Nearly two years in with Zurzuvae, Biogen tackles an ‘all of the above market’ to find patients and battle stigma in postpartum depression.
When Biogen set out to market the new postpartum depression drug Zurzuvae, the target audience for pitches seemed obvious to them: psychiatrists. The record was quickly set straight, however, when the scripts began instead coming in from the real front lines of the condition: obstetricians and gynecologists.
“If anyone were to talk about postpartum depression, you think psychiatry, and you think mental health,” Lawrence Wai, head of Biogen’s U.S. neuropsychiatry franchise, told BioSpace in an interview.
But the truth is, PPD treatment is an “all of the above” type of disorder. Any doctor who sees it first has a responsibility to act. And, since many women after birth are in the care of an OB/GYN, that’s typically where the disorder is discovered.
Wai described an oft-used meme that one popular psychiatry educator has shared on PPD: three versions of Spiderman standing in a circle pointing at each other.
“Whether you’re an OB/GYN, women’s health or primary care, you are responsible for treating it, not to point a finger at someone else,” Wai said. “That spoke to the nature of this market and the criticality and urgency behind this.”
A ‘Virtuous Cycle’
Later this year, Biogen and its partner Sage Therapeutics will celebrate two years of marketing Zurzuvae since its approval in August 2023. The drug has been a tricky one to launch, given it was approved only for PPD and not for the larger population suffering from major depressive disorder (MDD), as the companies originally sought.
In the first quarter, Biogen reported sales of $28 million with 10,000 women treated since launch. CEO Chris Viehbacher said during the first quarter earnings call in early May that the majority of these were first-line therapy for PPD.
“A lesson that we learned along the way was actually the physician who is the most important in treating postpartum depression is actually not the psychiatrists, but the OB/GYN,” Viehbacher told analysts.
During that first quarter, 80% of the prescriptions came from OB/GYNs, the CEO explained. Overall, there was a 20% increase in the number of physicians prescribing Zurzuvae in the first quarter.
“One of the most encouraging things is that we’re not only seeing the repeat prescriptions, but I think as physicians gain the experience with Zurzuvae, they’re also gaining the confidence to actually go and be more proactive about diagnosing postpartum depression,” Viehbacher said.
Zurzuvae treatment is typically “one and done,” according to the CEO. So Biogen has to build the market to encourage doctors to offer prescriptions to new patients.
“I think we’re actually seeing a virtuous cycle here where this positive response by patients is encouraging a greater attention to a disease that, unfortunately, I think, has been sadly neglected for so many women,” Viehbacher said.
Biogen’s data so far show that the neglect continues if PPD emerges outside of the typical postpartum “fourth trimester” period following birth when women return to their OB/GYN for a checkup.
“What we’ve seen just from looking at the data is that not only [do the] vast majority of PPD diagnoses happens within that window, but more importantly, is if you fall outside that window, your chance of actually being diagnosed and treated falls off dramatically,” Wai said.
Care can be very fragmented once a woman leaves the OB/GYN practice after childbirth, meaning their next touch point with a care team that could notice PPD may not be for awhile. Getting an appointment with a psychiatrist can be difficult, as well.
“Once the patient walks out of the OB/GYN office, who knows what’s going to happen,” Wai said.
Following this experience, Biogen is now targeting OB/GYNs as the front line of care for PPD. Family care physicians also have a role to play if they see mothers struggling in their clinics, but Biogen is zeroing in on post-birth care.
“We really feel that the most strategic part of where we can really impact and intervene is in that fourth trimester,” Wai said.
Stories From the Front Lines
Wai remembers being in a large OB/GYN practice promoting Biogen’s PPD work when the head of that practice brushed off Zurzuvae as just another selective serotonin reuptake inhibitor (SSRI). When the physician heard that Zurzuvae is not of the same class, and that it’s a 14-day treatment that begins working quickly, he was intrigued.
“We ended up having a conversation, and it went from ‘we know everything about everything already,’ to him saying, ‘Actually, wow,’” Wai said. Then, the doctor suggested the entire practice be brought together to be educated about the new option. Biogen has therefore focused on education to tap into these very busy, high-volume practices.
Zurzuvae seems to be living up to the expectations built by the clinical trials that underpinned its approval, Wai said. Those data suggested that the drug begins working quickly. Wai said they have heard back that patients are seeing relief of their depressive symptoms within three days.
“The overarching feedback that we have gotten from prescribers who have used it before is that the real-world experience is very consistent with the trial information and the trial data,” Wai said, adding that that’s not always the case when a new drug hits the market.
Wai remembers talking to another physician who lost a patient early on to PPD after a very difficult pregnancy. That patient experienced extreme hypertension and gestational diabetes—both conditions that are common during pregnancy but potentially very dangerous. After the birth, the doctor felt they had managed those conditions as well as possible, leading to a successful delivery. However, the patient took her own life a week later.
“It shook her core,” Wai said of the doctor, who felt as if she had missed the most important thing. She went on to complete a certification in mental health, Wai added.
Some of the challenge in diagnosing PPD comes down to stigma, a stubborn problem that has generally plagued the diagnosis of any mental health condition but PPD in particular. Wai said that OB/GYNs may know to screen for the condition, but they also must be aware of subtle clues coming from patients.
“A lot of patients actually suffer in silence or [are] hiding in plain sight,” Wai said. “Stories that we hear almost sometimes sound unreal.”
Due to stigma, patients can also be sensitive to the description of the disorder itself as caused by hormonal fluctuations. Sometimes the only clue doctors may get is a patient simply saying they feel overwhelmed. “A lot of times, physicians would think of that as, ‘Oh, of course, you’re overwhelmed. I mean, you just had a baby, right?’ Meanwhile, that’s [a] code word for the patient,” Wai said.
“All those things are pieces that then become very critical for us to connect, because otherwise you just run deeper into the stigma,” Wai concluded.
