Psoriasis - Biologics Impact Treatment Regimes Across the Globe
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- About the CNS and Arthritis pharmaceutical analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Scope of the analysis - page 3
- Datamonitor insight into the psoriasis market - page 4
- Psoriasis is currently under diagnosed, but awareness is increasing with the introduction of high-profile biologic brands. - page 4
- Topical treatments such as calcipotriol and corticosteroids still dominate psoriasis treatment, leaving a gap for the moderate severity patient not effectively treated by this group, but not severe enough for an expensive or toxic systemic treatment. - page 5
- Current and pipeline biologic brands are differentiated from selected traditional brands by their perceived superior efficacy, side-effect profile, dosing frequency and ability to treat comorbidities. - page 6
- CHAPTER 2 INTRODUCTION AND SCOPE - page 14
- 2.1 Coverage of the Stakeholder Insight Survey - page 14
- Section 1 - Epidemiology - page 14
- Section 2 - Treatment patterns - page 14
- Section 3 - Key prescribing influences - page 14
- Section 4 - Treatment outcomes and patient compliance - page 15
- Section 5 - Pipeline therapies and treatment challenges - page 15
- 2.1.1 Country level 'treatment trees' - page 17
- 2.1 Coverage of the Stakeholder Insight Survey - page 14
- CHAPTER 3 COUNTRY TREATMENT TREES - page 18
- US - page 20
- Japan - page 24
- France - page 28
- Germany - page 32
- Italy - page 36
- Spain - page 40
- UK - page 44
- CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION - page 48
- 4.1 Disease definition and classification - page 48
- Plaque (vulgaris) - page 48
- Guttate - page 48
- Inverse - page 48
- Pustular - page 49
- Erythrodermic - page 49
- Diagnostic criteria - page 49
- 4.2 Epidemiology of psoriasis - page 50
- US - page 51
- Japan - page 52
- Europe - page 52
- France - page 52
- Germany - page 52
- Italy - page 53
- Spain - page 53
- UK - page 53
- 4.3 Patient segmentations - page 54
- Age - page 54
- Gender - page 56
- 4.4 Comorbidities, complications and risk factors - page 56
- Lifestyle - page 57
- Trauma - page 58
- Infections - page 58
- Other autoimmune diseases - page 58
- 4.1 Disease definition and classification - page 48
- CHAPTER 5 DIAGNOSIS AND TREATMENT OPTIONS - page 59
- 5.1 Presentation and diagnosis - page 59
- Diagnosis rates and awareness - page 59
- Disease severity - page 60
- 5.2 Treatment rates - page 62
- 5.3 Treatment options - page 64
- Non-pharmacological - page 65
- Phototherapy - page 66
- Pharmacological - page 67
- Treatment class options - page 68
- Topical formulations - page 69
- Non-pharmacological - page 65
- 5.5 Off-label prescriptions - page 70
- 5.6 Treatment guidelines - page 73
- Awareness of guidelines - page 74
- Adherence to guidelines - page 75
- 5.1 Presentation and diagnosis - page 59
- CHAPTER 6 PRESCRIBING TRENDS AND INFLUENCING FACTORS - page 77
- 6.1 Prescribing trends - page 77
- 6.2 Factors influencing physician decision making - page 81
- Safety vs. efficacy - page 83
- Company representative visits - page 83
- Other stakeholders - page 84
- 6.3 Brand perception - page 85
- Brand Mapping - page 87
- Awareness by physician specialty - page 90
- Biologic prescribing influences - page 92
- Biologics brand map - page 94
- Amevive - page 96
- Raptiva - page 99
- Enbrel - page 101
- Remicade - page 104
- Steroids - page 106
- Steroid prescribing influences - page 106
- Elocon - page 110
- Vitamin derivatives - page 112
- Vitamin derivative prescribing influences - page 112
- Dovonex - page 114
- Tazorac - page 118
- Soriatane - page 120
- Traditional treatments brand map - page 123
- CHAPTER 7 IMPROVING TREATMENT OUTCOMES - page 124
- 7.1 Treatment outcomes - page 124
- PASI score - page 124
- PASI: issues and debates - page 125
- Patients reaching desired outcome - page 130
- 7.2 Patient compliance - page 132
- Unmet needs - page 137
- Physician/patient education - page 137
- Patient perspective - page 137
- Cost reduction - page 140
- Therapeutic unmet needs - page 141
- 7.3 New product development - page 142
- 7.3.1 Awareness - page 142
- BG-12 (fumarate derivative) - page 142
- Avandia (rosiglitazone) - page 143
- PsorBan (topical cyclosporine) - page 144
- Oral tazarotene - page 145
- Protopic (tacrolimus) - page 146
- Elidel (pimecrolimus) - page 147
- Humira (adalimumab) - page 149
- Impact - page 149
- Pharmacist perspectives - page 149
- 7.3.1 Awareness - page 142
- 7.1 Treatment outcomes - page 124
- CHAPTER 8 OPINION LEADER AND STAKEHOLDER TRANSCRIPTS - page 151
- Dr Liz Horn, PhD - National Psoriasis Foundation - page 151
- Dr Steven Feldman, MD - Professor of Dermatology, Pathology and Public Health Sciences at the Wake Forest University School of Medicine in Winston-Salem, North Carolina - page 158
- Dr Charles N. Ellis, MD - Professor and Associate Chair, Department of Dermatology, University of Michigan Medical, Ann Arbor, US - page 165
- Dr Michiko Haida, MD, PhD - Professor of Allergy and Immunology, Hanzoumon Hospital, Tokyo - page 175
- APPENDIX A - page 178
- Epidemiology - page 179
- Clinical trial data - page 179
- APPENDIX B - page 181
- Physician research methodology - page 181
- Brand Map Interpretation - page 181
- RX-Days - page 185
- Physician sample breakdown - page 186
- APPENDIX C - page 187
- THE SURVEY QUESTIONNAIRE - page 187
- Section 1: Epidemiology - page 187
- Section 2: Treatment patterns - page 190
- Section 3: Key prescribing and brand influences - page 196
- Section 4: Treatment outcomes and patient compliance - page 198
- Section 5: Pipeline therapies - page 202
- Disclaimer - page 203
- List of Tables
- Table 1: Features that have been considered in different classifications of psoriasis - page 49
- Table 2: Psoriasis prevalence, seven major markets, 2004 - page 51
- Table 3: Psoriasis population in the seven major markets, 2004-10 - page 54
- Table 4: Common psoriasis comorbidities, % diagnosed patients - page 56
- Table 5: Diagnosed psoriasis sufferers, by country, %, 2004 - page 59
- Table 6: Breakdown of physician-managed psoriasis population by disease severity in the seven major markets, %, 2004 - page 61
- Table 7: Breakdown of physicians surveyed, by specialty and mean patients treated per month - page 63
- Table 8: Pharmacological vs. non-pharmacological - page 64
- Table 9: Treatment delivery method, average use across all seven markets, by severity - page 68
- Table 10: Overview of common treatment classes - page 69
- Table 11: Biologics and TIMs prescribing, % of total diagnosed patients and patient number estimates - page 71
- Table 12: Biologic prescriptions from IMS data, percent of total prescriptions (RX) for psoriasis*, 2003 - page 72
- Table 13: Topical immunomodulators from IMS data, percentage of total prescriptions (RX) written for psoriasis* - page 72
- Table 14: Percentage and number of diagnosed patients receiving each drug class - page 78
- Table 15: Mean number of physician visits per month, by country and physician specialty - page 84
- Table 16: Key characteristics of surveyed psoriasis products - page 86
- Table 17: Biologic approval status, by market area - page 87
- Table 18: Scores for each brand, with attribute weighting* applied - page 88
- Table 19: Percentage of physicians aware of each brand, by specialist, % - page 90
- Table 20: Biologic prescribing influences, by country - page 94
- Table 21: Biologics weighted scores - page 96
- Table 22: Amevive brand perception and awareness, by country - page 98
- Table 23: Raptiva brand perception and awareness, by country - page 101
- Table 24: Enbrel brand perception and awareness, by country - page 103
- Table 25: Remicade brand perception and awareness, by country - page 105
- Table 26: Steroid prescribing influences, by country - page 107
- Table 27: Corticosteroid potency chart - page 108
- Table 28: Elocon brand perception and awareness - page 112
- Table 29: Vitamin derivative prescribing influences, by country - page 114
- Table 30: Marketing agreements for Dovonex - page 115
- Table 31: Dovonex brand perception and awareness - page 117
- Table 32: US use of topical vitamin D derivative plus topical steroid combination - page 118
- Table 33: Tazorac brand perceptions and awareness - page 120
- Table 34: Soriatane brand perception and awareness - page 122
- Table 35: Treatment outcomes rated on a scale of one to 10, where 10 is the most important - page 127
- Table 36: Patients reaching desired treatment outcome, % - page 130
- Table 37: Formal patient-reported outcomes - page 132
- Table 38: Assessment scale for compliance - page 133
- Table 39: Physician-reported patient compliance, % - page 134
- Table 40: Cost comparison of systemic antipsoriatic agents - page 140
- Table 41: BG-12 awareness - page 143
- Table 42: Avandia awareness - page 144
- Table 43: PsorBan awareness - page 145
- Table 44: Oral tazarotene awareness - page 146
- Table 45: Protopic awareness - page 147
- Table 46: Elidel awareness - page 148
- Table 47: US total patient numbers by class, 2004 - page 178
- Table 48: Physician demographics - page 178
- Table 49: Physician breakdown by country - page 186
- List of Figures
- Figure 1: Coverage of the Stakeholder Insight: Psoriasis survey, 2004 - page 16
- Figure 2: Drug-treated patient breakdown, by country, 2004 - page 19
- Figure 3: US, overview of treatment type by disease severity, 2004 - page 20
- Figure 4: US, breakdown of classes used to treat mild psoriasis, 2004 - page 21
- Figure 5: US, breakdown of classes used to treat moderate psoriasis, 2004 - page 22
- Figure 6: US, breakdown of classes used to treat severe psoriasis, 2004 - page 23
- Figure 7: Japan, overview of treatment type by disease severity, 2004 - page 24
- Figure 8: Japan, breakdown of classes used to treat mild psoriasis, 2004 - page 25
- Figure 9: Japan, breakdown of classes used to treat moderate psoriasis, 2004 - page 26
- Figure 10: Japan, breakdown of classes used to treat severe psoriasis, 2004 - page 27
- Figure 11: France, overview of treatment type by disease severity, 2004 - page 28
- Figure 12: France, breakdown of classes used to treat mild psoriasis, 2004 - page 29
- Figure 13: France, breakdown of classes used to treat moderate psoriasis, 2004 - page 30
- Figure 14: France, breakdown of classes used to treat severe psoriasis, 2004 - page 31
- Figure 15: Germany, overview of treatment type by disease severity, 2004 - page 32
- Figure 16: Germany, breakdown of classes used to treat mild psoriasis, 2004 - page 33
- Figure 17: Germany, breakdown of classes used to treat moderate psoriasis, 2004 - page 34
- Figure 18: Germany, breakdown of classes used to treat severe psoriasis, 2004 - page 35
- Figure 19: Italy, overview of treatment type by disease severity, 2004 - page 36
- Figure 20: Italy, breakdown of classes used to treat mild psoriasis, 2004 - page 37
- Figure 21: Italy, breakdown of classes used to treat moderate psoriasis, 2004 - page 38
- Figure 22: Italy, breakdown of classes used to treat severe psoriasis, 2004 - page 39
- Figure 23: Spain, overview of treatment type by disease severity, 2004 - page 40
- Figure 24: Spain, breakdown of classes used to treat mild psoriasis, 2004 - page 41
- Figure 25: Spain, breakdown of classes used to treat moderate psoriasis, 2004 - page 42
- Figure 26: Spain, breakdown of classes used to treat severe psoriasis, 2004 - page 43
- Figure 27: UK, overview of treatment type by disease severity, 2004 - page 44
- Figure 28: UK, breakdown of classes used to treat mild psoriasis, 2004 - page 45
- Figure 29: UK, breakdown of classes used to treat moderate psoriasis, 2004 - page 46
- Figure 30: UK, breakdown of classes used to treat severe psoriasis, 2004 - page 47
- Figure 31: Age distribution of prescriptions for psoriasis1, discounting population2 variation, by country, 2003 - page 55
- Figure 32: Common psoriasis comorbidities, percentage of patients with comorbidity - page 57
- Figure 33: Breakdown of physician-managed psoriasis population by disease severity in the seven major markets, 2004 - page 60
- Figure 34: PCP versus specialist breakdown of the treatment of psoriasis in the seven major markets, 2003 - page 63
- Figure 35: Percentage of physicians recommending a non-pharmacological treatment - page 65
- Figure 36: Types of non-pharmacological therapy recommended - page 66
- Figure 37: Treatment delivery method, average use across all seven markets, by severity - page 67
- Figure 38: Efficacy scores given for different topical formulations, out of 10*, by physician specialty - page 70
- Figure 39: Guideline awareness in each country - page 74
- Figure 40: Physician-reported adherence to psoriasis guidelines - page 76
- Figure 41: Top five psoriasis drug classes - page 79
- Figure 42: Comparison of top molecules for psoriasis diagnosis, RX, seven major markets - page 80
- Figure 43: Factors influencing physician decisions, by drug class - page 82
- Figure 44: Brand map of all seven brands assessed, with attribute weighting applied - page 89
- Figure 45: Known sites of action of psoriasis therapies - page 91
- Figure 46: Biologic prescribing influences - page 92
- Figure 47: Biologics weighted brand map - page 95
- Figure 48: Amevive average attribute scores compared to attribute not known - page 97
- Figure 49: Raptiva brand perception and awareness - page 100
- Figure 50: Enbrel brand perception and awareness - page 102
- Figure 51: Remicade brand perception and awareness - page 104
- Figure 52: Steroid prescribing influences - page 106
- Figure 53: Elocon brand perceptions and awareness - page 111
- Figure 54: Vitamin derivative prescribing influences - page 113
- Figure 55: Dovonex brand perception and awareness - page 116
- Figure 56: Tazorac brand perception and awareness - page 119
- Figure 57: Soriatane brand perception and awareness - page 121
- Figure 58: Traditional treatments brand map - page 123
- Figure 59: Percent of physicians using PASI score, by country and physician type - page 125
- Figure 60: Mean rating given to each treatment outcome, seven country average - page 126
- Figure 61: Alternative treatment outcome measures to PASI, by country - page 129
- Figure 62: Patients achieving desired outcome, %, by disease severity and country - page 131
- Figure 63: Physician-reported compliance, average across all seven markets, by disease severity - page 133
- Figure 64: Mild patient compliance - page 135
- Figure 65: Moderate patients compliance - page 135
- Figure 66: Severe patient compliance - page 136
- Figure 67: Satisfaction of psoriasis patients with treatments - page 136
- Figure 68: Quality of life factors vs. disease severity - page 139
- Figure 69: Brand map raw data for all brands - page 182
- Figure 70: Biologics Brand Map raw data - page 183
- Figure 71: Angles in the brand map - page 184
- Figure 72: Acute vs. chronic treatment brand map - page 185
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