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Survey: U.S. Neurologists Willing to Accept Safety Risk if New MS Therapies Can Reduce Disability Progression

Payers sensitive to risk profile of new therapies when making formulary decisions

Decision Resources Group, a health care research firm located in Burlington, Mass., finds that, for the treatment of primary-progressive multiple sclerosis (PP-MS), surveyed U.S. neurologists would be willing to accept a certain level of risk for a therapy with proven efficacy on disability progression, likely because of the absence of approved therapies for this indication.

This finding is reflected by the fact that, among hypothetical therapies, neurologists were most receptive to an agent with the greatest efficacy improvement over the market’s sales-leading therapy, glatiramer acetate injection (Copaxone, Teva), but which was also associated with the greatest risk of serious or life-threatening adverse effects.

In other key results, the survey found that a therapy’s effect on disability progression is weighted by surveyed U.S. and European neurologists as the most important efficacy attribute driving prescribing decisions for the treatment of PP-MS. However, according to available clinical data and interviewed experts’ opinions, none of the profiled current or emerging therapies is differentiated from glatiramer acetate injection on this attribute, making it an area of high unmet need.

Nearly all surveyed U.S. neurologists would prescribe the emerging product laquinimod (Nerventra, Teva), with it capturing 24% of currently treated PP-MS patient share. Although not yet studied in PP-MS, interest in laquinimod stems from the product’s putative neuroprotective effect, benign safety profile to date, and once-daily oral administration.

“Data suggest that surveyed U.S. managed care organization pharmacy directors are highly receptive to novel PP-MS therapies offering even modest improvements over Copaxone on disability progression,” said analyst Emma McFadden, PhD. “However, they are sensitive to the risk profile of such agents when making formulary decisions, with few willing to reimburse a therapy with greater than 1% risk of serious adverse events. This reluctance is likely owing to the high costs which can be incurred by riskier therapies, such as by the need for patient monitoring and potential hospitalization.”

Further, McFadden noted: “If proven effective in their respective ongoing PP-MS clinical trials, Novartis’ Gilenya [fingolimod] and Roche/Genentech’s ocrelizumab both have considerable market potential. Even prior to the availability of PP-MS clinical data, surveyed U.S. neurologists indicate that they would prescribe these therapies to 20% of their currently treated PP-MS patients.”

Source: PR Newswire; April 8, 2014.

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