Novartis‘ Gilenya (fingolimod), Sanofi Genzyme‘s Aubagio (teriflunomide), and Biogen’s Tysabri (natalizumab) and Tecfidera (dimethyl fumarate) are the top disease-modifying therapies to which patients with multiple sclerosis (MS) have most frequently switched in Europe recently. That’s according to a survey of more than 270 neurologists, conducted by Spherix Global Insights.
Among people with primary progressive multiple sclerosis (PPMS), switches to Roche‘s Ocrevus (ocrelizumab) dominate, the survey found. Researchers say its use has nonetheless been limited by the low treatment rates among this population. One factor weighing in on the switch decision is that Ocrevus is the only therapy, thus far, that is indicated for PPMS.
Relapsing-remitting multiple sclerosis (RRMS), and active secondary progressive multiple sclerosis (SPMS) — which have a relatively high treatment and switch rate among people with MS — offer the greatest opportunity for new disease-modifying therapies (DMTs) as switch options.
The survey results were detailed in a new audit as part of Spherix’s RealWorld Dynamix: DMT Switching in Multiple Sclerosis (EU) report. Findings were based on a survey given to 276 neurologists in France, Germany, Italy, Spain, and the U.K. It used data from 1,266 people with MS who had switched within the prior three months to a new DMT.
The report was designed to understand the drivers of switches from and to DMT brands.
According to the data, efficacy is the most common reason for a switch from a prior DMT. Relapse activity was the most prevalent trigger of treatment switches across all surveyed countries, the data show. Overall, patient choices influenced one out of five switch selections.
The survey also showed that, while neurologists had a preference for oral DMTs, “patient request was more frequent in switches to injectable DMTs (compared to the other DMT classes).” Among the therapies, Teva Pharmaceuticals‘ Copaxone (glatiramer acetate), given by injections under the skin, was usually requested by name, Spherix reported in a press release.
Glatiramer acetate is frequently the first choice for RRMS treatment due to its favorable safety and tolerability profiles. It also is suitable for family planning, including pregnancies and breast-feeding.
The researchers said patients’ demand for Copaxone may be related to the high rate of active pregnancy or pregnancy planning among young female patients. In contrast, fewer of those switching to generic glatiramer acetate requested the medication and were planning a pregnancy, “suggesting comfort with family planning does not transfer to the therapeutically equivalent generic agent,” Spherix noted.
Among those with PPMS switching treatment, Ocrevus clearly dominates as the preferred option. The fact that it holds the only approved indication for PPMS is important — and was a decisive factor in almost half of all switches among this patient group.
However, neurologists tend to underestimate their reliance on Ocrevus, and the influence of its exclusive indication, the researchers say. This is probably because few people with PPMS are treated with a DMT. The European neurologists predict a relatively low switch rate for this patient population.
In fact, the data showed that if a given DMT is not successful for a PPMS patient, more than one-third will discontinue treatment. This highlights the as-yet unmet need for more therapeutic alternatives for these individuals, the researchers said.
According to Spherix, the only investigational therapies currently in late-stage clinical development for PPMS in Europe are MedDay Pharmaceuticals‘ Qizenday (MD1003), AB Science‘s masitinib, and MediciNova‘s ibudilast.
If these experimental treatments had been available at the time of the most recent therapy switches, two-thirds or more of the PPMS patients included in the survey could have been potential candidates to receive one or more of these agents, according to the surveyed neurologists.
Qizenday and masitinib could have even greater chances of being selected as switching options in non-active SPMS patients, the survey found. Novartis’ Mayzent (siponimod), if approved for SPMS this year, would stand as the only competitor.