Stakeholder Insight: Psoriasis - Biologics are yet to make topical treatments

Stakeholder Insight: Psoriasis - Biologics are yet to make topical treatments obsolete

Published By: Datamonitor
March 2009
R313-46073
Online Download $15,200.00
Global Site License $38,000.00

Description

Introduction

Patient perception of disease severity drives treatment-seeking behavior in psoriasis. New therapeutic options targeting specific mechanisms are set to reshape severe psoriasis therapy. However, current biologics have not undermined first-line topical therapy. In addition to efficacy, reimbursement plays a crucial role in physicians' prescribing decisions.

Scope

Opinion from 180 practicing dermatologists, each treating at least 40 psoriasis patients per month Including data from physicians and opinion leaders across the seven major markets of the US, Japan, France, Germany, Spain, Italy and the UK Analysis of psoriasis population attributes, physicians' prescribing decisions, therapy outcomes and treatment satisfaction Brand analysis of key pharmaceuticals used in psoriasis, including biologics and branded topical formulations

Highlights

The low estimated diagnosis rate of 54% reflects a lack of treatment-seeking by mild sufferers. Despite nearly 10 million diagnosed patients, the market value of psoriasis is constrained by reliance on generic and non-prescription treatments in mild disease.

Biologics' risk-benefit and cost-benefit ratios are coming under review. Humira (adalimumab) and Stelara (ustekinumab) stand to benefit from the withdrawal of Raptiva (efalizumab) from the EU and more stringent labeling in the US. The position of biologics in moderate to severe psoriasis is up for challenge by payers attempting to control costs.

Topical treatments are the foundation of therapy, used alone by at least 82% of mild patients. Phototherapy is a cost-effective treatment option in psoriasis unresponsive to topical therapy. Most physicians surveyed recommend phototherapy to up to 30% of patients, and payers may influence greater use of phototherapy.

Reasons to Purchase

Understand how patient behavior controls the size of the psoriasis market
Interpret physicians' priorities in prescribing personalized psoriasis treatment regimens
Assess the regional dynamics of therapy choice in psoriasis, dictated by product availability, regulation and reimbursement

Please note: this is delivered as a Zip file.

Table of Contents

ABOUT DATAMONITOR HEALTHCARE: About the Immunology & Inflammation pharmaceutical analysis team
CHAPTER 1 EXECUTIVE SUMMARY: Scope of the analysis; Datamonitor insight into the psoriasis market; Contributing experts; Related reports; Upcoming related reports
CHAPTER 2 INTRODUCTION AND SCOPE: Coverage of the Stakeholder Insight Survey; Epidemiology and comorbidities of psoriasis; Patient segmentation, presentation and diagnosis; Treatment options and trends; Brand trends; Improving treatment outcomes; Future trends
CHAPTER 3 COUNTRY TREATMENT TREES: Introduction to treatment trees; US; Japan; France; Germany; Italy; Spain; UK
CHAPTER 4 EPIDEMIOLOGY AND COMORBIDITIES OF PSORIASIS: Disease definition and types; Plaque psoriasis affects the majority of psoriasis patients; Diagnostic criteria; Epidemiology of psoriasis; Studies of psoriasis prevalence in the US broadly align with each other; Psoriasis prevalence in Japan is lower than in the US and Europe; Europe; Estimates of psoriasis prevalence in France vary widely; German psoriasis prevalence estimates lead to a consensus figure; Two prevalence studies in Italy reach similar conclusions; Spanish psoriasis prevalence estimates vary within a narrow range; Two studies find similar psoriasis prevalence rates in the UK; Trends in psoriasis epidemiology; Psoriasis typically affects adolescents and middle-aged adults; Psoriasis affects slightly more men than women; Comorbidities, risk factors and complications; Comorbidities are common in psoriasis; Obesity and smoking are strongly associated with psoriasis; Physical trauma and infections can bring on psoriasis; Other autoimmune diseases affect over 20% of psoriasis patients with a comorbidity
CHAPTER 5 PATIENT SEGMENTATION, PRESENTATION AND DIAGNOSIS: Psoriasis diagnosis rates and awareness are relatively low; Reasons for the low diagnosis rates; Disease severity drives treatment-seeking behavior; Time to diagnosis; Many psoriasis patients wait over 10 months before presenting; Psoriasis diagnosis tends not to be immediate; Physicians do not perceive misdiagnosis as a key reason for lack of psoriasis diagnosis; Patient segmentation; The majority of psoriasis patients have mild or moderate disease
CHAPTER 6 TREATMENT OPTIONS AND TRENDS: Treatment guidelines; Various national treatment guidelines are interpreted and applied internationally; Non-pharmacological, pharmacological and combination treatment strategies; Non-pharmacological therapies; Phototherapy: principles and potential risks; Phototherapy usage is low in most markets; Excimer laser; Psoralen plus UVA (PUVA); Ultraviolet light B; Sunlight; Balneophototherapy; Pharmacological therapies; Topical and systemic therapies; Use of systemic and combination therapy increases with disease severity; Treatment class options and trends; Topical vitamin derivatives; Topical vitamin derivative use is common in mild to moderate psoriasis; Cytotoxic agents; Cytotoxic agents may be used instead of biologics in moderate to severe psoriasis; Systemic corticosteroids; Systemic corticosteroids are used nearly exclusively in severe psoriasis; Topical corticosteroids; Topical corticosteroid use varies significantly from market to market; Immunosuppressants; Immunosuppressant usage relies on situation-specific cost-benefit analysis; Topical immunomodulators; Topical immunomodulators see limited off-label use in psoriasis; Systemic retinoids; Biologic therapy; The market for anti-TNF therapy in moderate to severe psoriasis is maturing; Less than 10% of severe psoriasis patients use other biologic drugs; Other drug classes; Analgesics are used sparingly in psoriasis; NSAIDs and COX-2 inhibitors are used sparingly to manage inflammation; Topical NSAIDs are uncommon in psoriasis treatment regardless of disease severity; Traditional DMARDs are rarely used in psoriasis
CHAPTER 7 BRAND TRENDS: Biologic usage by brand, line and response dynamics; Usage of biologic brands by percentage; Overall Enbrel is currently the predominant brand in psoriasis; Preference by line of therapy; Physicians strongly prefer Enbrel at first line; Humira shines at second line in the US but opinion is split in Europe; Remicade and Raptiva are the clear favorites at third line; Outcomes by brand of biologic; Enbrel is preferred at first line but fails for a significant proportion of patients; Importance of prescribing factors; Question design; Efficacy and safety are important to all classes; Disease modification is the primary rationale for biologics use; Side-effect profile comparatively more important for vitamin derivatives; Speed of action dictates the prescribing decision for steroids; Physician perception of key brands; Amevive (alefacept; Astellas, Biogen Idec); Amevive: poorly understood or differentiated; Raptiva (efalizumab; Genentech, Xoma, Merck Serono); Cases of PML spell trouble for Raptiva; Dermatologists rated Raptiva highly in terms of dosing frequency; Raptiva's safety profile continues to signal doom for the brand; Enbrel (etanercept; Amgen, Wyeth); Enbrel loses out in terms of disease modification efficacy; Remicade (infliximab; Centocor, Schering-Plough, Mitsubishi Tanabe); Remicade used for speed of action in more severe patients; Remicade's downfall in psoriasis is its method of administration; Humira (adalimumab; Abbott, Eisai); Humira scores well on dose frequency, but loses out on top spot to Stelara for this attribute; Humira market share predicted to increase due to positive perception; Stelara (ustekinumab; Centocor, Janssen Cilag); Fewer dermatologists were able to rate Stelara, but overall scores were high; Stelara awarded higher scores than other biologics on efficacy attributes; Stelara's perceived speed of action is similar to Humira but lower than Remicade; Stelara's dosing frequency sets it apart from other biologic brands; Dovonex (calcipotriol; Leo Pharma, Warner Chilcott); Dovonex combines well with other therapies and rates positively in reimbursement status; Elocon (mometasone; Schering-Plough); Elocon received similar attribute scores to Dovonex
CHAPTER 8 IMPROVING TREATMENT OUTCOMES: Measuring the severity of psoriasis; PASI score is the standard endpoint in psoriasis clinical research; In the EU, payers have an influence on clinical usage of the PASI scores; Dermatologists generally accept PASI 75, but some prefer PASI 50; Most physicians using PASI clinically aim for a PASI score of 5 to 10; Other measures of treatment efficacy in psoriasis; Achieving treatment outcomes; Most mild patients reach desired outcomes after six months of treatment; Treatment satisfaction in psoriasis; Satisfaction with current psoriasis treatments is moderate to high; Unmet needs in psoriasis; Better formulations to increase adherence and tools to improve prescribing
BIBLIOGRAPHY: Journal papers; Websites; Datamonitor reports
APPENDIX A: Physician research methodology
APPENDIX B: The survey questionnaire; About Datamonitor; About Datamonitor Healthcare; About the Immunology & Inflammation analysis team; Disclaimer
List of Tables: Table 1: Subtypes of psoriasis, percentage of diagnosed patients across the seven major markets, 2008; Table 2: Features that have been considered in different classifications of psoriasis; Table 3: Psoriasis prevalence across the seven major markets, 2008; Table 4: Percentages of psoriasis patients with selected comorbidities in the seven major markets, 2004 and 2008; Table 5: Selected additional common psoriasis comorbidities, percentage of diagnosed patients across the seven major markets, 2008; Table 6: Autoimmune psoriasis comorbidities, percentage of patients with a comorbidity, across the seven major markets, 2008; Table 7: Percentage of psoriasis sufferers diagnosed in the seven major markets, 2004 and 2008; Table 8: Mean rating given to each reason for patients remaining undiagnosed, 5 = strongly agree,, seven major markets, 2008; Table 9: Total length of time from onset of symptoms to psoriasis diagnosis across the seven major markets (months) 2008; Table 10: Percentage of diagnosed psoriasis patients by disease severity in the seven major markets, 2008; Table 11: Treatment strategies recommended to psoriasis patients across the seven major markets, by disease severity, 2008; Table 12: Percentage of patients estimated to use non-pharmacological therapy only, by disease severity and country, 2008; Table 13: Types of phototherapy used by patients receiving phototherapy for psoriasis, by country, 2008; Table 14: Mean percentages of psoriasis patients estimated to use treatment options, by disease severity, per country, 2008; Table 15: Overview of drug classes commonly used in psoriasis treatment in the seven major markets, 2008; Table 16: Topical vitamin derivative class usage in psoriasis by disease severity across the seven major markets, 2008; Table 17: Cytotoxic agent class usage in psoriasis by disease severity across the seven major markets, 2008; Table 18: Systemic corticosteroid class usage in psoriasis by disease severity across the seven major markets, 2008; Table 19: Topical corticosteroid class usage in psoriasis by disease severity, across the seven major markets, 2008; Table 20: Immunosuppressant class usage in psoriasis by disease severity, across the seven major markets, 2008; Table 21: Topical immunomodulators class usage in psoriasis by disease severity and patients with inverse psoriasis across the seven major markets, 2008; Table 22: Systemic retinoid class usage in psoriasis by disease severity across the seven major markets, 2008; Table 23: Anti-TNF class usage in psoriasis by disease severity across the seven major markets, 2008; Table 24: Other biologics usage in psoriasis by disease severity across the seven major markets, 2008; Table 25: Analgesic usage in psoriasis by disease severity across the seven major markets, 2008; Table 26: Traditional systemic NSAID class usage in psoriasis by disease severity across the seven major markets, 2008; Table 27: COX-2 class usage in psoriasis by disease severity across the seven major markets, 2008; Table 28: Topical NSAID class usage in psoriasis by disease severity across the seven major markets, 2008; Table 29: DMARD class usage in psoriasis by disease severity across the seven major markets, 2008; Table 30: Percentage use by brand, for all patients receiving biologic therapy in the seven major markets, 2008; Table 31: Percentage of patients receiving each biologic brand with an initial inadequate response and who eventually become refractory; Table 32: Comparative importance of factors affecting dermatologist prescribing decisions, by country, for biologics; Table 33: Comparison of PASI 50, -75 and -90 scores between the biologic brands; Table 34: Comparative importance of factors affecting dermatologist prescribing decisions, by country, for vitamin derivatives; Table 35: Comparative importance of factors affecting dermatologist prescribing decisions, by country, for steroids; Table 36: Comparative scores across all brands assessed; Table 37: Amevive scores by attribute and country; Table 38: Raptiva scores by attribute and country; Table 39: Enbrel scores by attribute and country; Table 40: Remicade scores by attribute and country; Table 41: Humira scores by attribute and country; Table 42: Stelara scores by attribute and country; Table 43: Dovonex scores by attribute and country; Table 44: Elocon scores by attribute and country; Table 45: Percentages for successful PASI change across the seven major markets, 2008; Table 46: Percentages for minimum successful PASI change across the seven major markets, 2008; Table 47: Measures of treatment efficacy in psoriasis among physicians not using PASI score in clinical practice, 2008; Table 48: Percentage of patients reaching the desired outcome after 6 months of treatment, %; Table 49: Priority rating allocated by dermatologists to unmet needs in the treatment of psoriasis, 1=low priority, 2008; Table 50: Dermatologists surveyed regarding psoriasis, 2008
List of Figures: Figure 1: Psoriasis patient population, split by physician-estimated diagnoses, disease severity, drug-treated population and drug-class usage in the US, 2008; Figure 2: Preferred biologic drug brands by line of therapy in moderate to severe psoriasis in the US, 2008; Figure 3: Psoriasis patient population, split by physician-estimated diagnoses, disease severity, drug-treated population and drug-class usage in Japan, 2008; Figure 4: Psoriasis patient population, split by physician-estimated diagnoses, disease severity, drug-treated population and drug-class usage in France, 2008; Figure 5: Preferred biologic drug brands by line of therapy in moderate to severe psoriasis in France, 2008; Figure 6: Psoriasis patient population, split by physician-estimated diagnoses, disease severity, drug-treated population and drug-class usage in Germany, 2008; Figure 7: Preferred biologic drug brands by line of therapy in moderate to severe psoriasis in Germany, 2008; Figure 8: Psoriasis patient population, split by physician-estimated diagnoses, disease severity, drug-treated population and drug-class usage in Italy, 2008; Figure 9: Preferred biologic drug brands by line of therapy in moderate to severe psoriasis in Italy, 2008; Figure 10: Psoriasis patient population, split by physician-estimated diagnoses, disease severity, drug-treated population and drug-class usage in Spain, 2008; Figure 11: Preferred biologic drug brands by line of therapy in moderate to severe psoriasis in Spain, 2008; Figure 12: Psoriasis patient population, split by physician-estimated diagnoses, disease severity, drug-treated population and drug-class usage in the UK, 2008; Figure 13: Preferred biologic drug brands by line of therapy in moderate to severe psoriasis in the UK, 2008; Figure 14: Subtypes of psoriasis, percentage of diagnosed patients across the seven major markets, 2008; Figure 15: Mean percentage of psoriasis patients with at least one comorbidity in the seven major markets, 2008; Figure 16: Percentage of psoriasis patients with selected comorbidities in the seven major markets, 2004 and 2008; Figure 17: Selected additional common psoriasis comorbidities, percentage of diagnosed patients across the seven major markets, 2008; Figure 18: Autoimmune psoriasis comorbidities, percentage of patients with a comorbidity, across the seven major markets, 2008; Figure 19: Percentage of diagnosed versus undiagnosed psoriasis sufferers in the seven major markets, 2008; Figure 20: Total estimated psoriasis patient population, diagnosed versus undiagnosed, in the seven major markets, 2008; Figure 21: Mean rating given to each reason for patients remaining undiagnosed, seven major markets, 2008; Figure 22: Total length of time from onset of symptoms to psoriasis diagnosis across the seven major markets, 2008; Figure 23: Physicians indicating that psoriasis is diagnosed immediately upon presentation versus those who believe that patients experience a delay in receiving a diagnosis, 2008; Figure 24: Percentage of diagnosed psoriasis patients by disease severity in the seven major markets, 2008; Figure 25: Treatment strategies used by psoriasis patients across the seven major markets, by disease severity, 2008; Figure 26: Percentage of patients estimated to use non-pharmacological therapy strategies, by disease severity, across the seven major markets, 2008; Figure 27: Percentage of patients estimated to use non-pharmacological therapy only, by disease severity and country, 2008; Figure 28: Mean estimated percentages of patients recommended to use phototherapy, by country, 2008; Figure 29: Distribution of percentages of patients to whom phototherapy is recommended in the seven major markets, 2008; Figure 30: Types of phototherapy used by patients receiving phototherapy for psoriasis, by country, 2008; Figure 31: Mean percentages of psoriasis patients estimated to use topical and/or systemic treatment options, by disease severity, across the seven major markets, 2008; Figure 32: Percentage use by brand, for all patients receiving biologic therapy in the seven major markets, 2008,; Figure 33: Preferred biologic drug brands by line of therapy in moderate to severe psoriasis, US verses average of five major EU counties, 2008; Figure 34: Percentage of patients receiving each biologic brand with an initial inadequate response and who eventually become refractory; Figure 35: Comparative importance of factors affecting dermatologist prescribing decisions, by class; Figure 36: Comparative scores across all brands assessed; Figure 37: Stelara's clinical response between Week 0 and Week 28; Figure 38: Percentage of physicians using the PASI score across the seven major markets, 2008; Figure 39: Successful percentage of PASI change across the seven major markets, 2008; Figure 40: Successful minimum PASI change, %, across the seven major markets, 2008; Figure 41: Physicians stating 41%-50%, 61%-70% and 71%-80% as acceptable PASI scores, by country, 2008; Figure 42: Mean PASI scores physicians aim to reach in the seven major markets, 2008; Figure 43: Measures of treatment efficacy in psoriasis among physicians not using PASI score in clinical practice, seven major markets, 2008; Figure 44: Measures of treatment efficacy in psoriasis among US physicians not using PASI score in clinical practice, 2008; Figure 45: Distribution of physician responses for percentage of patients reaching the desired outcome, by severity; Figure 46: Dermatologists' satisfaction with currently available psoriasis treatments across the seven major markets, 2008; Figure 47: Distribution of dermatologists' ratings of satisfaction with currently available psoriasis treatments across the seven major markets, 2008; Figure 48: Priority rating allocated by dermatologists to unmet needs in the treatment of psoriasis,

Order Form

* Please reference product number R313-46073 when ordering or inquiring.

PUBLICATION: Stakeholder Insight: Psoriasis - Biologics are yet to make topical treatments obsolete
QTY.	FORMAT	PRICE	TOTAL
	Online Download	$15,200.00
	Global Site License	$38,000.00
		SUBTOTAL
		SHIPPING CHARGES (U.S. $25, Canada $35, Int'l $65)
		TOTAL
CONTACT INFORMATION		PAYMENT INFORMATION
Name	____________________________________________	MasterCard VISA AmEx Discover __________________________________ Account number Exp. date __________________________________ Signature __________________________________ Email Please invoice (shipment on receipt of payment) Payment enclosed *CHECKS / WIRE TRANSFERS: Checks must be paid in U.S. funds. Please call for details.
Company	____________________________________________
Job Title	____________________________________________
Address	____________________________________________
City	____________________________________________
Company	____________________________________________
State	______________________________ Zip__________
Country	____________________________________________
Phone	____________________________________________

MindBranch, Inc., 131 Ashland St., Suite 200 North Adams, MA��01247 �� tel: 800-774-4410 fax: +1-413-664-9791 www.mindbranch.com