Introduction:
Affecting more than 25 million people in the United States, chronic obstructive pulmonary disease (COPD) is a progressive illness that
imposes an enormous burden on those affected and on the healthcare system. The
COPD market is substantial—totaling more than $4.3 billion in U.S. sales in 2007, and growth will be driven both by market-leading maintenance therapies
such as GlaxoSmithKline’s Advair (salmeterol/fluticasone) and Boehringer Ingelheim/Pfizer’s
Spiriva (tiotropium) and by more recently launched therapies such as
AstraZeneca's Symbicort (formoterol/budesonide). Using patient-level claims data,
as well as insight from 153 surveyed pulmonologists and primary care physicians
(PCPs), this report determines the share of each currently marketed drug by
line of therapy, analyzes why key drugs are chosen over others, and explains
how physicians predict that this dynamic will change over the next two years.
Questions Answered in This Report:
- Lines of therapy: Despite extensive clinical data demonstrating
Spiriva’s efficacy in improving quality of life in COPD patients, Spiriva is
positioned behind Advair in lines of therapy. What clinical and commercial
features of Advair lead to its positioning ahead of Spiriva? How do surveyed
physicians expect to use these drugs across lines of therapy differently over
the next two years than they do today? Where in lines of therapy are physicians
using Symbicort, and how will use of this agent shift over the next two years?
- Pathways to key therapies: Among single-agent inhaled
corticosteroid (ICS) therapies, one agent captures a larger share of its
patients from the first and second lines, indicating that physicians will
either use this drug early in lines of therapy or not at all. Which ICS is
used most often in the first and second lines? Which drugs do patients take
before each ICS, and what do these data reveal about their positioning relative
to one another? Which of the newly launched nebulized long-acting beta2
agonists (LABAs) will see more growth among surveyed physicians?
- Physician behavior: In preparation for the December 31,
2008, deadline for full compliance with the Montreal Protocol,
chlorofluorocarbon (CFC)-propelled inhalers are being removed from the market.
As of January 1, 2009, such products will no longer be available in the United States (unless they have an essential use designation from the FDA) and will be
replaced by hydrofluoroalkane (HFA)-propelled versions. Which branded
HFA-propelled rescue therapy do one-third of surveyed physicians say is not
available in their area, and how closely does this perceived shortage reflect
real availability versus the influence of marketing? What clinical or
commercial features of short-acting beta2 agonists (SABAs) drive
physician choice among agents in this class, and what can makers of each SABA do to improve their market position?
- Forecast: 55% of surveyed pulmonologists and 53% of
surveyed PCPs say they expect to increase their use of Symbicort over the next
two years. Which agents will see the most growth in COPD, and which agents
will be replaced? Which major class of agents will see robust growth on the
first line of therapy, and which major class will see most of its growth on the
second line? How will physicians react to possible outcomes of the FDA’s
decision regarding whether to allow Boehringer Ingelheim's Combivent (albuterol/ipratropium)
to remain on the market? Which agents will benefit if Combivent is removed from
the market?