Patient requests buoy oral meds from Biogen, Novartis in crowded MS market

multiple sclerosis
The multiple sclerosis drug market shifted toward oral treatments in 2016, notably linked to patient requests.

The multiple sclerosis drug market shifted to oral disease-modifying therapies (DMTs) in 2016. One big reason? Patient requests, according to new research.

A pair of Spherix Global Insights studies, one involving 100 U.S. neurologists and another involving more than 1,000 MS patients, found that oral drugs captured a significantly higher market share at the end of 2016 than at the end of the previous year. And the oral meds—leader Tecfidera from Biogen, Gilenya from Novartis and Aubagio from Sanofi, which are locked in a fierce battle for market share—benefited importantly from patient requests. 

“According to the neurologists surveyed in December, about half of their most recent new starts were prescribed an oral agent, and in more than one in four of these cases, patient request was the primary driver,” Jennifer Robinson, president at Spherix, told FiercePharma in an email interview. “This is something you don’t typically see with the platform injectables or infused DMTs.”

That influence was confirmed in the patient study, which found that patients were “highly involved” in almost 80% of oral-start cases.

While Spherix expects oral prescriptions to continue to increase, the highly anticipated infused MS drug Ocrevus from Roche is expected to impact the entire market of 13 FDA-approved MS meds. It's slated to become the first medication to receive an indication for hard-to-treat primary progressive MS, and as Spherix found, neurologists are already “warehousing” their PPMS patients in anticipation.

In the larger share of the MS market—85% of patients have relapsing forms of MS—Ocrevus poses the biggest threat to other infused treatments like Biogen’s Tysabri and Sanofi's Lemtrada, Robinson said. But orals will also feel some impact from Ocrevus, she said, especially Gilenya.

Ocrevus was scheduled to receive an FDA verdict in December, but manufacturing delays have pushed the decision date to March.

Marketing will also continue to play an important role in the shifting MS market, particularly for new players, Robinson said. Among oral drugs, for instance, the No. 3 player Aubagio could benefit from increased DTC efforts to drive patient requests, which are often granted. Manufacturer support is also important to doctors, Robinson said, with Biogen named most often for its support in the neurologists study.

However, the third key to MS market success is market access, Spherix found. Some 60% of neurologists said payers are becoming more aggressive with MS patient management and 37% said payers influence the use of specific brands.

Robinson said one of the best examples of payer involvement is Sandoz’s Glatopa, the first generic of Teva’s Copaxone to hit the market.

“We consistently see that payer policies are driving the use of Glatopa instead of Copaxone in certain areas, and those who are not using Glatopa report that one of the main reasons is that they just aren’t being pressured to … yet,” she said.