However, Only 15 Percent of Surveyed MCO Pharmacy Directors Perceive Donepezil Plus Memantine to Be the Most Efficacious Treatment for the Indication, According to Findings from Decision Resources
March 8, 2011 – Burlington, Mass.—Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that the majority of surveyed neurologists (78 percent) consider the combination of donepezil (Eisai/Pfizer’s Aricept, Bracco’s Memac, generics) plus memantine (Merz Pharmaceuticals/Grünenthal’s Axura, Lundbeck’s Ebixa, Forest Laboratories’ Namenda) to be the most efficacious treatment for mild to moderate Alzheimer’s disease compared with other currently available treatments, despite memantine’s labeling only for moderate to severe Alzheimer’s disease. However, only 15 percent of surveyed managed care organizations’ (MCOs) pharmacy directors perceive the combination regimen to be the most efficacious treatment for mild to moderate Alzheimer’s disease.
The findings from Decision Resources’ analysis of the Alzheimer’s disease drug market reveal that the combination of an acetylcholinesterase inhibitor (AChEI), most often donepezil, plus memantine is increasingly considered to be the clinical standard of care for the treatment of mild to moderate Alzheimer’s disease. This finding is echoed by interviewed thought leaders who report prescribing the two drugs in combination to their mild to moderate Alzheimer’s disease patients in an attempt to provide greater efficacy than what may be attained with either therapy alone. This prescribing pattern occurs despite clinical trial data in mild to moderate Alzheimer’s disease showing no benefit to adding memantine to an AChEI. Such combination use in mild to moderate Alzheimer’s disease is likely inspired by data from clinical trials in moderate to severe Alzheimer’s disease, in which the combination of donepezil and memantine showed a slight but statistically significant improvement in efficacy over donepezil alone.
Although the majority of surveyed neurologists perceived the donepezil plus memantine combination to be the most efficacious treatment, these neurologists indicated that they were only neutral to satisfied with the donepezil plus memantine combination on all efficacy attributes, including key efficacy measures such as effect on cognitive decline, effect on function and effect on behavior.
“The small proportion of payers who selected the donepezil plus memantine combination as being the most efficacious reported being dissatisfied to neutral with the combination on efficacy attributes,” said Decision Resources Analyst Georgiana Kuhlmann, M.Sc. “Payers are likely less familiar with how the efficacy of donepezil and memantine in combination compares with that of the drugs when used as monotherapies because very limited clinical data are available regarding the efficacy of the combination in mild to moderate Alzheimer’s disease. Furthermore, while neurologists learn through their own experience treating patients, or through colleagues’ experiences, payers have access only to clinical trial data, which for an AChEI plus memantine in mild to moderate Alzheimer’s disease is lackluster.”
Surveyed neurologists and MCO pharmacy directors agree that effect on cognitive decline is one of the attributes that most influences their decisions regarding prescribing and tier placement decisions, respectively, in mild to moderate Alzheimer’s disease. Clinical data and the opinions of interviewed thought leaders indicate that Eli Lilly’s anti-beta-amyloid monoclonal antibody solanezumab, Johnson & Johnson/Pfizer’s anti-beta-amyloid monoclonal antibody bapineuzumab and Baxter’s Gammagard, all potentially disease-modifying therapies currently in clinical trials, have advantages over sales-leading donepezil on this attribute.
The findings also reveal that the total Alzheimer’s disease market will triple over the next decade, increasing from $4.1 billion in 2009 to $12 billion in 2019 in the United States, France, Germany, Italy, Spain, the United Kingdom and Japan. The emergence of new potentially disease-modifying biologic agents, most notably solanezumab and bapineuzumab, and the expanding prevalent population will be the key drivers of market growth.
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