EXTON, Pa., Feb. 27, 2019 /PRNewswire/ -- In the latest quarterly wave of RealTime Dynamix™: Atopic Dermatitis (US) published last week, US dermatologists (n=102) report continued uptake of Sanofi/Regeneron's first-to-market biologic, Dupixent, for the treatment of atopic dermatitis (AD), with a growing number of patients being initiated on the drug each quarter. However, overall use of the IL-13/4 inhibitor in the EU5 is not as vigorous as it is in the US, according to Spherix Global Insights' inaugural wave of the bi-annual RealTime Dynamix™: Atopic Dermatitis (EU) report series (n=262 EU5 dermatologists). Having gained European Medicines Agency (EMA) approval a short six months after the US FDA approval, Dupixent has not yet garnered the same momentum that is has in the states, though three-quarters of EU5 respondents do report use of the drug in at least one of their AD patients. Indeed, over half of the respondents in both studies indicate a high unmet need for new pharmacologic options for the treatment of AD – higher than that in psoriasis, in which there are a plethora of biologic agents to choose from.
With increased initiations also comes discontinuations. In the US, more than half of respondents discontinued Dupixent in at least one patient, although overall persistency rates have remained stable quarter over quarter. In the majority of cases, patients were on Dupixent for less than six months prior to ceasing treatment, and lack of efficacy was the most frequently cited reason for stopping treatment. Discontinuations relating to insurance and out of pocket costs declined for the second quarter in a row, while those related to side effects are the highest reported to date. Indeed, US dermatologists report that 10% of all Dupixent-treated patients have experienced an ocular side effect associated with their Dupixent treatment, and respondents report stopping treatment in almost one-fifth of those cases. Overall, and consistent with US reports, just over one-tenth of all Dupixent patients in the EU5 have subsequently discontinued treatment after initiation. Of note, respondents from Germany appear more willing to cease treatment, as significantly more German patients have discontinued compared to France and Italy. The leading reason for discontinuations in France, Italy and the UK mimics that of the US (lack of efficacy), while patients achieving remission accounts for more stoppages in Germany and Spain.
The real discrepancy between US and EU5 dermatologists is seen in the use of Dupixent as a short-term/flare management treatment, with EU5 dermatologists reporting that double the amount of their Dupixent patients are being treated with a short-term course of the IL-13/4 inhibitor, compared to their US counterparts (as opposed to long-term maintenance therapy). However, the reasons behind short-term treatment align in both geographical areas and are largely due to patient remission/skin clearance and patient request. Of note, the majority of US dermatologists believe that their patients would prefer an oral agent over a subcutaneous (SC) administered agent (assuming comparable efficacy), and over half agree that they would be more inclined to prescribe an oral agent for short-term flare management than they would a SC biologic – which may lead to Sanofi/Regeneron losing patients who solely use the brand when experiencing flares. Indeed, acute use may call into question the longevity of prescriptions at the patient level and allow for ample competition of pipeline agents with patient-preferred modes of administration.
Regarding the robust pipeline for the treatment of moderate-to-severe AD, JAK inhibitors (AbbVie's upadacitinib, Eli Lilly's baricitinib, and Pfizer's abrocitinib) arguably have the potential to disrupt the market with a new mechanism of action and sought-after administration – even more so in the EU, where the extent of experience prescribing baricitinib (Olumiant) in rheumatoid arthritis will likely provide a boost in uptake for the treatment of AD. Indeed, EU5 dermatologists are split on whether JAK inhibitors or IL-13 inhibitors have the greatest potential to treat the disease, if approved. On the contrary, while US dermatologists most certainly view JAK inhibitors as filling a large unmet need for AD treatment, Galderma's IL-31 inhibitor, nemolizumab, was selected with the greatest frequency as the agent they would most like to see gain approval, notably due to the unique mechanism and respect Galderma has as a strong partner in dermatology. With both US and EU5 dermatologists reporting that the biologic/small molecule candidate pool is substantially greater than the currently treated Dupixent population, there is ample room for new biologics or other advanced systemic treatments to enter each market.
About RealTime Dynamix™ The RealTime Dynamix™: Atopic Dermatitis (US) report series provides a detailed and timely look at current and future trends in the AD market, and the effects of the future shifting landscape. The quarterly releases allow for close monitoring and trending of key performance metrics. In addition to the fixed trended measures, the report also includes variable content addressing key current issues updated quarterly. The rapid field-to-insight turnaround time, highly relevant content, and unparalleled knowledge of the dermatology market make this an essential tool for companies competing in the space, as well as those with near-term plans to enter it. A parallel report tracking the EU5 (France, Italy, Germany, Spain, and the UK) atopic dermatitis landscape, RealTime Dynamix™: Atopic Dermatitis (EU), publishes on a bi-annual basis.
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.
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