While neurologists favor Novartis‘ Mayzent (siponimod) for people with active secondary progressive multiple sclerosis (SPMS) and transitioning relapsing-remitting MS (RRMS), EMD Serono‘s Mavenclad (cladribine) could serve as a first option for patients with RRMS who failed initial therapy, Spherix Global Insights says in its latest report.

Mayzent and Mavenclad were both approved by the U.S. Food and Drug Administration in March as new oral disease-modifying therapies (DMTs) for relapsing forms of MS, including RRMS and active SPMS.

In the opinion of nearly 100 U.S. neurologists surveyed by Spherix — and reported in its most recent RealTime Dynamix: Multiple Sclerosis (US) quarterly analysis — the use of these newest DMTs for active SPMS and patients transitioning from RRMS “will be a given for both brands,” the company states in a press release. Both EMD Serono and Novartis have been heavily advocating their medicines’ use for these two overlapping MS populations (RRMS and active SPMS).

“However, interest in and opportunity for Mayzent outpaces Mavenclad,” Spherix’s data found, with more than one in five patients recently prescribed the Novartis therapy by neurologists.

According to Spherix’s report, EMD Serono could go around this by shifting its focus to RRMS patients who are changing medication for the first time, after an initial therapy failed to work.

“Early launch perceptions and uptake patterns support an ideal first switch position for Mavenclad,” Spherix said.

Neurologists who adopted EMD Serono’s medicine for an earlier stage of RRMS are more willing to prescribe Mavenclad to patients in need of a change in treatment, compared with non-prescribers. The survey showed more than half of these Mavenclad-treated individuals were switched from typical first-line DMTs, including Sanofi Genzyme‘s Aubagio (teriflunomide), Biogen‘s Tecfidera (dimethyl fumarate), and injectable DMTs.

In Spherix’s view, positioning Mavenclad use as an early switch option could “win prescriber loyalty and payer favor.” This could “ease market access barriers,” as neurologists consider a change in medications due to lack of efficacy the “easiest scenario for which to obtain payer approval.”

Importantly, while the use of Mayzent and Mavenclad is expected to climb, neurologists agree that prescriptions for Genentech‘s Ocrevus (ocrelizumab) infusions also will continue to increase as before. Conversely, Tecfidera pills are likely to be “hit especially hard over the next six months,” the report said.

Use of Biogen‘s Tysabri (natalizumab) also is forecast to decline slowly, as observed since Ocrevus’ launch.

Still, data collected over the last three years foretells that Tecfidera will keep its share as a first-line option for RRMS, Spherix said. However, its use will depend mostly on the success of Teva‘s Copaxone (glatiramer acetate), or its generic equivalents from Sandoz (Glatopa) and Mylan.

Tecfidera is the neurologists’ therapy of choice for people with RRMS, especially as an initial treatment. But patient data from Spherix’s third annual RealWorld Dynamix: DMT New Starts in Multiple Sclerosis (US) audit suggests that glatiramer acetate-based therapies will continue to outpace Tecfidera by a ratio of nearly 2-to-1.

Glatiramer acetate is frequently the first choice for RRMS due to favorable safety and tolerability profiles, as well as suitability for family planning, including pregnancies and breast-feeding.

However, as younger and more female patients begin to adopt Tecfidera over other oral DMTs, more clinical data will become available to support its use as “the ideal oral DMT for treatment-naïve patients considering family planning,” Spherix says.

Spherix Global Insights is an independent market research company that provides analysis of MS medications and their use, focusing on brand gains and losses, industry contact rates, familiarity and adoption rates of recently launched products, and awareness of products in development.