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Physician survey signals continued growth for NuplazidPhysician survey signals continued growth for Nuplazid BAML - Industry Overview Equity | 11 February 2019 Nuplazid as a key part of PDP treatment algorithm As part of our continued monitoring of the Nuplazid launch, we recently surveyed 26 physicians (17 neurologists and 9 psychiatrists) to better understand the use of Nuplazid in their current treatment algorithms. We see dissipating negative impact of CNN articles from last year, and the survey strengthens our thesis that Nuplazid sales growth will continue to be sustained. We highlight our key takeaways: (i) Nuplazid has become a key part of Parkinson’s disease psychosis (PDP) treatment paradigm with 41% of their patients on Nuplazid (compared to 43% on Seroquel and 6% on other antipsychotics). Psychiatrists are adopting Nuplazid faster than neurologists (51% on Nuplazid vs 36%, see Chart 2); (ii) On efficacy, 92% of physicians view Nuplazid as equally or more efficacious than antipsychotics (44% of psychiatrists and 41% of neurologists view Nuplazid as more efficacious); (iii) On safety, physician satisfaction is even higher compared to satisfaction with efficacy (see Chart 7). We highlight that the most common advantage of Nuplazid over antipsychotics cited by more than half of physicians is the avoidance of motor complications from treatment (consistent with previous checks). Our detailed doctor feedback from a neurologist in academic center and a psychiatrist in private practice confirms our findings from the survey (see page 8 for detailed feedback). Nuplazid use to increase by 24% over two years Our survey signals healthy growth of Nuplazid over the next two years (see Chart 9). We note that a bigger portion of growth will come from neurologists (26% growth over two years compared to 20% from psychiatrists). We believe the expected growth trend is bolstered by the positive impact from FDA’s reiteration of confidence in Nuplazid’s safety (from September) and launch of branded direct-to-consumer campaign including television commercials. We believe patients can now transition from any past negative perception of Nuplazid primarily based on media reports to learning more about efficacy and safety profile of Nuplazid in PDP. Stronger growth expected from non-LTC channel Nuplazid appears to be more widely adopted in long-term care (LTC) facilities compared to private practice and academic centers. Recall that publicly available scripts data from IMS and SHS only capture a segment of the LTC channel (contributes one-third of sales). We note that while non-LTC channel currently adopts less use of Nuplazid compared to LTC channel, we expect stronger uptake from non-LTC channel in the next two years (see Chart 17). Our estimates for future Nuplazid sales We currently assume $277mn (+24% y/y) for Nuplazid PDP sales in 2019 ramping up to $732mn in 2026. We view upcoming data from schizophrenia (ph 3 ENHANCE readout in mid-2019) and dementia-related psychosis (ph 3 HARMONY interim readout in 2H19 and full data in 2020) could provide additional source for future revenue growth. We maintain our Buy rating on Acadia Pharmaceuticals (ACAD) with a $27 PO. Nuplazid survey signals healthy growth Survey of 26 physicians using Nuplazid to treat PDP We conducted a survey of 26 US physicians (17 neurologists and 9 psychiatrists) who treat Parkinson’s disease psychosis (PDP). Physicians were required to satisfy the following: (i) US-based; (ii) practiced for at least three years; (iii) active prescribers of Nuplazid with more than 15 patients on Nuplazid; (iv) used Nuplazid for at least 12 months. Our respondents treat an average of 57 PDP patients with Nuplazid and half of them practiced for 15 years or longer. Our respondents include 6 physicians from longterm care (LTC) facility, 7 physicians from private practice and 13 physicians from academic medical center. Together, they treat over 1.4k PDP patients with Nuplazid. Physicians are readily employing Nuplazid in their treatment algorithm We asked physicians about their treatment paradigm for PDP patients. We note that use of Seroquel and Nuplazid was comparable and together accounts for 84% of drugs currently used for PDP patients (See Chart 1). Other drugs include donepezil, trazodone and benzodiazepine prescribed by two physicians. We view the prevalent use of Nuplazid in PDP patients as expected given physician’s view on efficacy and safety profile of Nuplazid. We also note that more than half of physicians viewed “no need to modify dosing of drugs for motor symptoms” as the greatest advantage of Nuplazid over antipsychotics. Out of 26 respondents, psychiatrists (n=9) have incorporated Nuplazid more into their treatment paradigm compared to neurologists (n=17). This is not surprising as psychiatrists have viewed Nuplazid efficacy and safety profile more favorable than neurologists which led to higher uptake of Nuplazid into their treatment algorithm (see Chart 2). High physician satisfaction in efficacy especially from psychiatrists We believe Nuplazid becoming a key part of treatment algorithm by physicians is driven by satisfaction in both efficacy and safety. Our survey signals that over 92% of physicians view Nuplazid efficacy as equal as or more efficacious than antipsychotic treatments (See Chart 3). We highlight that psychiatrists have viewed Nuplazid efficacy as more favorable than neurologists which is to be expected as we have seen more psychiatrists adopting Nuplazid into their treatment paradigm (see Chart 4). On average, physicians rated efficacy of Nuplazid as 3.96 and antipsychotic drugs as 3.46 (out of 5). We asked physicians about their satisfaction with Nuplazid efficacy by providing three options: (1) “Very satisfied”; (2) “Somewhat satisfied”; and (3) “Not satisfied”. We note that all 26 respondents have selected “very satisfied” and “somewhat satisfied” with none expressing discontent with Nuplazid efficacy (See Chart 5). Physicians who picked “very satisfied” underlined use of Nuplazid as both first line treatment for new patient starts and potential switch/add-on option to current treatment paradigm. From “somewhat satisfied” physicians, common theme was subset of PDP patients not responding well to Nuplazid. We believe this is consistent with our expectations and there was only one physician who pointed out reimbursement/bad coverage. We highlight several of our respondents’ answers below. Physicians “very satisfied” with efficacy (n=18) • “Good option for first line therapy.” Neurologist with 70 patients on Nuplazid practicing in academic center • “Works well in Seroquel failures.” Neurologist with 15 patients on Nuplazid practicing in academic center • “At least as efficacious as current atypical antipsychotics.” Psychiatrist with 15 patients on Nuplazid practicing in academic center • “Great addition to my arsenal against PDP and allows me to add more dopaminergic agents.” Neurologist with 40 patients on Nuplazid in private practice Physicians “somewhat satisfied” with efficacy (n=8) • “About 25% of patients don’t respond to it well.” Psychiatrist with 45 patients on Nuplazid in academic center • “At approved doses it seems to significantly reduce or eliminate psychosis in over 50% of cases; higher doses may be better but data and experience are limited.” Neurologist with 28 patients on Nuplazid in academic center • “The medication appears more effective than Seroquel for treatment of PDP, but poorly covered and hard to get approved by insurance.” Neurologist with 55 patients on Nuplazid in private practice Physicians are even more satisfied with safety profile of Nuplazid On safety, we note that a higher percentage of physicians deemed Nuplazid safety as “very satisfied” (81%) compared to 69% of physicians who viewed efficacy as “very satisfied”. We note that majority of physicians are highly content with the safety profile of Nuplazid as no severe side effects or tolerability issues have been encountered (see Chart 6). We highlight several of our respondents’ answers below. Consistent with how psychiatrists viewed efficacy, we note that psychiatrists viewed Nuplazid safety as more favorable than neurologists (see Chart 7). Physicians “very satisfied” with safety (n=21) • “No obvious motor safety concerns, no worsening of tremor or extra-pyramidal symptoms.” Neurologist with 50 patients on Nuplazid in academic center • “No long term safety concern encountered”, “So far, no severe side effects that I encountered.” Two neurologists with 57 patients on Nuplazid in private practice and academic center Physicians “somewhat satisfied” with safety (n=5) • “Too early to tell for some patients.” Neurologist with 30 patients on Nuplazid in LTC • “As of now there is no evidence that it is less safe than antipsychotics we currently use.” Neurologist with 55 patients on Nuplazid in private practice…. …. Impact from CNN article is largely going away Our respondents signaled that 81% of physicians were aware of the CNN article (see Chart 13). Of those 81% of respondents, we note that 24% of physicians (n=5) have seen impact to their prescription of Nuplazid after the CNN article (see Chart 14). Those five physicians highlighted that 13.3% of their patients discontinued due to the article. Upon the FDA statement in September reaffirming Nuplazid’s safety in treating PDP, 85% of physicians were aware of the FDA statement. From the five physicians above who had discontinued patients due to CNN article, four physicians replied “This has alleviated some of the fears”, “I can reassure patients with this information”, and “Now [I] can reference both article and FDA statement, seems to be a non-issue now.” We note that only one physician continued to have “patients [who] were still concerned after article.” We view this as reassuring given that the impact of CNN article, if there were any, has now subsided and will prevent discontinuations due to bad publicity. |
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Msg # | Subject | Author | Recs | Date Posted |
14800 | Re: Physician survey signals continued growth for Nuplazid | Sundance_Al | 2 | 2/11/2019 1:21:44 PM |
14808 | Re: Physician survey signals continued growth for Nuplazid | tblant | 0 | 2/13/2019 6:14:22 AM |