- 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,
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