Pathology in Japan: Treatment Algorithms: Schizophrenia – New antipsychotic launches underwhelm

• Publication date: May 2012
• Report size: 81 pages

Early uptake data suggest that product pipelne such as Fanapt (iloperidone; Novartis) and Latuda (lurasidone; Dainippon Sumitomo) have failed to make an impact on the schizophrenia treatment landscape. These products will find it increasingly difficult to supplant the industry leaders as generic competition heralds the end of an era for multi-billion dollar atypical antipsychotic brands....

Early uptake data suggest that product pipelne such as Fanapt (iloperidone; Novartis) and Latuda (lurasidone; Dainippon Sumitomo) have failed to make an impact on the schizophrenia treatment landscape. These products will find it increasingly difficult to supplant the industry leaders as generic competition heralds the end of an era for multi-billion dollar atypical antipsychotic brands.Quantify the prevalent, diagnosed, and treated schizophrenia patient populations in each of the seven major industries.Analyze physician prescribing habits by drug class, formulation, and line of therapy.Understand how and why treatment, polypharmacy, and compliance rates vary in the seven major industries.Identify opportunities for increasing industry share through effective product positioning.Psychiatrists estimate that just under half of prevalent schizophrenia cases do not market research report their symptoms and seek treatment, while one third of patients do not receive an accurate diagnosis. The nature of schizophrenia complicates its presentation, as sufferers may lack the drive or insight into their symptoms needed to seek help.Abilify (aripiprazole; Bristol-Myers Squibb/Otsuka) is the most commonly used antipsychotic brand for first- and second-line treatment of schizophrenia. In a industry where treatment decisions are largely driven by safety profiles, Abilify is crucially associated with lower incidences of common antipsychotic side effects than some of its competitors.The three latest antipsychotics to reach the industry have all experienced very slow uptake and have so far failed to penetrate first-line therapy. Their underwhelming industry shares reveal that the US schizophrenia drug industry is now saturated with atypical antipsychotics and that the industry not very receptive to new, undifferentiated treatments.How does each drug’s patient share vary by country and line of therapy?What can be done to influence the patient pathway to increase industry share?What is the realistic patient population that a new industry entrant can target?How have generic antipsychotics affected prescribing behaviors in the seven major industry s?What proportion of patients experience treatment a complete response with currently available antipsychotics?

Pathology Industry in Europe

OVERVIEW•Catalyst
•Summary

EXECUTIVE SUMMARY•Strategic scoping and focus
•Datamonitor key findings
•Related reports

COUNTRY TREATMENT TREES•Introduction to treatment trees
•Seven major industry s
•US
•Japan
•France
•Germany
•Italy
•Spain
•UK

DISEASE DEFINITION AND DIAGNOSIS•Disease definition
•Etiology - Environmental risk factors
- Genetic risk factors
- Pathophysiology of schizophrenia

•Symptoms - Schizophrenia is typified by positive, negative, and cognitive symptoms

•Presentation and diagnosis - Just over one in two prevalent schizophrenia sufferers report symptoms and seek treatment
- One third of prevalent schizophrenia patients are either undiagnosed or misdiagnosed

•Treatment rates - Schizophrenia has a higher pharmacological treatment rate than other common psychiatric disorders

•Referral patterns - Schizophrenia is largely managed in specialist care
- The Japanese referral pathway differs to those in the US and EUR pe

PATIENT SEGMENTATION•Age and sex - Schizophrenia typically afflicts more males, although the treated population is similar between sexes

•Line of therapy - More than half of patients have changed from their initial antipsychotic regimen

CURRENT TREATMENT OPTIONS•Overview of the available drug classes - Conventional antipsychotics
- Atypical antipsychotics

•Prescribing trends - Class trends
- Formulation trends
- Combination therapy trends
- Generic prescribing trends

•Changes in therapy - First line
- Second line

•Treatment outcomes - Response to therapy
- Progression through lines of therapy
- Compliance

BIBLIOGRAPHY•Journal papers
•Websites
•Datamonitor reports

APPENDIX A•Physician research methodology - Physician sample breakdown

•The survey questionnaire - Screener
- Section 1: Drug Treatments for Schizophrenia
- Section 2: Acute treatment of schizophrenia
- Section 3: Maintenance treatment of schizophrenia
- Section 4: Schizophrenia – Compliance
- Demographics

APPENDIX B•PharmaVitae Explorer database
•Contributing experts
•Conferences attended
•Report methodology

TABLES•Table: Schizophrenia symptoms
•Table: Referral patterns of schizophrenia patients in the seven major industry s (%), 2012
•Table: Key treatments currently approved for schizophrenia across the seven major industries, 2012
•Table: Antipsychotic use in the seven major industries, by class (%), 2012
•Table: Antipsychotic use in the seven major industries, by formulation (%), 2012
•Table: Combination antipsychotic use in the seven major industry s (%), 2012
•Table: First-line antipsychotics prescribed for schizophrenia in the seven major industry s (%), 2012
•Table: Second-line antipsychotics prescribed for schizophrenia in the seven major industry s (%), 2012
•Table: Treatment response to antipsychotics in the seven major industries, 2012
•Table: Progression beyond first-line antipsychotic therapy in the seven major industry s (%), 2012
•Table: Psychiatrists surveyed regarding schizophrenia across the seven major industries, 2012

FIGURES•Figure: Schizophrenia treatment algorithm in the seven major industries, 2012
•Figure: Schizophrenia treatment algorithm in the US, 2012
•Figure: Schizophrenia treatment algorithm in Japan, 2012
•Figure: Schizophrenia treatment algorithm in France, 2012
•Figure: Schizophrenia treatment algorithm in Germany, 2012
•Figure: Schizophrenia treatment algorithm in Italy, 2012
•Figure: Schizophrenia treatment algorithm in Spain, 2012
•Figure: Schizophrenia treatment algorithm in the UK, 2012
•Figure: Presentation rate of schizophrenia in the seven major industry s (%), 2012
•Figure: Diagnosis rate of schizophrenia in the seven major industry s (%), 2012
•Figure: Pharmacological treatment rate of diagnosed schizophrenia patients in the seven major industry s (%), 2012
•Figure: Comparison of pharmacological treatment rates of schizophrenia, bipolar disorder, and major depressive disorder in the seven major industry s (%)
•Figure: Management of schizophrenia patients in the seven major industries, 2012
•Figure: Age- and sex-specific diagnosed schizophrenia prevalence rates in the UK, 2000
•Figure: Schizophrenia patients in the seven major industries, by line of maintenance therapy, 2011
•Figure: Antipsychotic use in the seven major industries, by class (%), 2012
•Figure: Antipsychotic use in the seven major industries, by formulation (%), 2012
•Figure: Combination antipsychotic use in the seven major industry s (%), 2012
•Figure: Mean number of antipsychotic drugs received by schizophrenia patients in the seven major industries, 2012
•Figure: Antipsychotic use in the seven major industries, by branded versus generic (%), 2012
•Figure: First-line use of leading and selected other atypical antipsychotic brands in the seven major industries, 2012
•Figure: Patient shares of antipsychotic depot formulations at first-line therapy in the seven major industries, 2012
•Figure: Second-line use of leading and selected other atypical antipsychotic brands in the seven major industries, 2012
•Figure: Patient shares of antipsychotic depot formulations at second-line therapy in the seven major industries, 2012
•Figure: Treatment response to antipsychotics in the seven major industries, 2012
•Figure: Progression beyond first-line antipsychotic therapy in the seven major industries, 2012
•Figure: Mean compliance rate among schizophrenia patients in the seven major industry s (%), 2012
•Figure: First-line treatment of schizophrenia
•Figure: Second-line treatment of schizophrenia
•Figure: The PharmaVitae Explorer

Companies mentioned

Bull, Caterpillar Logistics Services, Inc., Dairy Farm International Holdings Limited, Hutchison 3G UK Limited, Janssen Pharmaceuticals, Inc., Novartis AG, Schindler Holding Ltd.