Introduction:
Early-line treatment choice in psoriasis depends on the
location of psoriatic plaques and the extent to which plaques cover the body
surface. Our analysis of patient-level claims data of newly diagnosed patients shows
that physicians are more readily moving patients from first-line topical
corticosteroids to second-line conventional systemic agents than they were one
year ago and are foregoing additional lines of topical treatment in the second
line. Methotrexate is frequently turned to as a first-line systemic agent and tumor
necrosis factor (TNF)-alpha inhibitors, including Amgen/Pfizer’s Enbrel and
Abbott’s Humira, may follow methotrexate therapy for the most severe patients. The
availability of Centocor Ortho Biotech’s Stelara, the first of a new class of
agents (interleukin [IL]-12/23 inhibitors) entering the psoriasis market, is
expected to change the prescribing habits of dermatologists and substantially
alter patient flow to currently marketed biological agents. In this report, we
analyze patient-level claims data and data from 163 surveyed U.S.
dermatologists and primary care physicians (PCPs) to elucidate how patients
arrive at biological agents and explore how their use of key brands in
psoriasis by line of therapy will change over the next two years.
Questions Answered in This Report:
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Lines of therapy: Enbrel is the leading biological agent in
the first three lines of therapy for newly diagnosed patients.
What proportion
of patients initiate treatment with topical therapy versus systemic therapy? What
are the retention rates for early-line treatments, including systemic agents such
as methotrexate and Stiefel’s Soriatane? What are the major barriers to
initiating treatment with biological agents? How have the patient shares of
Enbrel and Humira in newly diagnosed patients changed from one year ago?
*
Pathways to key therapies: Longitudinal claims data reveal the
source of business for key brands in psoriasis, providing insight on how brands
are positioned relative to one another in lines of therapy.
How long does it
take for patients to move to biologics therapy? How are the topical
immunosuppressants, Novartis’s Elidel and Astellas Pharma’s Protopic, positioned
relative to one other? What drugs are frequently used in combination with topical
corticosteroids, and what does this say about how physicians approach treatment
for mild and moderate to severe patients? What drugs precede the use of Enbrel
and Humira, and how are reimbursement constraints evident in the flow to
biologics?
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Physician behavior: Psoriasis patients are frequently
diagnosed by PCPs, who generally control when patients see a dermatologist.
What
factors drive PCPs to refer patients to a dermatologist? What do physicians believe
are the primary reasons that patients with moderate to severe disease remain on
topical treatments only? What attributes are most critical to dermatologists in
differentiating among Enbrel, Humira, and Centocor Ortho Biotech’s Remicade? What
reasons do dermatologists most frequently cite for discontinuing use of each
biologic?
*
Forecast: Many surveyed dermatologists indicate their use of
biologics before nonbiological systemic agents will increase over the next two
years.
For which biological agents do dermatologists anticipate writing fewer
prescriptions over the next two years? How will the availability of Stelara
change dermatologists’ prescribing habits? How will the use of topical agents
including Leo Pharma/Warner Chilcott’s Taclonex and Galderma’s Vectical change
between now and 2011? Are dermatologists aware of Abbott’s emerging IL-12/23
inhibitor, briakinumab, expected to launch in 2010?Scope:
Primary research: Quantitative results from our survey of 163
physicians (78 dermatologists and 85 PCPs):
- Physician opinion on how drug use differs by patient
severity.
- Most-influential drug attributes when physicians choose
between agents.
- Anticipated changes in the line of therapy in which
physicians use key agents.
- Primary patient-level data: Quantitative findings from our
analysis of data covering 61 million lives from 98 geographically diverse U.S. health
plans:
- Quantified lines of therapy analysis showing exact share of
each agent in each line of therapy, including rate of progression between lines
and length of time patients are on each line.
- Progression flowcharts through one year of treatment for
newly diagnosed patients receiving each of the following first-line agents: Topical
corticosteroids, calcipotriene, Taclonex, Protopic, Elidel, cyclosporine,
anthralin, methotrexate, Allergan’s Tazorac, Soriatane, Enbrel, Humira,
Remicade, and Astellas Pharma’s Amevive.
- Flowcharts tracking the preceding therapy patterns for
patients taking each of the following key therapies: Calcipotriene, Taclonex, Tazorac,
Protopic, Elidel, cyclosporine, methotrexate, Soriatane, Enbrel, Humira, and Remicade.