Gilenya Remains Favorite S1P Receptor Modulator in US, But Zeposia May Catch Up, Survey Finds

Among oral sphingosine-1-phosphate (S1P) receptor modulators for multiple sclerosis (MS), Novartis’s Gilenya (fingolimod) remains physicians’ favorite in the U.S., but prescriptions of recently-launched Bristol Myers Squibb’s Zeposia (ozanimod) are beginning to rise, according to a survey conducted by Spherix Global Insights.

Also, COVID-19 not only has delayed and impaired the launch of Zeposia —  approved in the U.S in March — but also affected the way physicians managed their MS patients and was often the cause of drops in S1P receptor modulators use “over the past three months,” a press release summarizing the report noted.

Results of the online survey, sent to 99 neurologists in the U.S. between July and August, were detailed in the newest quarterly report “RealTime Dynamix: Multiple Sclerosis (US).” The survey looked into trends regarding disease-modifying therapy (DMT) use and future expectations.

Zeposia, developed by Bristol Myers Squibb’s Celgene, is the third oral S1P receptor modulator approved for relapsing forms of MS, following Gilenya and Mayzent (siponimod), both marketed by Novartis.

This type of therapy works by preventing immune cells from leaving the lymph nodes, entering circulation, and reaching the brain and spinal cord, where they can promote further inflammation and nerve cell damage.

Because Zeposia is more selective for certain types of S1P receptors, it is thought to have a better safety profile than Gilenya. According to Bristol Myers Squibb, Zeposia also is currently the only S1P receptor modulator that does not require a genetic test or an observation period for most patients being given the first dose.

Despite its delayed launch in June, Zeposia was prescribed by about 20% of surveyed physicians within its first two months of availability. Consistent with Bristol Myers Squibb’s positioning efforts, neurologists were most willing to prescribe Zeposia to people with relapsing-remitting MS (RRMS), active secondary progressive MS (SPMS), or those transitioning between the two disease forms.

However, the therapy faces substantial competition within the field of relapsing MS, both from other high-efficacy oral DMTs (including S1P receptor modulators) and especially from Ocrevus (ocrelizumab), the report noted.

Still, neurologists expect Zeposia to equal Mayzent’s share within the next six months, and Gilenya to suffer even more from Zeposia’s growth. While Gilenya currently remains the most preferred S1P receptor modulator, more neurologists already favor Zeposia over Mayzent among oral DMTs.

Notably, more than one third of respondents anticipate that Zeposia’s initiation process will be easier than that of Gilenya or Mayzent, and about 40% believe the lack of a mandatory first-dose observation period will work in its favor.

The survey also showed different use patterns between Zeposia and Mayzent, with Zeposia being most frequently prescribed to RRMS patients and Mayzent to people with active SPMS.

According to the report, this is the result of Novartis’ efforts to highlight Mayzent as the first and only oral DMT proven to slow disability progression in a broad range of SPMS patients.

Compared with Roche’s into-the-vein Ocrevus, many neurologists stated that Zeposia wins in terms of mode of administration, but may lose in parameters such as effectiveness, known safety profile, clinical data support, and overall familiarity or comfort.

In addition to issues related to Zeposia’s short time on market, use of an alternative S1P receptor modulator was one of the most commonly reported obstacles to its use, particularly among those who have not yet prescribed it.

“Should this attitude remain consistent over the next year, Zeposia uptake could suffer,” Spherix stated in the release.

The report also emphasized the impact of COVID-19 on these high-efficacy DMTs, as half of the surveyed neurologists admitted changing the way they managed their MS patients due to the pandemic, including temporary switches to more conservative practices and a preference for DMTs with stronger safety profiles.

In addition, more than half of the sizable minority of physicians who reported drops in their use of Gilenya or Mayzent over the past three months stated that COVID-19 had a high influence in such reductions.

The pandemic also affected Zeposia prescriptions by limiting the frequency of visits from sales representatives, with nearly 75% of neurologists stating no previous contact with a Zeposia sales representative.

Notably, more than half of respondents who had been contacted by a Zeposia sales representative in the past month were currently prescribing the therapy, compared with 7% of those who had not. This highlighted the influence that contact with sales representatives (whether in person or virtual) can have on a therapy launch.

The report also noted that the use of oral DMTs increased slightly over the past year, with Mayzent and Biogen’s Vumerity (diroximel fumarate) experiencing modest growth over the past quarter.

Spherix announced it will launch a new tracking service in the coming months, called Launch Dynamix: Zeposia in Multiple Sclerosis (US), which will further monitor Zeposia’s progression, including awareness, use patterns, and neurologists’ perceptions, over 18 months. It also will compare key data of Zeposia’s launch with recent, historical launches in MS, including those of Ocrevus, Mayzent, and EMD Serono‘s Mavenclad.

Spherix plans to also track other branded launches in MS, including Vumerity, Novartis’ Kesimpta (ofatumumab), and Janssen Pharmaceuticals’ investigational oral therapy ponesimod (should it be approved in the beginning of 2021).