physicians report managing their patients and how specific populations are managed differently. It augments claims data by providing the “why” behind the switching behavior and by providing essential details not available in claims data that may be driving the switch, such as MS subtype, payer pressure, co-morbid conditions, or patient requests.
About Spherix Global Insights
Spherix Global Insights is an independent business intelligence and market research company, specializing in renal, autoimmune, neurologic and rare disease markets. Our aim is to apply our commercial experience and unique relationships within core specialty markets to translate data into insight, enabling our clients to make smarter business decisions.
All company, brand or product names in this document are trademarks of their respective holders.
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