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August
2008
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Data Download provides highlights of recently released data from GfK Market Measures’ Therapeutic Class Studies (TCS). Based on primary market research, TCS provide in-depth analysis of market trends, physician practice patterns and competitive brand positioning.
This month’s selections cover research conducted in the areas of MRSA, fibromyalgia and psoriasis.
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Summary: Hospitals taking steps to better identify and manage spread of MRSA, but physicians say treatment options remain unfulfilled |
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The prevalence of methicillin-resistant Staphylococcus aureus (MRSA), or the so-called “superbug,” is on the rise in hospitals and routinely encountered in the emergency room. While tests to detect MRSA are becoming more common, and hospitals are intensifying procedures to better control its spread, there remains a need to develop more effective treatment options, according to new research by GfK Market Measures.
Supporting reports of MRSA’s increasing prevalence, which over the past year garnered the public’s attention as stories of the MRSA “superbug” made national news headlines, almost 90 percent of physicians participating in GfK’s study confirm that the prevalence of community-acquired MRSA infections is increasing. The research revealed that almost one in five hospitalized patients treated with an injectable antibiotic is suspected of having a MRSA infection. Although adults show the greatest prevalence of MRSA cases, emergency room physicians are seeing a notable proportion of MRSA in college-aged patients.
While hospital-acquired MRSA infections have not shown as dramatic a rise as community-acquired MRSA cases, with 60 percent of physicians reporting an increase, culture testing for MRSA in the hospital setting has increased, according to almost 80 percent of physicians. In addition to more widespread testing, to better manage the spread of MRSA in the hospital setting, physicians report that hospitals are focused on isolation procedures, hand-washing protocols and screening/surveillance of certain patient types.
Treatment options for MRSA remain generally limited to two agents. Vancomycin, which has been the standard of care for quite some time, continues to be the treatment of choice by almost 80 percent of physicians. However, infectious disease specialists – those who deal most closely with MRSA – are increasingly turning to a newer option, Zyvox, and it is anticipated that this agent will become a more visible player for the MRSA pathogen as other specialists follow this group’s lead. Despite these treatment options, GfK’s research shows that the MRSA market remains unfulfilled, as physicians report a variety of unmet needs.
Antibiotic resistance is of particular concern and thus a key driver in physicians’ desire for a wider treatment selection. After empiric treatment, almost 50 percent of patients are shown to have an infection that would be susceptible to a narrower-spectrum antibiotic, and after culture results are received about three-quarters of these patients are switched to the new agent. However, the need to immediately treat infections in the hospital setting at the risk of septicemia and shock necessitates the continued practice of empiric treatment. Thus, physicians are seeking broad-spectrum antibiotics that are safe for empiric use. The need for additional targeted-spectrum agents, presumably to treat new variant, resistant strains, was also reported by physicians.
“Cephalosporins and quinolones have been highly regarded for safety and appropriateness for empiric use. At the time we fielded this study, it was anticipated both classes would remain pillars in the physician’s antibiotic armamentarium. And that may be the case. However, the recent ‘black box’ warning applied to quinolones for risk of Achilles tendon rupture may temper their use and pave the way for Zosyn to continue its growth in the market, provided it maintains a favorable position on the hospital formulary, which its superior efficacy should help to do,” said Sue Ramspacher, Senior Vice President and Category Business Leader, Antibiotics, GfK Market Measures. “Our research with managed care organizations on injectable antibiotics shows that black box warnings are particularly influential on hospitals’ reassessment of formulary placement.”
| Reflecting insights from 276 hospital-based physicians, including infectious disease specialists, internists, emergency room physicians, critical care medicine physicians and pulmonologists, fielded via Internet questionnaire in April 2008, GfK Market Measures’ 2008 Hospital Injectable Antibiotics Study provides an in-depth understanding of injectable antibiotics in the hospital setting from the perspective of physicians. |
Contact: Sue Ramspacher, VP, Category Business Leader, Antibiotics
sramspacher@gfkmm.com
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Summary: Cymbalta, Lyrica and new entrants in fibromyalgia market must address complex range of symptoms and manage patient expectations through awareness and education to succeed |
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Fibromyalgia, a chronic condition within the neuropathic pain category, is complicated both in its initial diagnosis and ongoing treatment because of a wide range of pain and nonpain symptoms. The success of drugs such as Cymbalta, Lyrica and future entrants in this market are dependent on marketers having a more holistic view of patient satisfaction as well as implementing awareness and education programs for physicians and patients, according to new research by GfK Market Measures.
Among the four conditions that comprise the neuropathic pain category, which also includes diabetic neuropathic pain, postherpetic neuralgia and neuropathic lower back pain, fibromyalgia is recognized as particularly difficult to set a definitive diagnose despite criteria that were established more than 17 years ago by the American College of Rheumatology. Almost one-third of patients participating in GfK’s research reported that it took two years or more of suffering symptoms before they visited a physician. Furthermore, fibromyalgia patients visited almost three different physicians, on average, before a diagnosis was made, and almost one-third reported that the diagnosis was determined more than two years after the initial physician visit.
Fibromyalgia patients report a much more wide-ranging set of symptoms when compared to more traditional neuropathic pain conditions. These patients are more likely to describe their pain as “aching pain,” and more likely to report muscle spasms (64 percent of patients), tenderness (65 percent) and overly sensitive to touch (74 percent). Compared to other neuropathic pain patients, a larger proportion of fibromyalgia patients report suffering from a host of nonpain symptoms: fatigue/tiredness (cited by 96 percent of fibromyalgia patients vs. 60 to 66 percent of patients with other pain conditions), sleeplessness/insomnia (78 percent vs. 44 to 60 percent for other conditions), feelings of depression (75 percent vs. 33 to 43 percent for other conditions) and headaches (57 percent vs. 23 to 36 percent for other conditions).
As a result of the wide variety of symptoms experienced, fibromyalgia patients put a particular emphasis on a drug’s ability to “improve quality of life,” with 43 percent of fibromyalgia patients ranking it as a Top 3 attribute.
“Pain reduction will certainly improve quality of life to a degree, but given the range of nonpain symptoms experienced by fibromyalgia patients, marketers face a particular challenge in managing patients’ expectations of a drug’s effects across all symptoms,” said Geoff Penney, Vice President and Category Business Leader, Neurology, GfK Market Measures. “Especially in fibromyalgia, discontinuance might be influenced by patients’ disappointment that not all symptoms have been alleviated with their brand medication. Therefore, a critical part of a brand’s marketing campaign should be patient support materials that serve to educate on how these other nonpain symptoms can be alleviated through additional medical services or treatments.”
In comparing the two medications with fibromyalgia indications – Cymbalta, which was approved last month, and Lyrica, which was approved in June 2007 – both seem to have very similar efficacy experiences reported by patients (Cymbalta rated 4.50 and Lyrica rated 4.72 on a seven-point scale). However, Cymbalta appears to hold an advantage in higher satisfaction ratings by patients for “whether it has significant side effects” (Cymbalta rated 4.71 and Lyrica rated 3.94 on a seven-point scale). Similar to other pain conditions, fibromyalgia patients report high combination therapy use. GfK’s research shows almost three-quarters of fibromyalgia patients using Lyrica or Cymbalta are also using a traditional analgesic medication (about 30 percent are using hydrocodone-acetaminophen). Additionally, 20 percent of patients using Cymbalta report also using Lyrica.
| Reflecting insights from 905 neuropathic pain patients including those diagnosed with diabetic neuropathic pain, fibromyalgia, neuropathic lower back pain and postherpetic neuralgia, fielded via Internet questionnaire in February 2008, GfK Market Measures’ 2008 Neuropathic Pain Patient Study provides a comprehensive analysis of the neuropathic pain market from the perspective of patients using prescription medication to treat their pain. |
Contact: Geoff Penney, VP, Category Business Leader, Neurology
gpenney@gfkmm.com
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Summary: Opportunity for biologics growth remains untapped as many patients continue to show hesitation toward therapy |
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Despite the fact biologics are considered to be the most effective option for treating severe cases of psoriasis, they have been unable to gain patients’ favor and penetrate to date as a class, according to new research by GfK Market Measures.
Among dermatologists, who are significantly more likely to prescribe biologic therapy for psoriasis than primary care physicians, biologics usage is still fairly low. The therapy is only prescribed to about one in four patients suffering from severe psoriasis and about half of patients suffering from moderate-to- severe psoriatic arthritis. As an overall class, biologics have not increased in share during the last 12 months. Meanwhile, dermatologists report that the proportion of moderate-to-severe psoriasis patients using only topical products has remained consistent over the last year (54 percent of moderate patients in 2008 vs. 56 percent in 2007 and 26 percent of severe patients in 2008 vs. 28 percent in 2007).
Among moderate-to-severe psoriasis patients who are treated with only topical treatments, “patient preference” is the primary reason cited by 39 percent of dermatologists for not using a more aggressive treatment, with “safety” cited as a primary reason by 22 percent of dermatologists.
“Our research continues to show that biologics have been unable to penetrate as a class, largely as a result of patient concerns over perceived safety risks as well as patients’ discomfort with injection dosing,” said Kim Lazarus, Vice President and Category Business Leader, Dermatology, for GfK Market Measures. “Continued education of both physicians and patients on the benefits of biologics therapy should assist in growing the class and overcome patient reluctance, particularly among patients with severe psoriasis and/or psoriatic arthritis. Physicians must be given the verbiage to convince patients that biologics are the most appropriate therapy for their condition, and as part of that message biologics manufacturers should provide more long-term data to support biologics’ safety.”
Although Enbrel continues to be the biologic of choice, prescribed by 89 percent of dermatologists (compared with 88 percent in 2007), Humira has gained significant ground in the past year, with usage increasing to 70 percent among dermatologists (compared with 49 percent in 2007). Looking forward, GfK’s research revealed that dermatologists’ usage of Humira is expected to increase by 50 percent over the next 100 prescriptions, bringing its psoriasis share closer to that of Enbrel.
“Although biologics are not growing as a class, Humira is gaining ground on Enbrel, likely due to its safety and dosing profiles,” said Ms. Lazarus. “Humira requires less frequent dosing, which helps with the patient comfort factor.”
| Reflecting insights from 205 physicians, including dermatologists and primary care physicians, fielded via Internet questionnaire in May 2008, GfK Market Measures’ 2008 Psoriasis Physician Study provides a comprehensive analysis of the psoriasis market from the perspective of treating physicians. |
Contact: Kim Lazarus, VP, Category Business Leader, Dermatology
klazarus@gfkmm.com
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Research Highlights: Antibiotics, Neurology and Dermatology
