Mayzent and Kesimpta Gaining Ground as MS Treatments in Canada

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by Marta Figueiredo, PhD |

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Novartis’ Mayzent (siponimod) and Kesimpta (ofatumumab) are gaining ground among multiple sclerosis (MS) therapies in Canada, according to the latest Spherix Global Insights’ report.

“Following an eventful 2021 that included the launch of two new brands — Novartis’ Kesimpta and BMS’ Zeposia — and generic versions of Biogen’s Tecfidera, the Canadian multiple sclerosis (MS) market appears to be settling into patterns of strong uptake of new therapies,” a Spherix press release summarizing the report noted.

The report was part of Spherix’s RealTime Dynamix: Multiple Sclerosis (Canada) service, which collects data on market trends of MS disease-modifying therapies (DMTs) in Canada by surveying healthcare providers in the country. This most recent report is based on responses from 50 MS specialists and neurologists, given in April.

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Mayzent, approved in March 2020 as the first oral treatment for active secondary progressive MS, was the second S1P receptor modulator to enter the Canadian MS market, following Novartis’ Gilenya (fingolimod) for relapsing-remitting MS (RRMS).

S1P receptor modulators work by “trapping” immune cells in lymph nodes (important immune structures), preventing these cells from entering the nervous system and causing damage.

Following a strong launch in Canada, Mayzent has sustained a steady growth, especially after the pan-Canadian Pharmaceutical Alliance (pCPA) gave Novartis the green light to work with Canadian provinces to provide public funding for the treatment in October 2021.

Similar trends were reported for Kesimpta, which was approved in early 2021 as the first self-administered, at-home B-cell depleting therapy for active RRMS. The company received a letter of intent from pCPA in March to advance work on treatment reimbursement, and the therapy was added to public reimbursement plans in two Canadian provinces a month later.

Based on surveyed neurologists, Mayzent and Kesimpta showed the greatest increases in promotional efforts, as well as the highest frequencies of recent interactions with sales representatives.

Neurologists were also most likely to select Kesimpta as the brand with the best sales representatives, surpassing the previous winner and direct competitor in the active RRMS field, Roche’s B-cell depleting therapy Ocrevus (ocrelizumab).

Ocrevus, administered directly into the bloodstream at hospitals or specialist infusion centers, is also approved in the country for primary progressive MS — the only approved treatment for this MS subtype.

Zeposia (ozanimod), the third SP1 receptor modulator approved in Canada for MS — particularly for RRMS — also showed a strong and steady growth in shares, even though the Canadian Drug Expert Committee (CDEC) decided against its public reimbursement in June 2021.

Zeposia, by Bristol Myers Squibb, is thought to have a better safety profile than Gilenya due to its greater selectivity, and it was shown to aid cognitive function in addition to lowering relapse rates and brain lesions.

Its share in the first-line treatment of RRMS has increased since launch, and neurologists are now more willing to prescribe Zeposia as a first DMT to RRMS patients, regardless of whether they have highly active disease or not, the report noted.

Both Zeposia’s share and prescriber base are expected to grow over the next six months, with nearly half of the neurologists not currently prescribing the therapy saying they were thinking of doing so in the coming months.

Lack of familiarity remains neurologists’ biggest barrier to prescribing, while concerns over market accessibility have dropped.

Two new oral DMTs also are poised to possibly enter the Canadian MS market: Biogen’s Vumerity (diroximel fumarate) and Janssen’s Ponvory (ponesimod).

Should they be approved, Vumerity will become the third-to-market fumarate agent after Tecfidera (dimethyl fumarate) and generic dimethyl fumarate (DMF), and Ponvory will be the fourth S1P receptor modulator available. Both therapies are approved in the U.S. and Europe for relapsing forms of MS.

Pre-launch perceptions and anticipated use patterns among surveyed neurologists showed that prescribers think that both agents have the potential to capture meaningful patient share should they be made available and reimbursable.

“While Vumerity will draw share somewhat from DMF (branded or generic) and Ponvory will do the same from in-class competitors, these two brands will nonetheless contribute to overall net growth of both moderate efficacy and high efficacy oral DMT classes,” Spherix concluded in its release.

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