Mavenclad May Surpass Gilenya as DMT of Choice for Treatment of MS in Canada

Mavenclad (cladribine) may surpass Gilenya (fingolimod) in the category of oral disease-modifying therapy (DMT) of choice for the treatment of multiple sclerosis (MS) in Canada, according to a press release.

The Canadian healthcare market for MS has grown considerably over the past two years. In November 2017, Health Canada approved EMD Serono‘s Mavenclad for the treatment of patients with relapsing-remitting MS (RRMS).

In August 2017, it had approved Roche‘s Ocrevus (ocrelizumab) for the same indication, and in February 2018 Ocrevus’ indication was expanded to include patients with early primary progressive MS (PPMS).

According to data from the ongoing “RealTime Dynamix: Multiple Sclerosis Canada,” a report published every other year that summarizes trends of the Canadian healthcare market for MS based on the opinions of 50 neurologists, the most preferred disease-modifying therapies (DMTs) for the treatment of MS in the country include Ocrevus, Teva Pharmaceutical Industries‘ Copaxone (glatiramer acetate), and Novartis‘ Gilenya.

Mavenclad, which is normally prescribed as a second-line therapy, has been trailing Gilenya in the category of oral DMTs of choice.

However, recent market switches have put Mavenclad in first place. These include mostly RRMS and active secondary progressive MS (SPMS) patients switching from first-line treatment with interferons, Sanofi Genzyme‘s Aubagio (teriflunomide), or Biogen‘s Tecfidera (dimethyl fumarate) to Mavenclad.

As a result, Mavenclad is now in a position to compete directly with Gilenya. Meanwhile, according to the report, Gilenya is feeling the pressure posed by Mavenclad’s superiority in terms of the risk of progressive multifocal leukoencephalopathy (PML), mode of administration, required patient monitoring, and therapeutic efficacy in relapsing forms of MS.

The situation may become even brighter for Mavenclad, provided neurologists surpass the obstacle of familiarity with the therapy, and start prescribing the medication more often.

The report says the future also looks bright for Ocrevus, whose favorable risk-benefits profile and  therapeutic efficacy, together with the recent recommendation issued by the pan-Canadian Pharmaceutical Alliance (pCPA) to make the treatment available through all provincial public formularies, place it among the top DMTs of choice in Canada.

However, according to data from Spherix Global Insights — the company behind the RealTime Dynamix reports — the number of patients to whom Ocrevus is being prescribed is leveling off.  A possible strategy for Roche to overcome this plateau and expand Ocrevus’ user base is to promote its use among RRMS patients.

Also according to the report, neurologists in Canada are looking forward to the approval of Mayzent (siponimod), Novartis’ sphingosine 1-phosphate (S1P) receptor modulator recently approved by the U.S. Food and Drug Administration (FDA) for the treatment of patients with relapsing forms of MS, including active SPMS.

Despite the potential success of Mayzent in the Canadian market, only one-third of the neurologists participating in the survey said they would consider switching the treatment regimen of a patient with non-active SPMS to Mayzent.

If Health Canada grants Mayzent a broad indication for SPMS (including both active and non-active forms), Novartis must keep this information in mind to work toward a shift in patient treatment paradigms.