Surveyed Neurologists Anticipate That < 30% Of Their Use Of Emerging Oral Agents In MS Will Be In The First Line

[doublevision1]

Surveyed Neurologists Anticipate That Less Than 30 Percent Of Their Use Of Emerging Oral Agents In Multiple Sclerosis Will Be In The First Line

Article Date: 16 Apr 2009 - 3:00 PDT

www. medicalnewstoday .com/articles/146211.php

Decision Resources, one of the world's leading research and advisory firms focusing on pharmaceutical and healthcare issues, finds that surveyed neurologists anticipate that less than 30 percent of their use of emerging oral agents --- Merck Serono's oral cladribine, Novartis/Mitsubishi Pharma's fingolimod (FTY-720) --- for the treatment of multiple sclerosis will be in the first line. Surveyed neurologists expect to use these drugs in patients who refuse injectables, filling an important unmet need and potentially increasing the drug-treatment rate in newly diagnosed patients.

"Surveyed neurologists' responses suggest that Biogen Idec's Avonex is more at-risk than Teva's Copaxone of losing share upon the launch of either oral cladribine or fingolimod, as more physicians cite Avonex as having potential for being replaced by either emerging oral agent," stated Amanda Puffer, M.Sc., analyst at Decision Resources. "However, approximately half of the surveyed neurologists who are aware of these therapies are unsure if they will prescribe them, most likely because of uncertainty about these agents' side-effect/safety profiles."

The new report entitled Treatment Algorithms in Multiple Sclerosis also finds that only 38.8 percent of newly diagnosed patients receive a drug within one year of their first diagnosis. This highlights the substantial room for increased uptake of disease-modifying therapies in newly diagnosed patients. While surveyed neurologists indicate they prescribe disease-modifying therapies to the majority of relapsing-remitting patients (the dominant multiple sclerosis subtype), they are less likely to prescribe disease-modifying therapies to patients with clinically isolated syndrome (early-stage multiple sclerosis). This is despite clinical studies indicating that early initiation of disease-modifying therapies can delay progression of the disease, and specifically, delay disability progression.

"Those patients who do not start disease-modifying treatment right away represent an untapped opportunity for marketers of disease-modifying drugs," added Ms. Puffer. "Treatment rates could be improved, especially for patients with early stage disease, through increased awareness among both neurologists and primary care physicians, of the benefits surrounding early treatment initiation. These improvements would facilitate increased use of disease-modifying therapies."

[patientx]

One thing to keep in mind, and this may play into the 30% number, is that the oral meds are not the same medicines as the injectables.  They have completely different mechanisms of action.  Both Cladribine and Fingolimod are immune suppressants.  Fingolimod works by keeping lymphocytes in the lymph nodes, and Cladribine is an oral form of chemotherapy.  I'm not saying this is good or bad (though, personally, I have questions when long term immune suppression is the way to go with MS treatment).  But this isn't an apples to apples comparison, and, if one of the injectables is working for a patient, a doctor may be hesitant to switch.

Having said all of this, the oral meds have shown better efficacy than the injections.  Cladribine, which will probably be the first FDA approved (probably in 2010), has shown something like 58% relapse reductions over placebo.

[shoshin]

From what I understand, there is at least one valid reason for neuros to be conservative in prescribing the new oral meds. Although the ones closest to getting approved seem to be more effective than the current meds and are certainly more convenient, they also appear to be more dangerous. I don't think they yet know how the cost-benefit analysis will work out.

I don't know if anyone has ever died from one of the standard DMDs. If they have, it seems to be pretty rare. The oral meds seem to potentially have stronger side effects. I am in a clinical trial for FTY720 (fingolimod), which is an oral med and two people in trials for this have died of infections (and this is not from a whole lot of people taking the med for a long time like with the current DMDs). Also, they just recently reported a case of hemorrhaging focal encephalitis, which is an inflammation of the brain and doesn't sound too good to me. (see http://online.wsj.com/article/BT-CO-20090414-708933.html)

sho

[Khiba]

I for sure will be looking into the orals! I had a horrible reaction to Copaxone and stopped it and refuse to take the other DMDs currently available. So as soon as the orals come out I will discuss with my neurologist and if they look safe enough will jump  on one.

Thanks, doublevision for the great research! :)

jessica

[saveone]

I have to admit that though I knew oral meds where in the pipeline I have been to caught up in my own drama to do much research.  You have put me back on course by tweaking my interest.

I am disappointed at the <30% ratio.  It appears it is not going to be left up to the patient to make the decision because 1. the neuro will not inform the patient of the option 2. the neuro may discourage the option even if it is known to the patient.

Par for course everything is a struggle.  Some days I really do not like neuros.

terry

[essdipity]

Very interesting.

I'm wondering how many MS patients currently on an injectible will ask to switch. That of course depends on how many even know about them, which in turn depends for many on their doctors even telling them.

We have so many savvy members here that that won't happen in this group (!) Once they're really on the market, one of us can start a poll asking whether neuros mention this, what members choose, and so on.

Thanks as always, deebs.

ess

[Lulu54]

Thanks Deeb,
You are a great researcher - I appreciate you sharing even when it isn't the greatest of news.

This is certainly not the response I expected to read about oral therapy.  I just assumed that the neurologists are going to be as excited about the prospect of injection-free treatment as those of us who do the daily or weekly jabs.  

Shell says it all about the CIS folks ..... :-(

Have you been following the posts here about the Myelin Repair Foundation?  Be sure and read their stuff - it sounds promising too and approaches the problem of MS from a totally different angle.

you should be our lead scientist/researcher here!

Lulu

[sllowe]

Wow!

This article further shows that Drs are "still" reluctant to follow the 05 McDonald and they are reluctant to treat CIS - it's disappointing to say the least.  

I'm so glad to see write ups like this - sheds light on the recommendations and hopefully shames those who are not treating their patients early.

Thanks again,
shell

[Erin0313]

Great info. I envy your energy and love it when you share these articles and info with everyone!

  We are all better when we can go to our doctor informed with up to date info on our conditions and medications available to us.

Thanks for sharing!

Erin :)