Stakeholder Opinions: Physician perception of biologics in autoimmune disease - Targeted detailing is the key to success

Summary

Introduction

Factors influencing a prescribing decision can diverge from clinical facts. In the highly competitive autoimmune area, misconceptions and physician habits can result in loss of sales. Targeted detailing of specialist physicians, differentiating by indications is the key to success. Datamonitor has surveyed gastroenterologists, rheumatologists and dermatologists on attribute and brand perceptions

Scope

Opinion from 540 physicians including rheumatologists, dermatologists and gastroenterologists

• Data from physicians and opinion leaders across the seven major markets of the US, Japan, France, Germany, Spain, Italy and the UK
• Analysis of the extent to which certain factors affect physician prescribing, with comparison across each specialty
• Analysis of the opinion dynamics for the key brands used across prominent autoimmune diseases

Highlights

Efficacy and safety factors will always be any physician's main consideration, drawing an average of 62% of the weighting by importance when prescribing a biologic therapy. Actemra's positive perception from rheumatologists, despite known side-effects, exemplifies the importance of informing physicians about issues, rather than masking them.

New TNF inhibitors in autoimmune disease battle against 'me-too' status and the strong positive opinion of the existing three products in the category. Humira leads the group with a total score 16% above the average. Newcomer anti-TNF options Simponi (golimumab) and Cimzia (certolizumab) are not well perceived by EU prescribing rheumatologists.

Dermatologists' exhibit cynicism towards biologic therapies, scoring all brands lower than other physician types, less surprising when considering the nature of most psoriasis therapies. However, Centocor's Stelara (ustekinumab) is highly anticipated with dermatologists scoring it 40% above average in terms of predicted efficacy.

Reasons to Purchase

• Target physicians more efficiently by understanding the differences in brand perception between physician specialties
• Tailor your marketing message to the attributes most important to prescribing physicians
• Assess the regional dynamics of physician perception in autoimmune disease across the seven major markets

Contents

• ABOUT DATAMONITOR HEALTHCARE
  • About the Immunology and Inflammation (I&I) pharmaceutical analysis team
• CHAPTER 1 EXECUTIVE SUMMARY
  • Datamonitor insight into the autoimmune biologics market
  • Contributing experts
  • Related reports
  • Upcoming 2009 reports
• CHAPTER 2 PHYSICIAN DYNAMICS AND QUESTIONNAIRE DESIGN
  • Physician types surveyed
  • Questionnaire design
  • Importance of attributes
  • Rating of brands
  • Physician demographics
  • Rheumatologists
  • Dermatologists
  • Gastroenterologists
• CHAPTER 3 FACTORS INFLUENCING PHYSICIAN DECISION MAKING
  • Comparative importance of factors to the prescribing decision
  • Disease modification and side-effects are the most important factors to all prescribing physicians
  • Variation by country and physician type
  • Little variation seen between physician type
  • The UK and US show commonality while Japan is still an outlier in all but rheumatology
  • Interpreting a map
  • Prescribing factors
  • Efficacy
  • Brand comparison shows novel drugs not perceived to be as effective
  • The ability to predict response is a key unmet need
  • Remicade leads in terms of speed of action, but this attribute requires further comparative investigation
  • Side effects
  • Infection rates and in particular tuberculosis reactivation is of primary concern
  • Dermatologists consider a drug's effect on child-bearing ability
  • Immunogenicity divides the brands
  • Formulary or reimbursement status
  • DMARDs are considered ineffective for ankylosing spondylitis, but insurance constraints can prevent move to biologics
  • Time spent on a biologic is limited by cost constraints
  • Dosing frequency and delivery method
  • Gastroenterologists consider method of administration important
  • Brand comparison shows iv Remicade is not well received by dermatologists
  • Marketing and familiarity
  • Smarter physician detailing needed
  • Time on market influences score but is not always the defining pressure
  • Anti-TNF brand websites provide examples of best practice
  • Brands with other mechanisms vary their messages
• CHAPTER 4 BRAND DYNAMICS
  • Brand overview
  • Brand sales trends
  • Biologic sales overview shows Enbrel leads in terms of total brand sales for all indications
  • Rheumatoid arthritis underpins total brand sales in 2007
  • Growth driven by ulcerative colitis and spondyloarthropathies
  • Brand awareness
  • Trends in preliminary brand scores by physician type
  • Rheumatologist
  • Dermatologist
  • Gastroenterologist
  • Brand assessment comparisons
  • Total score by brand shows future promise for Humira
  • Interpreting a brand map
  • Trends in brand scores by country
  • Brand profiles
  • Enbrel (etanercept; Amgen, Wyeth)
  • Enbrel scores close to the average, driven down by dermatologists' opinion
  • Activation of Crohn's disease with ankylosing spondylitis patients treated with Enbrel
  • Remicade (infliximab; Centocor, Schering-Plough, Mitsubishi Tanabe)
  • A fast-acting effective drug but tuberculosis reactivation is an issue
  • Remicade considered less focused on each specific disease
  • Humira (adalimumab; Abbott)
  • Humira's dominance shows as brand scores above average on all factors
  • Abbott's US co-pay system praised but should be reinforced with dermatologists
  • Orencia (abatacept; Bristol-Myers Squibb)
  • Orencia is perceived as the safe option
  • Rituxan/MabThera (rituximab; Roche, Genentach, Biogen Idec)
  • Re-treatment data are needed and data from the latest SUNRISE trial should be communicated
  • Raptiva (efalizumab; Genentech, Xoma, Merck Serono)
  • Raptiva hit by multifocal leukoencephalopathy side-effect
  • Amevive (alfacept; Astellas, Biogen Idec)
  • Amevive's poor efficacy and unusual dosing regime relegate it to last place
  • Tysabri (natalizumab; Biogen Idec, Elan)
  • Tysabri recognized by most US and some EU gastroenterologists, but poorly rated by both
  • Pipeline profiles
  • Pipeline overview
  • Licensing opportunities
  • Pipeline anti-TNFs
  • The three available anti-TNFs are perceived to be similar, but pipeline anti-TNFs offer little apparent improvement
  • Cimzia (certolizumab; UCB)
  • Cimzia administration issues expected to be solved by arthritis approval
  • Perception of Cimzia is variable
  • Simponi (golimumab; Centocor, Schering-Plough, Mitsubishi Tanabe, Janssen)
  • Multiple formulation options do not improve perception
  • Other pipeline mechanisms
  • Stelara (ustekinumab; Centocor, Janssen Cilag)
  • Actemra (tocilizumab; Chugai, Roche)
• BIBLIOGRAPHY
  • Journal papers
  • Websites
  • About Datamonitor
  • About Datamonitor Healthcare
  • Datamonitor Healthcare's research and analysis methodologies
  • Datamonitor Healthcare's therapy area capabilities
  • Disclaimer
• List of Tables
  • Table 1: Physician type surveyed
  • Table 2: Comparison of physician demographics
  • Table 3: Characteristics of rheumatologists surveyed across the seven major markets, 2008
  • Table 4: Characteristics of dermatologists surveyed across the seven major markets, 2008
  • Table 5: Characteristics of gastroenterologists surveyed across the seven major markets, 2007
  • Table 6: Attributes assessed by each physician type
  • Table 7: Anti-TNF prescribing information efficacy comparison across indications
  • Table 8: Other mechanism prescribing information efficacy data
  • Table 9: Summary of pros and cons of biomarkers to predict response to TNF therapy
  • Table 10: Summary of prescribing information black box and major warnings by brand
  • Table 11: Percent of patients showing positive antibodies against each brand according to prescribing information
  • Table 12: Formulary prices across the seven major markets, 2008
  • Table 13: Importance of dosing frequency and delivery method to prescribing of biologics, by country and by physician specialty, %
  • Table 14: Overview of brand details including mechanism, indications and launch dates
  • Table 15: Number and percent of physicians able to rate each brand, by country
  • Table 16: Score given to each brand by attribute, by rheumatologists, 2008
  • Table 17: Score given to each brand by attribute, by dermatologists, 2008
  • Table 18: Score given to each brand by attribute, by gastroenterologist, 2007
  • Table 19: Brand scores by country
  • Table 20: Enbrel's attribute scores, by country and physician type
  • Table 21: Remicade's attribute score, by country and physician type
  • Table 22: Humira's scores by country, attribute and physician type
  • Table 23: Orencia's scores from rheumatologists by country
  • Table 24: Rituxan/MabThera's scores, from rheumatologists by country
  • Table 25: Raptiva's scores by attribute and country, from dermatologists
  • Table 26: Amevive scores by country and attribute, from dermatologists
  • Table 27: Tysabri scores by country and attribute, from gastroenterologists
  • Table 28: Antibody products in clinical trials for autoimmune diseases (rheumatoid arthritis, inflammatory bowel disease, psoriasis)
  • Table 29: Late stage pipeline product profiles and status by indication and region
  • Table 30: Cimzia's attribute scores by country and physician type
  • Table 31: Simponi scores by country and attribute, from rheumatologists
  • Table 32: Stelara scores by country and attribute, from dermatologists
  • Table 33: Actemra scores by country and attribute, from rheumatologists
• List of Figures
  • Figure 1: Grouped attribute average importance
  • Figure 2: Attribute importance, split by physician type
  • Figure 3: Average attribute importance to prescribing decision for biologic therapies, by country
  • Figure 4: Importance of grouped attributes to the prescribing decision by physician specialty
  • Figure 5: Mapping country dynamics with reference to attribute importance, split by physician type
  • Figure 6: Importance of efficacy factors to prescribing decision for biologic therapies, by country and specialist
  • Figure 7: Biologic comparative brand scores for efficacy factors, by physician type
  • Figure 8: Speed of action scores by dermatologists and gastroenterologists, non-weighted
  • Figure 9: Importance of a good side-effect profile to prescribing decision for biologic therapies, by country and specialist
  • Figure 10: Importance of formulary and reimbursement status to prescribing decision for biologic therapies, by country and specialist
  • Figure 11: Brand comparison scores for formulary/reimbursement status, by physician type
  • Figure 12: Ankylosing spondylitis treatment tree, 2008, seven major markets
  • Figure 13: Importance of dosing frequency and delivery method to prescribing of biologic, by country and by physician specialty
  • Figure 14: Brand scores comparison for administration attributes
  • Figure 15: Importance of marketing and familiarity to prescribing of biologics, by country and by physician specialty
  • Figure 16: Representation of influences of prescribing
  • Figure 17: Total representative count, 2003-2007
  • Figure 18: Brand scores comparison for marketing and familiarity attributes
  • Figure 19: Time on the market versus score for marketing/familiarity factors
  • Figure 20: Humira's website messages
  • Figure 21: Enbrel's directed messages for each indication
  • Figure 22: Remicade's US website messages
  • Figure 23: Online marketing for non-TNF mechanisms
  • Figure 24: Total brand sales for the top autoimmune biologics in the US, five major EU markets and Japan, $m, 2007
  • Figure 25: Total brand sales across the seven major markets, split by indication, $bn, 2007
  • Figure 26: Sales growth versus market share by indication for the major biologic brands in the seven major markets, 2004-07
  • Figure 27: Percentage of physicians able to rate each brand, by country
  • Figure 28: Sum of score for all attributes, by brand and physician type
  • Figure 29: Average score for each of the eight comparable attributes, by brand
  • Figure 30: Overview brand map of attributes versus brand perception by physician specialty
  • Figure 31: Average weighted brand scores by attribute
  • Figure 32: Brand scores by country
  • Figure 33: Enbrel's weighted score compared to average
  • Figure 34: Enbrel map, country preference to prescribing attributes
  • Figure 35: Remicade's weighted score compared to the average
  • Figure 36: Remicade map, country preference to prescribing attributes
  • Figure 37: Humira's weighted score compared to the average
  • Figure 38: Humira map, country preference for prescribing attributes
  • Figure 39: Orencia's weighted scores compared to all physicians average scores and rheumatologists average
  • Figure 40: Rituxan/MabThera's weighted scores compared to all physicians average scores and rheumatologists average
  • Figure 41: Raptiva's weighted score compared to all physicians average scores and dermatologists average
  • Figure 42: Amevive weighted score compared to all physicians average scores and dermatologists average
  • Figure 43: Tysabri weighted score compared to all physicians average scores and gastroenterologist average
  • Figure 44: Phase I to pre-registration projects in the pipeline, split by mechanism, 2009
  • Figure 45: Comparative physician perception of the pipeline and marketed anti-TNF inhibitors
  • Figure 46: Cimzia's weighted score compared to the average
  • Figure 47: Cimzia map, country preference for prescribing attributes
  • Figure 48: Simponi (golimumab) weighted score compared to the average
  • Figure 49: Stelara's weighted score compared to all physicians' average scores and dermatologists' average
  • Figure 50: Actemra's weighted score compared to all physicians average scores and rheumatologist average