EXTON, Pa., July 6, 2020 /PRNewswire/ -- Results from the seventh wave of an ongoing study examining the impact of COVID-19 on specialty physician practices were released last week and offer a glimmer of optimism about the path forward. In all, 257 dermatologists, gastroenterologists, nephrologists, neurologists, and rheumatologists provided feedback about the impact on their practices, strategies they have adopted to function during the outbreak, the involvement with pharmaceutical companies and promotion, and their future outlook and concerns.
Overall, substantial shifts have been observed between early May and early June, with 39% of respondents reporting their practices are now fully open and following social distancing guidelines (up from just 15% in May). Furthermore, the percent of specialists reporting they are currently "sheltering in place, operating essential businesses only" decreased from 34% in May to just 5% in June. Despite these indicators of rebound, fewer than 10% report that their practice operations have returned to normal (or above normal) capacity.
Gastroenterology has been one of the hardest hit groups, losing a substantial part of revenue from elective procedures. None of the surveyed gastroenterologists report that practice operations are back to normal, with 38% stating they are operating at less than half their patient capacity levels. More than one-quarter report it will take more than six months for patient volume to return to normal levels. The greatest impacts have been on the use of telemedicine, which most gastroenterologists had no experience with prior to the COVID-19 outbreak, and the financial impact to practices. In an attempt to buffer against financial doom, more than half have reduced office hours, and a similar percentage were forced to furlough employees. In terms of impact to brands used to treat inflammatory bowel disease (IBD), after some hesitation to initiate new patients early in the outbreak, gastroenterologists now seem to be reverting to previous practice patterns. Some concern remains, as 30% agree that treatment with biologic agents does pose a greater risk of COVID-19 infection.
Dermatologists, who previously aligned with gastroenterologists as being disproportionately impacted, seem to be rebounding at a faster rate. Half of those surveyed report that they are operating at 75% or greater capacity, and more than one-third expect the bounce back to be complete within two months. Office visits, while still depressed from normal levels, showed a marked uptick compared to the beginning of May. Some lasting impact to brand utilization can be expected, as more than 40% report that COVID-19 has influenced the brands they intend to prescribe. Mirroring patterns already in motion before COVID-19, TNF inhibitors and Janssen's Stelara may be the most negatively impacted, while Amgen's Otezla, IL-23 inhibitors (including Janssen's Tremfya, AbbVie's Skyrizi, Sun Pharma's Ilumya), and Sanofi-Regeneron's Dupixent could potentially see upside.
Rounding out the autoimmune specialists, rheumatologists report average offsets to pre-COVID office visits are still down in excess of 60%, but they continue to expand their use of telemedicine and appear to be comfortable initiating therapy and making treatment changes virtually. Compared to gastroenterologists and dermatologists, rheumatologists estimate a higher percentage of their patients are at high risk of complications from COVID-19. They also are more likely to report issues related to their patients' ability to fill prescriptions, likely lingering sentiments related to hydroxychloroquine shortages reported in earlier months of the pandemic. Generally speaking, rheumatologists have weathered the pandemic marginally better than their dermatology and gastroenterology counterparts, and a significantly lower percentage of rheumatologists have applied for and/or received a loan under the stimulus package compared to other autoimmune specialists. Even though they report concerns about the financial health of their practice, this is becoming less overt.
The surveyed neurologists are also reporting some rebound, however, they remain concerned about risk in their MS patients, particularly those being treated with immunosuppressive disease modifying therapies (DMTs) such as Novartis' Gilenya and Mayzent, Roche-Genentech's Ocrevus, Biogen's Tysabri, and Sanofi-Genzyme's Lemtrada. Neurologists also report hesitancy in adopting new agents, such as BMS' Zeposia at this time. The respondents estimate that more than one-third of their MS patients are at high risk of developing complications from COVID-19 compared to just 2% of their migraine patients. The major shift in the migraine space seems to be less use of Botox due to its requirement for in-office administration. Lundbeck's Vyepti, administered as an infusion, also appears to be somewhat stifled, as more than 30% report being less likely to initiate treatment with the new brand at the current time.
Nephrology has been perhaps the least impacted specialty, as for the most part, dialysis administration was business as usual, and large chains, like DaVita and Fresenius, stepped in early with contingency plans to combat disruptions from the outbreak. Nephrologists pumped the breaks a bit on sending patients for vascular access creation, proceeding with kidney transplants, and ordering IV iron infusions in non-dialysis patients, but reported being more likely to start or switch dialysis patients to a home modality. Although office visits were also down for nephrology, there was quick adaptation to and implementation of telemedicine, albeit some frustration early on with patients – who are typically older and struggled to use the technology and some who simply did not have home access to telemedicine platforms. Among all the specialists surveyed, nephrologists had the highest estimates of patients in the high-risk group for COVID-19 complications.
Industry engagement overall remains largely virtual, and specialists anticipate their interaction with pharmaceutical representatives to look different once their practices are re-opened. Sales representative visits will likely be by appointment only (if they happen at all), and representatives may be screened and/or required to wear masks and avoid any common areas. Most would like to see industry conferences return to the traditional, in-person format, but for now are glad that associations are conducting them virtually rather than cancelling altogether. Navigating the future path of engagement will be a big challenge for industry as the re-opening process further develops.
Spherix will engage specialists on a monthly cadence assessing the evolving impact of the COVID-19 pandemic. The next wave of research will be fielded on July 10th.
About the Special Report Special Report: Multi-Specialty Impact of COVID-19 is an ongoing series of weekly (until mid-May) and monthly (from June to September) monitoring that evaluates the impact of COVID-19 on physicians and their practices – including, but not limited to, the utilization of telemedicine, at-risk patient groups, key concerns, support from industry, and future changes in prescribing patterns. Specialty reports are available for dermatology, gastroenterology, nephrology, neurology, and rheumatology.
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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