Use of Monoclonal Antibody Disease-Modifying Therapies on the Rise in Multiple Sclerosis, Fueled Largely by the Introduction of Genentech's Ocrevus
According to the most recent quarterly update from Spherix Global Insights, multiple sclerosis-focused neurologists report increased use of monoclonal antibody disease-modifying therapies and a recent chart audit of over 500 patients on monoclonal antibody disease-modifying therapy highlights important characteristics for patients being selected for this class of disease-modifying therapies
EXTON, Pa., Jan. 10, 2018 /PRNewswire/ -- With the April 2017 launch of Genentech's Ocrevus, the monoclonal antibody (mAb) disease-modifying therapy (DMT) class share of DMT-treated multiple sclerosis (MS) patients has increased steadily over the past three consecutive quarters, according to neurologists' self-reported prescribing behavior in the RealTime Dynamix™: Multiple Sclerosis (US) report series. Approximately two out of five neurologists agree that, when initiating a patient on DMT treatment, they prefer to use an induction approach (i.e., initiate with a high efficacy option such as one of the mAb DMTs) as opposed to an escalation therapy approach. However, in the most recent RealTime Dynamix™, neurologists reported that only 10% of their Ocrevus-treated relapsing-remitting MS (RRMS) patients were treatment-naive prior to initiation of Ocrevus. To validate neurologists' self-reported prescribing behavior and perceptions with real world clinical experiences, Spherix Global Insights compared self-reported responses with MS patient audit data in over 2,600 patients in 2017.
The most recent audit, RealWorld Dynamix™: The Use of Monoclonal Antibody DMTs in MS, focused exclusively on MS patients currently treated with one of five mAb DMTs (i.e., Ocrevus, Genzyme's Lemtrada, Genentech's Rituxan, Biogen's Tysabri, or Biogen/AbbVie's Zinbryta). The study found that, when self-reported behavior is contrasted with patient-level data, neurologists overestimate the percent of their mAb DMT-treated patients who are currently on their third line or later therapy. The difference was particularly large for patients currently treated with Rituxan and Tysabri but also evident for Ocrevus (for relapsing MS) and Lemtrada. While neurologists report payers being at least somewhat restrictive during the current DMT selection process, only 28% of mAb DMT-treated patients were required to step through prior therapies before obtaining access to their current DMT. This finding suggests that payer-influenced treatment sequencing may not be a substantial barrier to increased use of mAb DMTs as induction therapy in appropriate candidates.
Unlike their self-reported concern with the risk-benefit profiles of individual mAb DMTs, neurologists report being not at all concerned with the risk-benefit profile of the current mAb DMT for half of the audited patients. This is consistent with the reported need for a high efficacy agent outweighing safety concerns in three-fifths of patients and a more physician-driven selection process for mAb DMTs. As an example, even with the recent EU Zinbryta label restrictions to reduce the risk of serious liver damage, neurologists report being completely comfortable with the DMT's risk-benefit profile in 60% of Zinbryta-treated patients that were included in the audit. The relatively low liver function levels among Zinbryta-treated patients compared with other mAb DMT subgroups suggest that neurologists may be minimizing hepatic safety concerns through careful prescreening for liver contraindications prior to Zinbryta selection.
The upcoming RealWorld Dynamix™: DMT New Starts in MS and RealWorld Dynamix: DMT Switching in MS, which will analyze over 2,000 unique patient records of newly initiated and recently switched patients in the US, will uncover how prescribing patterns have changed since the prior year's audits. According to Virginia Schobel, Neurology Franchise Head at Spherix, "These patient audits are essential to understanding the drivers of DMT brand choice at a very granular level. While claims data can be useful in helping to size patient segments and switching patterns, the patient audit data fills in the gaps around why therapy choices are made, what role patient requests play in therapy decisions, what alternative agents are being considered, and what the next step in the treatment algorithm will be if optimal outcomes are not achieved. These data help bridge the gap between self-reported treatment patterns and real world patient management."
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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