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Survey: Aubagio (Teriflunomide) Trails Gilenya (Fingolimod) for Multiple Sclerosis Treatment

Prescribers shy away from perceived high cost (May 30)

BioTrends Research Group, a research and advisory firm located in Exton, Pennsylvania, finds that more than half of surveyed neurologists have prescribed Aubagio (teriflunomide; Genzyme) — the second oral disease-modifying agent (DMA) marketed for the treatment of multiple sclerosis (MS) — to at least one of their MS patients at 6 months post-launch.

While this represents a significant increase in the prescriber base from 1 and 3 months post-launch, Aubagio trails Gilenya (fingolimod; Novartis) at the same stage of product launch. This difference in the prescriber base between the two oral DMAs is reflected in a smaller Aubagio patient share among DMA-treated patients with relapsing-remitting MS (RR-MS) compared with the 6-month share reported for Gilenya. Nevertheless, the initial uptake of Aubagio continues to be driven by the drug’s convenient once-daily oral formulation, with most patients initiated on Aubagio coming from switches, the survey finds.

After the recent approval of Tecfidera (dimethyl fumarate; Biogen Idec), substantial press coverage was given to the comparative wholesale prices of the DMAs, with Aubagio being the least expensive. Survey data suggest that this information has not had the expected effect on neurologists’ perceptions of the cost of Aubagio, as significantly more of the 73 surveyed neurologists now perceive Aubagio as being more expensive than the other DMAs.

Moreover, while current prescribers continue to express high overall satisfaction with Aubagio, especially for its efficacy, they rate their satisfaction with the product’s cost significantly lower than at 3 months post-launch. Feedback suggests that difficulties with managed care coverage of Aubagio may be having a trickle-down effect on neurologists’ perception of the drug’s price.

“Given that neurologists report currently treating 9% of their DMA-treated RR-MS patients with the oral DMAs available at the time of survey fielding (Aubagio and Gilenya), it is interesting to note that surveyed neurologists expect the oral DMA group to capture 23% patient share over the next 6 months,” said analyst Emma Williams, PhD. “Although this growth is anticipated to be driven predominantly by Tecfidera uptake, Aubagio patient share is also projected to significantly increase, while Gilenya patient share is expected to remain stable.”

Overall, these results highlight neurologists’ growing receptivity to oral DMAs and indicate a general shift in the MS treatment algorithm, away from both the platform DMAs (i.e., Avonex [interferon beta-1a; Biogen Idec], Rebif [interferon beta-1a; Pfizer/EMD Serono], Betaseron [interferon beta-1b; Bayer HealthCare], and Copaxone [glatiramer acetate; Teva]) and Tysabri (natalizumab; Biogen Idec), the survey finds.

Source: BioTrends Research Group; May 30, 2013.

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