Ocrevus’ (ocrelizumab’s) market introduction is off to a stellar start, with nearly half of neurologists surveyed by Spherix Global Insights saying they are using the therapy — the first ever approved for both relapsing and primary progressive multiple sclerosis (MS).
Within six months, 80 percent of neurologists are expected to prescribe Ocrevus, according to a report in the second-quarter edition of RealTime Dynamix: Multiple Sclerosis by Spherix Global Insights.
But insurance is having an increasing impact on treatment decisions, the report also found, according to a Spherix press release. More patients are receiving less than optimal care because of inadequate or inferior insurance coverage, and neurologists report that insurers have become more aggressive in managing MS patients.
Surveying 104 neurologists in June, the report showed that physicians followed through with their intent — reported in earlier surveys — to prescribe Ocrevus as it became available.
With Ocrevus being the first approved drug for primary progressive MS, these patients make up a sizable part of those receiving it. But patients with relapsing forms of MS represent more than half of new users, according to the report.
Ocrevus was also, by far, the drug that neurologists had learned most about, and felt most excited about using, the report added.
Most of the patients on Ocrevus were switched from Biogen‘s Tysabri (natalizumab) or Rituxan (rituximab) — a drug that, like Ocrevus, is also produced by Genentech/Roche. One in five patients was switched from an oral disease-modifying treatment, mainly Biogen’s Tecfidera (dimethyl fumarate).
But for about 25 percent of Ocrevus-treated patients, the drug is the first disease-modifying therapy they have received.
The survey also revealed that patients are the driving force behind new Ocrevus prescriptions. Seventy-one percent of neurologists receive requests from patients who want to start the treatment.
While neurologists have to turn some of these requests down for various reasons, a large proportion of those who ask for the treatment receive it.
Another insight from Spherix’s “RealWorld Dynamix: DMT Brand Switching in MS” survey was that patients’ requests for a specific brand are often honored. Seventy-seven percent were prescribed the brand they requested, the survey showed. Interestingly, neurologists believed the number to be lower.
Most patients who made a specific request, the report indicated, asked for Tecfidera in the past year and a half. Tecfidera is by far the leading oral disease-modifying drug prescribed in MS.
Meanwhile, according to the report, Biogen’s Avonex (interferon beta-1a), Bayer‘s Betaseron (interferon beta-1b), Teva‘s Copaxone (glatiramer acetate), and EMD Serono‘s Rebif (interferon beta-1a) continue on a downward path. At least 30 percent of neurologists report lower use of these therapies in the past three months.
Patients previously on these drugs are mainly switched to oral disease-modifying drugs. But this trend is projected to slow, with only Sanofi-Genzyme‘s oral Aubagio (teriflunomide) continuing to grow.
But the choice of treatment may increasingly be driven by insurance. Compared with the same quarter of 2016 — when neurologists estimated that 14 percent of patients received suboptimal treatment because of poor insurance coverage — 20 percent of patients are now judged to be in this situation.
Also, 60 percent of surveyed physicians feel that insurance companies have become more aggressive in MS treatment management. A similar percentage also say that insurance policies influence how they prescribe specific disease-modifying drugs.
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