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Survey: Neurologists Seek Better Seizure-Free Efficacy for Epilepsy Patients

Payers willing to grant preferred formulary status to drugs delivering improvement (June 20)

Decision Resources, a research and advisory firm based in Burlington, Mass., finds that surveyed U.S. and European neurologists identify efficacy improvements in the percentage of seizure-free patients as one of the key unmet needs in controlling partial-onset seizures in treatment-refractory epilepsy patients. However, clinical data and the opinions of interviewed thought leaders indicate that none of the five emerging agents assessed in the report has clearly demonstrated the potential to fulfill this unmet need.

Surveyed U.S. neurologists said they would prescribe the agents profiled — perampanel (Fycompa, Eisai), brivaracetam (Rikelta, UCB), and three reformulations of currently available products — to no more than 10% of their drug-treated epilepsy patients. Compared with the market-leading, second-generation antiepileptic drug (AED), immediate-release levetiracetam (Keppra, UCB/Otsuka; and generics), investigational products appear to lack differentiation in efficacy, safety, tolerability, and/or delivery that would be necessary for them to assume a more dominant role in clinical care.

The findings also show that 95% of surveyed pharmacy directors in U.S. managed care organizations (MCOs) report a willingness to grant preferred formulary status to a drug that delivers improvements in seizure-free efficacy, with 45% indicating a high willingness.

Payers are also receptive to new products that increase the percentage of adult treatment-refractory patients who successfully complete a conversion to a monotherapy trial and/or that more effectively reduce partial-onset seizure frequency as an adjunctive therapy in pediatric treatment-refractory patients. However, 30% to 40% of surveyed MCO pharmacy directors would require a 75% improvement over immediate-release lamotrigine (Lamictal, GlaxoSmithKline; other brands, and generics) on these metrics to consider reimbursement, the highest level of improvement assessed in the report.

“While our findings suggest that most payers will require that a drug deliver a strong clinical performance in these arenas to inspire coverage, they indicate they will accept price premiums under either scenario, although tier-dependent cost controls are likely,” said analyst John Crowley, PhD.

Source: Decision Resources; June 20, 2013.

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Decision supported by data from more than 4,000 patients