Stakeholder Opinions: Physician perception of biologics in Autoimmune Disease - Targeted detailing is the key to success

Table of Contents

EXECUTIVE SUMMARY

• Datamonitor insight into the autoimmune biologics market
• Contributing experts
  • Related reports
  • Upcoming 2009 reports

PHYSICIAN DYNAMICS AND QUESTIONNAIRE DESIGN

• Physician types surveyed
• Questionnaire design
  • Importance of attributes
  • Rating of brands

• Physician demographics
• Rheumatologists
• Dermatologists
• Gastroenterologists

FACTORS INFLUENCING PHYSICIAN DECISION MAKING

• Comparative importance of factors to the prescribing decision
  • Disease modification and side-effects are the most important factors to all prescribing physicians

• Variation by country and physician type
  • Little variation seen between physician type
  • The UK and US show commonality while Japan is still an outlier in all but rheumatology

• Prescribing factors
  • Efficacy
  • Side effects
  • Formulary or reimbursement status
  • Marketing and familiarity

BRAND DYNAMICS

• Brand overview
• Brand sales trends
  • Biologic sales overview shows Enbrel leads in terms of total brand sales for all indications

• Brand awareness
  • Trends in preliminary brand scores by physician type

• Brand assessment comparisons
  • Total score by brand shows future promise for Humira
  • Trends in brand scores by country

• Brand profiles
  • Enbrel (etanercept; Amgen, Wyeth)
  • Remicade (infliximab; Centocor, Schering-Plough, Mitsubishi Tanabe)
  • Humira (adalimumab; Abbott)
  • Orencia (abatacept; Bristol-Myers Squibb)
  • Rituxan/MabThera (rituximab; Roche, Genentach, Biogen Idec)
  • Raptiva (efalizumab; Genentech, Xoma, Merck Serono)
  • Amevive (alfacept; Astellas, Biogen Idec)
  • Tysabri (natalizumab; Biogen Idec, Elan)

• Pipeline profiles
  • Pipeline overview
  • Licensing opportunities

• Pipeline anti-TNFs
  • The three available anti-TNFs are perceived to be similar, but pipeline anti-TNFs offer little apparent improvement
  • Cimzia (certolizumab; UCB)
  • Simponi (golimumab; Centocor, Schering-Plough, Mitsubishi Tanabe, Janssen)

• Other pipeline mechanisms
• Stelara (ustekinumab; Centocor, Janssen Cilag)
• Actemra (tocilizumab; Chugai, Roche)

BIBLIOGRAPHY

• Journal papers
• Websites

TABLES

• Table: Physician type surveyed
• Table: Comparison of physician demographics
• Table: Characteristics of rheumatologists surveyed across the seven major markets, 2008
• Table: Characteristics of dermatologists surveyed across the seven major markets, 2008
• Table: Characteristics of gastroenterologists surveyed across the seven major markets, 2007
• Table: Attributes assessed by each physician type
• Table: Anti-TNF prescribing information efficacy comparison across indications
• Table: Other mechanism prescribing information efficacy data
• Table: Summary of pros and cons of biomarkers to predict response to TNF therapy
• Table: Summary of prescribing information black box and major warnings by brand
• Table: Percent of patients showing positive antibodies against each brand according to prescribing information
• Table: Formulary prices across the seven major markets, 2008
• Table: Importance of dosing frequency and delivery method to prescribing of biologics, by country and by physician specialty, %
• Table: Overview of brand details including mechanism, indications and launch dates
• Table: Number and percent of physicians able to rate each brand, by country
• Table: Score given to each brand by attribute, by rheumatologists, 2008
• Table: Score given to each brand by attribute, by dermatologists, 2008
• Table: Score given to each brand by attribute, by gastroenterologist, 2007
• Table: Brand scores by country
• Table: Enbrel' s attribute scores, by country and physician type
• Table: Remicade' s attribute score, by country and physician type
• Table: Humira' s scores by country, attribute and physician type
• Table: Orencia' s scores from rheumatologists by country
• Table: Rituxan/MabThera' s scores, from rheumatologists by country
• Table: Raptiva' s scores by attribute and country, from dermatologists
• Table: Amevive scores by country and attribute, from dermatologists
• Table: Tysabri scores by country and attribute, from gastroenterologists
• Table: Antibody products in clinical trials for autoimmune diseases (rheumatoid arthritis, inflammatory bowel disease, psoriasis)
• Table: Late stage pipeline product profiles and status by indication and region
• Table: Cimzia' s attribute scores by country and physician type
• Table: Simponi scores by country and attribute, from rheumatologists
• Table: Stelara scores by country and attribute, from dermatologists
• Table: Actemra scores by country and attribute, from rheumatologists

FIGURES

• Figure: Grouped attribute average importance
• Figure: Attribute importance, split by physician type
• Figure: Average attribute importance to prescribing decision for biologic therapies, by country
• Figure: Importance of grouped attributes to the prescribing decision by physician specialty
• Figure: Mapping country dynamics with reference to attribute importance, split by physician type
• Figure: Importance of efficacy factors to prescribing decision for biologic therapies, by country and specialist
• Figure: Biologic comparative brand scores for efficacy factors, by physician type
• Figure: Speed of action scores by dermatologists and gastroenterologists, non-weighted
• Figure: Importance of a good side-effect profile to prescribing decision for biologic therapies, by country and specialist
• Figure: Importance of formulary and reimbursement status to prescribing decision for biologic therapies, by country and specialist
• Figure: Brand comparison scores for formulary/reimbursement status, by physician type
• Figure: Ankylosing spondylitis treatment tree, 2008, seven major markets
• Figure: Importance of dosing frequency and delivery method to prescribing of biologic, by country and by physician specialty
• Figure: Brand scores comparison for administration attributes
• Figure: Importance of marketing and familiarity to prescribing of biologics, by country and by physician specialty
• Figure: Representation of influences of prescribing
• Figure: Total representative count, 2003 - 2007
• Figure: Brand scores comparison for marketing and familiarity attributes
• Figure: Time on the market versus score for marketing/familiarity factors
• Figure: Humira' s website messages
• Figure: Enbrel' s directed messages for each indication
• Figure: Remicade' s US website messages
• Figure: Online marketing for non-TNF mechanisms
• Figure: Total brand sales for the top autoimmune biologics in the US, five major EU markets and Japan, $m, 2007
• Figure: Total brand sales across the seven major markets, split by indication, $bn, 2007
• Figure: Sales growth versus market share by indication for the major biologic brands in the seven major markets, 2004 - 07
• Figure: Percentage of physicians able to rate each brand, by country
• Figure: Sum of score for all attributes, by brand and physician type
• Figure: Average score for each of the eight comparable attributes, by brand
• Figure: Overview brand map of attributes versus brand perception by physician specialty
• Figure: Average weighted brand scores by attribute
• Figure: Brand scores by country
• Figure: Enbrel' s weighted score compared to average
• Figure: Enbrel map, country preference to prescribing attributes
• Figure: Remicade' s weighted score compared to the average
• Figure: Remicade map, country preference to prescribing attributes
• Figure: Humira' s weighted score compared to the average
• Figure: Humira map, country preference for prescribing attributes
• Figure: Orencia' s weighted scores compared to all physicians average scores and rheumatologists average
• Figure: Rituxan/MabThera' s weighted scores compared to all physicians average scores and rheumatologists average
• Figure: Raptiva' s weighted score compared to all physicians average scores and dermatologists average
• Figure: Amevive weighted score compared to all physicians average scores and dermatologists average
• Figure: Tysabri weighted score compared to all physicians average scores and gastroenterologist average
• Figure: Phase I to pre-registration projects in the pipeline, split by mechanism, 2009
• Figure: Comparative physician perception of the pipeline and marketed anti-TNF inhibitors
• Figure: Cimzia' s weighted score compared to the average
• Figure: Cimzia map, country preference for prescribing attributes
• Figure: Simponi (golimumab) weighted score compared to the average
• Figure: Stelara' s weighted score compared to all physicians' average scores and dermatologists' average
• Figure: Actemra' s weighted score compared to all physicians average scores and rheumatologist average