Spherix Global Insights

June 08, 2021

What Has the Evolution of Ocrevus Taught You About the MS Market? Here’s What I’ve Learned…

By: Virginia Schobel

 

 

June 9, 2021 – My name is Virginia Schobel and I’m the Neurology Franchise Head at Spherix Global Insights. I have spent the last 20 years monitoring and analyzing the multiple sclerosis (MS) markets in the United States, Canada, and Europe both on the client and vendor side – most recently supporting global insights for Copaxone and laquinimod at Teva Pharmaceuticals before joining Spherix. For the past four years, I have infused that passion for and expertise in MS to the primary market research conducted here at Spherix.

Over the last two decades, I have tracked the launches of many of the now 19 disease-modifying therapies (DMTs) approved for the treatment of MS. In my opinion, not one of these launches succeeded in shaking up the treatment paradigm more than Genentech’s Ocrevus in early 2017, with its high efficacy profile and broad label for both relapsing forms of MS and primary progressive MS (PPMS). Four years later, Ocrevus is still the only DMT approved for PPMS.

While working on a patient chart audit earlier this year, I was struck by the shifts I saw in what was motivating the prescribing of Ocrevus and what type of patient was initiating treatment with the brand.

Intrigued, I went back to look at Spherix’s physician-reported launch data from the first 18 months of Ocrevus availability and wondered what would their responses look like now with the entry of new products (most notably Novartis’ Kesimpta and Mayzent and EMD Serono’s Mavenclad) and the restrictions and concerns arising from the COVID-19 pandemic.

Two months later, those answers were shared with subscribed clients through the development of Special Topix™: Evolution of a Blockbuster – Ocrevus (US).

While Ocrevus’ unique PPMS indication created waves when the brand first launched in 2017, Genentech’s strategy to move Ocrevus up in the relapsing remitting MS (RRMS) treatment algorithm has also appeared to work well.

Here’s what I can tell you – while Ocrevus’ unique PPMS indication created waves when the brand first launched in 2017, Genentech’s strategy to move Ocrevus up in the relapsing remitting MS (RRMS) treatment algorithm has also appeared to work well.

Data from a Spherix survey fielded with 100 neurologists this past March show that, when compared to launch benchmarking data, Ocrevus’ prescribing has increasingly shifted away from PPMS to RRMS, with reported first-line use in that segment almost double compared to earlier launch metrics.

Indeed, data from our RealWorld Dynamix™ audit confirmed these perceptions when examining actual patient records, as Ocrevus’ share of first-line RRMS patients also nearly doubled over the past three years. Even more telling, these patients were less likely each year to have unfavorable prognostic profiles, suggesting that Ocrevus was not being reserved for only the most severe patients.

 

As Ocrevus becomes an increasingly viable early option for RRMS patients, the impact of the brand on competitors has also evolved. In 2017, neurologists reported that therapy switches to Ocrevus most often came from discontinuations of Biogen’s Tysabri. However, based upon both patient-level and self-reported data trends, fumarate agents (such as Biogen’s Tecfidera) and Novartis’ Gilenya are now under the most pressure.

 

Tecfidera is not only losing share to Ocrevus due to switches; it’s also losing potential new prescriptions, as Tecfidera is the DMT most often discussed with patients as another viable option when DMT-naïve RRMS patients are prescribed Ocrevus first line.

When could success actually circle back on Ocrevus? When a hot newcomer can claim the same benefit and build off the existing brand’s groundwork – such could be the case for Ocrevus and Kesimpta. In this case, the specific anti-CD20 mechanism of action has played an increasingly influential role in Ocrevus selection and is now one of the most common drivers of prescribing. This positive association has already benefited Kesimpta, a once-monthly subcutaneous anti-CD20, as mechanism of action drove more first-line selections of Kesimpta than Ocrevus in the most recent audit sampling this patient population.

 

The impact of COVID-19 is most clearly seen in Ocrevus discontinuations. Four years ago, discontinuations were primarily related to market access and infusion reaction concerns. Now, COVID-19-related concerns regarding sustained immunosuppression/vaccination response and patient requests to discontinue drive most switches from Ocrevus.

Among neurologists who reported decreased use of Ocrevus over the first three months of 2021, the majority rated both the COVID-19 pandemic and vaccine availability as highly influential in their shift away from the Genentech brand. It came as somewhat of a surprise to me which brands were benefiting most from these changes in Ocrevus prescribing patterns – as it was not always the most obvious answer.

 

Each year, the richness of Special Topix™: Evolution of a Blockbuster – Ocrevus (US) will evolve with the fielding of another “launch tracking” survey and additional patient-level data from our audits.

  • Five years postlaunch, will Ocrevus still enjoy easy gains across dynamic and subtype segments or will Kesimpta eat away at its dominance?
  • Six years postlaunch, how much will TG Therapeutics’ ublituximab muddy the waters for both brands?
  • Seven years postlaunch, will Genentech’s own fenebrutinib knock Ocrevus off of its throne in PPMS? Or could it be AB Science’ masitinib?

Join me to find out.

 

References:

Special Topix™: Evolution of a Blockbuster – Ocrevus (US) is a comprehensive service that captures the full scope of Ocrevus’ impact on the multiple sclerosis market through a combination of physician-reported and patient-level data. Historical launch trending has been augmented by fresh data capturing physician perceptions and prescribing patterns at the four-year post-launch mark, while chart audit data assess changes in the “when” and “why” behind Ocrevus prescribing (or discontinuations) among new start, switching, and progressive forms of MS patient segments.