Encouraging Appropriate Patients with RA to Take Biologics: The Tipping Point

Encouraging Appropriate Patients with RA to Take Biologics: The Tipping Point

Independently Commissioned by the

1Q2014 Tipping Point for Biologics in RA ©2014 QRC Working Group

This is an independently funded syndicated report. The QRC Working Group owns all rights to this report. This report may not be distributed outside of the purchasing organization without written permission from the QRC Working Group

About the QRC Working Group

•  The QRC Working Group was founded in 2013 as a collaborative effort to conduct cutting-edge research on timely and compelling topics within the healthcare field

•  The QRC Working Group consists of four professional colleagues with extensive healthcare experience. We bring together our ability to identify rich, actionable insights through progressive research techniques, tools and methodologies gained during our respective careers as well as our leadership in the Qualitative Research Consultants Association

•  Our Syndicated Research Series is designed to heighten awareness and acceptance of innovative qualitative techniques. These techniques are proven to be very effective in uncovering prescriber and consumer behaviors and emotions while addressing common pharma business issues

•  The 2014 Syndicated Report is dedicated to those who suffer from the debilitating disease of Rheumatoid Arthritis

1 1Q2014 Tipping Point for Biologics in RA ©2014 QRC Working Group

2014 QRC Working Group: Authors •  Pat Sabena – Sabena Qualitative Research

–  Specializing in healthcare research for over 40 years, Pat is a recognized leader in qualitative research. A pioneer of innovative projective tools, techniques and research best practices, Pat has taught award-winning peer workshops across the globe. A three-term President of (QRCA) the Qualitative Research Consultants Association, she has personally conducted over 11,000 focus groups /IDIs during her career

–  Contact: 203.292.9680, [email protected]

•  Susan Thornhill – Thornhill Associates –  Susan brings over 14 years of experience working with a broad range of qualitative research clients. She

specializes in creative approaches to customer immersion, understanding the patient journey and strategic brainstorming, and served as a recent Past President of QRCA

–  Contact: 310.318.2600, [email protected] •  Camille Carlin – Camille Carlin Qualitative Research

–  Camille has over 25 years of experience conducting extensive qualitative research with physicians, nurses, dietitians, pharmacists and consumers in the healthcare industry. She is an active member and presenter at QRCA Conferences

–  Contact: 914.332.8647, [email protected]

•  Glenn Naphy – Calign, Inc. –  Managing Director of Calign Inc., an innovative marketing consulting and marketing research firm

specializing in the healthcare industry, Glenn brings a unique perspective with his 22 years of experience both on the client and supplier sides of medical research. He currently serves as QRCA Southern California Chapter Treasurer

–  Contact: 888.729.1139 x21, [email protected]


Independently funded

This QRC Working Group Syndicated Report was


and is the first in a series of syndicated reports

3

Table of Contents

Business Purpose and Objectives ………………………… Research Methodology …………………………………… Executive Summary ……………………………………… Detailed Reports …………………………………………

Rheumatologists Executive Summary ……………… Rheumatologists Detailed Report …………………

“Considering” Biologics Executive Summary ……… “Considering” Biologics Detailed Report ……………

“On” Biologics Executive Summary ………………… “On” Biologics Detailed Report ……………………


5 6 9 12

13 20 73 82 135 143

Business Purpose and Objectives

Background and Business Purpose: •  As Rheumatoid Arthritis (RA) advances, Rheumatologists and patients have an active

dialogue surrounding the issue of when and if the patient should go on a biologic. By gaining a better understanding of the physician-patient dialogue, we have a clearer view of the struggles patients and physicians experience during this point on the patient journey

•  A clearer understanding of the physician-patient dialogue helps the pharmaceutical industry identify with the needs of the patient and physician, thereby improving the transition from biologic naïve to treatment with a biologic

Objectives: •  Determine the tipping points for patients and physicians to accept and prescribe

biologics for appropriate patients with RA •  Identify the levers that will convert a biologic naïve patient to a biologic


Research Methodology

•  Research sample contains 89 respondents: –  31 Rheumatologists –  25 Patients who are currently considering a biologic but are reluctant –  33 Patients who have accepted and are currently taking a biologic

•  Qualification criteria focused on: –  Rheumatologists in practice 3-33 years, experienced users of biologics, and with an ample patient case

load for rheumatoid arthritis –  “Considering” Patients had to have moderate to severe RA and have at least one discussion regarding

initiating a biologic within the last 12 months –  “On” biologic patients had to have moderate to severe RA and have been started on a biologic within

the last 12 months

•  Multiple projective techniques were used to facilitate a deep understanding of the drivers and barriers to the Tipping Point – accepting a biologic

•  A total of 29 tele-depth interviews (TDIs) were conducted

•  A total of 60 interviews were conducted using QualBoard™ - an interactive bulletin board platform


Excerpts

Independently commissioned by the


Rheumatologists



When Rheumatologists think about RA … Their focus is on their Own Emo<ons and their Pa<ents’ Journey to Remission

*The larger the word the more often it represents individual mentions


The Best Things About Treating RA...

•  Rheumatologists report that the best things about treating RA today are: –  So many new treatment options really make a difference in improving many lives –  Our ability to stop or significantly slow the destructive process of the disease –  I can really impact people's lives with the ever increasing armamentarium and efficacy –  Instilling hope after periods of pre-diagnosis anxiety and uncertainty –  We can now put this disease in remission if it is caught early and treated aggressively –  Ability to affect meaningful change in the disease process and achieve remission –  To make a difference in the quality of people's lives to give them their life back

•  "Ten years ago we had prednisone, methotrexate, sulfasalizine, and two biologics. Now we have seven biologics with five of them having different mechanisms of action...now I can switch from a TNF inhibitor to IL6 inhibitor to a T-cell inhibitor to a B-cell inhibitor." Dr. David

•  "The best thing about treating RA is the satisfaction when patients improve and the pleasure in seeing them able to do things that they have not been able to do before because of their symptoms." Dr. Jeff

•  "The best thing about treating RA is the satisfaction you get with seeing some patients respond, improve, and reverse the course that they were on." Dr. Frank

10

Advances in drug therapy help patients achieve “remission” and “good QoL”


Rheumatologists cite their Frustrations about Treating RA

•  Rheumatologists lament that the worst things about treating RA today are: –  The bureaucratic hassles we sometimes have to put up with to get patients treated

properly –  Frustration when insurance companies often erect barriers to diagnosis and treatment –  Cost of biologics are often too expensive or require a lot of time and effort to get

approved –  Some poor patients even with insurance cannot afford co-pays –  Dealing with patients' anxiety about potential adverse reactions of medications –  Patients' advanced disease diagnosed years earlier which could have been prevented –  The frustration and challenge of a few patients who do not respond or respond

inadequately even to biologics –  Ignorance of urgent care providers, orthopedic surgeons and PCPs who do not refer

patients early enough to Rheumatologists –  TV commercials listing the side effects of newer drugs without priority or contexts

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Rheums cite “roadblocks” to treatment, side effect fears, and lack of response


CONVERTING PATIENTS FROM DMARDS TO BIOLOGICS

Rheumatologists provide their perspectives on the tipping point

1Q2014 Tipping Point for Biologics in RA ©2014 QRC Working Group 12

Digging Deep into Physician-Patient Attitudes and Conversations ��Leading up to the Decision to Start a Biologic

•  We implemented a series of thought-provoking projective techniques to probe: –  What diseases Rheumatologists love versus hate to treat, and why

–  What emotions RA diagnosis evokes in Rheumatologists and their patients

–  How Rheumatologists perceive the emotional and lifestyle burdens of RA

–  How Rheumatologists compare the efficacy of DMARDs vs. Biologics

–  What Rheumatologists say to patients when they are biologic-ready

–  What they think when approaching patients with this important decision

–  What Rheumatologists feel as they engage in these conversations and Rx’s

–  Metaphors, analogies, similes as Rheumatologists reflect on this process

–  How Rheumatologists classify patients who accept versus refuse biologics

–  Similar projectives were pursued among Considering Biologics and On Biologics patients


Thinking... Saying...

Feeling...

When presen<ng a Pa<ent with RA the op<on to go on a Biologic, Rheumatologists reveal what they “Think, Say, and Feel”

the full report expands on these and more

•  I'm tossing out a lifesaver to rescue somebody • This is Russian Roulette not knowing how patient will respond • 

•  Your disease will not be controlled by a DMARD alone •  You're likely to feel better, less likely to have joint damage • 

•  Giving a valuable gift to the patient to get the best results •  Thrilled and thankful I have these wonder drugs • 


BARRIERS TO BIOLOGICS Rheumatologists Discuss


Rheumatologists discuss how they approach the barriers to biologics

16

Rheums discuss the Safety Profile of Biologics


The injection barrier

Insurance an operational barrier

Rheumatologists acknowledge that Assistance Programs make a big difference

Rheumatologists Utilize Pharma Assistance Programs

•  Depending on their geography and their patient population, Rheumatologists are grateful when pharmaceutical assistance programs grant "compassionate need."

–  "Sometimes I can't get beyond the barrier of cost of co-pays. Other times I can engage pharma's generous co-pay assistance. Other times I can get free biologics for the patient through foundations and sometimes 'compassionate need' Dr. Dale

–  More in the complete report

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Rheumatologists acknowledge that Assistance Programs make a big difference


Considering Biologics



��Patients who are involved in their treatment choices ��

reflect on their Fear, Worry and Confusion��

•  Weighing the benefits and risks of feared biologic side effects creates confusion and uncertainty.

–  “It is again side effects and it is like, wow, so it is like you can get something for that but then you have all these side effects. So sometimes side effects can be kind of frightening.” FEMALE

–  “But I’m frightened by a lot of the long-term side effects of some of the drugs that are out there. I would like to take something that I could take all the time without having to worry about [any] side effects.” FEMALE

–  “Taking any kind of drug for a prolonged period of time can create other problems in your body. It can create other illnesses, it can create other weaknesses, and that is what I get really worried about.” FEMALE

19

Therapeutic choices for treatment and their side effects make for some hard decision-making


Patients Associate their RA with Feelings of Pain, ��Aging, Anguish, and Concern for Medication Side Effects

20

Patients in the “considering” biologic phase often cite Pain and Feeling Old


*The larger the word the more often it represents individual mentions

Discussing biologics was

like ...

Pa<ents Give Rich Metaphors and Analogies ….

•  A baby bird leaving its nest – curious yet cautious; on the lookout for dangers yet hopeful

•  Traveling to an exotic place with new places and things to discover – unsure of what you will see and whether you will like it or not

• 

•  Walking into a dark cave and not knowing which way leads out - many choices, unsure of the right biologic

•  Sitting in an English-as-a-second-language class and I speak Spanish - foreign medical terminology and not proven to be a success scares me

•  ��

•  A shot in the dark - not knowing beforehand what the results would be •  Being sent into an operating room for elective surgery – would only undergo if completely necessary • 

Accepting a biologic would be like …

The worst thing about being treated with a

biologics would be like...


More in the complete report!

On Biologics


Already On Biologics Patients: Demographics

Current Age %

30-‐40 15%

41-‐50 40%

51-‐60 30%

61 plus 15%

Total 100%

% of paGents currently taking the following biologics

HUMIRA 48%

ENBREL 25%

REMICADE 15%

ORENCIA 6%

ACTERMA 3%

RITUXAN 3%

Number of years diagnosed with RA

0 to 2 years 36%

3 to 5 years 36%

6 to 8 years 9%

9 -‐ 10 years 0%

> 11 years 19%

Total 100%


QRC Working Group is pleased to provide you with this Syndicated Report


This study was conducted in compliance with all

applicable CASRO, MRA, QRCA, HIPAA and Adverse Event Repor<ng in Market Research Policies

A contribu<on of $1,000 will be made to a Founda<on from the proceeds of this report

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￼Encouraging Appropriate Patients with RA to Take Biologics: The Tipping Point

Encouraging Appropriate Patients with RA to Take Biologics: The Tipping Point