Treatment Algorithms: Psoriasis - Prescribing trends mirror guidelines
Datamonitor, February 2012, Pages: 69
Prescribing trends at earlier lines of therapy remain relatively unchanged. However, biologics Enbrel (etanercept; Amgen/Pfizer), Humira (adalimumab; Abbott/Eisai), and Stelara (ustekinumab; Janssen Biotech) continue to reshape the management of moderate to severe psoriasis patients. This trend is expected to continue over the next decade, as physicians gain clinical experience with these agents.
Scope of the report:
- Enhance understanding of patient flow and estimate the size of the psoriasis patient pool using interactive country-specific treatment trees.
- Assess the regional dynamics of pharmacological therapy (topical and systemic agents) choice in psoriasis.
- Access a snapshot of current patient-numbers receiving drug therapy at first line and second line and beyond (following first line therapy failure).
- Gain insight into how formulation impacts compliance and how this changes according to disease severity.
Highlights:
- Dermatologists reveal that most psoriasis patients receive a combination of drug and non-drug therapy to manage symptoms, with a seven major market mean of 36.1% of mild diagnosed patients receiving this treatment strategy, rising to 52.1% in severe patients. However, this is unsurprising and mirrors treatment guidelines for psoriasis.
- Biologics Enbrel and Humira continue to be heavily prescribed by dermatologists at first line for moderate to severe patients. In the US and EU, Stelara has gained traction and Datamonitor anticipates that greater familiarity and experience with its safety profile will fuel its ascendance across the seven major markets over the coming decade.
- Across all disease severities, the chief reason for psoriasis patients not progressing to second line and beyond of drug therapy is the exploration of other forms of non-drug therapy. Datamonitor speculates that the high annual cost of therapies such as biologics steers patients to seek cheaper, non-drug alternatives to control their symptoms.
Reasons to buy:
- Which topical and biologic brands experience the greatest physician uptake in each seven major market?
- To what extent is Stelara challenging established biologic drugs Enbrel and Humira from dermatologists’ viewpoint?
- What are the current psoriasis market dynamics and the competitive landscape in terms of patient numbers?
OVERVIEW
Catalyst
Summary
EXECUTIVE SUMMARY
Strategic scoping and focus
Datamonitor key findings
Related reports
COUNTRY TREATMENT TREES
Introduction to treatment trees
US
Japan
France
Germany
Italy
Spain
UK
DISEASE DEFINITION AND DIAGNOSIS
Disease definition
Etiology
The exact etiology of psoriasis remains unknown
Symptoms
Variant types of psoriasis display different symptoms
Presentation and diagnosis
Time to diagnosis: psoriasis patients wait over 10 months before presenting
PATIENT SEGMENTATION
Severity: moderate sufferers are the largest patient segment
CURRENT TREATMENT OPTIONS
Pharmacological versus non-pharmacological
Most psoriasis patients are treated with non-pharmacological and pharmacological therapy
Country trends: most notable is the heavy reliance on pharmacological therapy by Japanese physicians
Overview of the available drug classes
Prescribing trends
Use of combination therapy generally increases with disease severity and line of therapy
Biologic usage by brand and line of therapy
Majority of patients not progressing to second line and beyond of therapy explore other forms of non-pharmacological therapy
Changes in therapy
Compliance increases with disease severity and from topical to systemic therapies
Treatment outcomes
Most mild patients reach desired outcomes after 6 months of treatment
BIBLIOGRAPHY
Journal papers
Websites
Datamonitor reports
APPENDIX A – SURVEY INFORMATION
Physician research methodology
The 2011 survey questionnaire
Physician research methodology
The 2009 survey questionnaire
APPENDIX B
Contributing experts
Report methodology
TABLES
Table: Mean percentage of psoriasis patients with each sub-type of the disease, by country (%),
Table: Total length of time from onset of symptoms to psoriasis diagnosis across the seven major markets (months)
Table: Mean percentage of diagnosed psoriasis patients with each severity, by country (%),
Table: Mean percentage of psoriasis patients treated with various forms of therapy, across the seven major markets, by disease severity,
Table: Leading treatments in psoriasis,
Table: Mean percentage of psoriasis patients receiving monotherapy versus combination therapy, by severity, line of therapy, and country (%),
Table: Mean percentage of psoriasis patients across the seven major markets receiving each biologic, by line of therapy, severity, and country (%),
Table: Reasons why patients do not progress to second-line pharmacological therapy and beyond, percentage of respondents, by severity and country (%),
Table: Mean compliance rates for psoriasis patients in each of the seven major markets, by formulation and severity (%, n),
Table: Mean percentage of psoriasis patients reaching the desired outcome after 6 months of treatment across the seven major markets, by severity (%)
Table: Dermatologists surveyed regarding psoriasis across the seven major markets
Table: Percentage of diagnosed psoriasis patients suffering with mild, moderate, and severe disease
Table: Percentage of all psoriasis patients suffering with each sub-type of psoriasis
Table: Percentage of psoriasis patients treated with a particular type of therapy
Table: Compliance rate percentage for psoriasis patients at each severity, receiving each formulation type (%),
Table: Dermatologists surveyed regarding psoriasis across the seven major markets
FIGURES
Figure: US psoriasis diagnosed patient population, by physician-estimated treatment rates for each disease severity and usage of key brands at first line (%, n),
Figure: US psoriasis patients progressing to drug therapy at second line and beyond following first-line therapy failure (%, n),
Figure: Japan psoriasis diagnosed patient population, by physician-estimated treatment rates for each disease severity and usage of key brands at first line (%, n),
Figure: Japan psoriasis patients progressing to drug therapy at second line and beyond following first-line therapy failure (%, n),
Figure: France psoriasis diagnosed patient population, by physician-estimated treatment rates for each disease severity and usage of key brands at first line (%, n),
Figure: France psoriasis patients progressing to drug therapy at second line and beyond following first-line therapy failure (%, n), 2011
Figure: Germany psoriasis diagnosed patient population, by physician-estimated treatment rates for each disease severity and usage of key brands at first line (%, n),
Figure: Germany psoriasis patients progressing to drug therapy at second line and beyond following first-line therapy failure (%, n), 2011
Figure: Italy psoriasis diagnosed patient population, by physician-estimated treatment rates for each disease severity and usage of key brands at first line (%, n),
Figure: Italy psoriasis patients progressing to drug therapy at second line and beyond following first-line therapy failure (%, n), 2011
Figure: Spain psoriasis diagnosed patient population, by physician-estimated treatment rates for each disease severity and usage of key brands at first line (%, n),
Figure: Spain psoriasis patients progressing to drug therapy at second line and beyond following first-line therapy failure (%, n), 2011
Figure: UK psoriasis diagnosed patient population, by physician-estimated treatment rates for each disease severity and usage of key brands at first line (%, n),
Figure: UK psoriasis patients progressing to drug therapy at second line and beyond following first-line therapy failure (%, n),
Figure: Key features of the current understanding of psoriasis pathogenesis, with an illustration of targets for clinical candidates and marketed therapies
Figure: Total length of time from onset of symptoms to psoriasis diagnosis across the seven major markets
Figure: Physicians indicating that psoriasis is diagnosed immediately upon presentation versus those who believe that patients experience a delay in receiving a diagnosis
Figure: Mean percentage of diagnosed psoriasis patients with each severity, by country (%),
Figure: Mean percentage of psoriasis patients treated with various forms of therapy, across the seven major markets, by disease severity,
Figure: Mean percentage of psoriasis patients receiving monotherapy versus combination therapy, by severity, line of therapy across the seven major markets (%),
Figure: Mean percentage of psoriasis patients receiving each biologic across the seven major markets, by line of therapy and severity (%),
Figure: Reasons why patients do not progress to second-line pharmacological therapy and beyond, percentage of respondents, by severity (%),
Figure: Mean compliance rates for psoriasis patients, by formulation and severity across the seven major markets (%),
Figure: Distribution of physician responses for percentage of patients reaching the desired outcome, by severity (%)
Figure: Treatment flow: mild – first-line pharmacological therapy (initial therapy prescribed)
Figure: Treatment flow: mild – second-line pharmacological therapy and beyond
Figure: Treatment flow: moderate – first-line pharmacological therapy (initial therapy prescribed)
Figure: Treatment flow: moderate – second-line pharmacological therapy and beyond
Figure: Treatment flow: severe – first-line pharmacological therapy (initial therapy prescribed)
Figure: Treatment flow: severe – second-line pharmacological therapy and beyond
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