March 16, 2015
By Riley McDermid, BioSpace.com Breaking News Sr. Editor
A recent conference call hosted by financial analysis firm Piper Jaffray found that a specialist in multiple sclerosis believes that she sees continued growth of Biogen Idec ‘s Tecfidera and Plegridy, and aggressive switching of daily Copaxone to three times a week.
Joshua Schimmer, a biotech analyst with Piper Jaffray, said that for emerging treatments, ocrelizumab (Biogen/Genentech) was the “most exciting in her opinion,” as well as laquinimod (Teva).
“She was less enthusiastic for new S1P targeting drugs or for Lemtrada or daclizumab,” wrote Schimmer in a note to investors. “While BIIB’s franchise seems to be increasing in influence, there may be some dilutive effect from its partial-ownership of ocrelizumab.”
There were also some surprises. Schimmer said the specialist had expected cases of progressive multifocal leukoencephalopathy to appear in Tecfidera treated patients. In anticipation of this, she began monitoring bloodwork every three months, even more regularly than recommended—which meant the overall impact to prescribing Tecfidera “is expected to be minimal.”
“The utility of lymphocyte assessment to gauge risk of PML with Tysabri was seen as differentiated versus Gilenya, for which most patients experience lymphopenia and as such identifying high-risk populations is more challenging,” wrote Schimmer.
Still, ocrelizumab And laquinimod were seen as promising. “The specialist was most excited about ocrelizumab, the fully humanized CD20 antibody in development by BIIB/Roche, and if Phase II data is replicated in Phase III, she expects to use it in 15 to 20 percent or more of patients, taking share from all other therapies.
“The specialist was less enthusiastic for S1P1-selective follow-on compounds, primarily due to the fact that many patients are not being started on Gilenya and the safety issues are largely associated with starting treatment,” said Schimmer.
“We note that she is not a high prescriber of Gilenya. Daclizumab is also expected to compete in this ‘higher efficacy’ market segment, but the positioning is unclear and dependent on both the safety data and administration profile,” said Schimmer. “Despite the generally negative press around laquinimod, the specialist is a fan, due to the potential neuroprotective qualities, which is important for secondary progressive (SPMS) patients with no effective neuroprotective options.”
Secondary-progressive MS is “still a tough nut to crack,” said the note, with the specialist saying she “does not expect success with Tysabri in SPMS based on experience with Tysabri in the commercial setting for that indication.” As patients progress from RRMS to SPMS they are still kept on active treatment to control lesions and improve quality of life, “but no efficacious options exist to prevent neuronal degeneration much less repair.”
“The specialist noted that although she was not optimistic for the potential of Tysabri in SPMS given prior drug failures in the indication, if the data were positive (particularly EDSS), this would increase her use with 10 to 15 percent of patients switching to Tysabri,” said Schimmer.
In the end, as with so much in the MS field, much remains undecided as the community awaits the results of anti-lingo.
“The specialist noted that like many of her colleagues, she is waiting for the anti-Lingo data in MS, and if positive, would add it on to other treatments, with the expectation that it won’t provide anti-inflammatory effects helps repair neuronal damage,” said Schimmer.
