OVERVIEW
Catalyst
Summary

EXECUTIVE SUMMARY
Strategic scoping and focus
Datamonitor key findings
Related reports

UNMET NEEDS
Improved efficacy of treatments for negative symptoms
Current therapies do not adequately treat the negative symptoms of schizophrenia
Multiple classifications of negative symptoms complicate development of targeted treatments
The FDA recognizes the need for treatments for the negative symptoms of schizophrenia
Management of refractory patients
Few effective pharmacological treatment options are available for the treatment of refractory patients
Off-label prescribing and polypharmacy are treatment strategies currently employed for refractory schizophrenia
Treatments with more favorable side-effect profiles
Antipsychotics are associated with a poor side-effect profile, which exerts a negative impact on compliance
It is necessary for antipsychotics to balance good efficacy with a favorable side-effect profile
Improved patient compliance
A large proportion of schizophrenic patients are not fully compliant with medication
Poor compliance negatively impacts treatment outcomes
Patients are switched to long-acting depots to improve patient compliance
Treatment options for cognitive impairment in schizophrenia
A sizable proportion of patients with schizophrenia are affected by cognitive impairment
The underlying mechanisms of cognitive impairment create challenges for developing targeted therapies
The need for treatment of cognitive symptoms has been recognized by the FDA and the NIMH-MATRICS initiative
Less invasive modes of administration for acute patients
Novel formulations improve treatment options for physicians
Treatments preventing self-harm
A heterogeneous range of factors are associated with suicide risk in schizophrenia
Clozapine is the only medication recommended for the management of suicide risk in schizophrenia

PRESCRIBING INFLUENCES
Treatment guidelines
No single antipsychotic medication is recommended for first-line treatment of schizophrenia in the US, Germany, Spain, and the UK
Patient-related factors should be considered when deciding upon antipsychotic treatment
Long-acting injectable formulations are a treatment option for patients who are non-adherent to therapy
Clozapine can be used in treatment-resistant patients and for the treatment of residual symptoms
Weight gain is an important side effect to consider for patients with schizophrenia
Physicians’ prescription practices are in line with recommendations in published clinical guidelines
Patient acquisition process
Patient care path
Points of influence in the patient care pathway
Trends in marketing strategies
Marketing strategy for leading brands
Sponsorship/disease awareness campaigns
Physician detailing
Direct-to-consumer advertising
Factors influencing physician decision-making
Efficacy in treating positive symptoms exerts the greatest influence on physicians’ prescribing decisions
Efficacy in treating negative symptoms of schizophrenia
Safety and side-effect profiles are an ongoing concern when prescribing medication
Prescribers have limited choice for the treatment of cognitive symptoms
Convenience of dosing and administration exert the least influence on prescribers’ decisions
Reimbursement
US formulary tier status for leading brands

BIBLIOGRAPHY
Journal papers
Websites
Datamonitor reports
Other

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
Section 5: Schizophrenia- Prescribing Influences and Product Profiles
Section 6: Schizophrenia: Unmet needs

APPENDIX B
PharmaVitae Explorer database
Contributing experts
Conferences attended

List Of Tables

Table: Classifications of the negative symptoms of schizophrenia
Table: Pipeline therapies targeting negative symptoms of schizophrenia, 2012
Table: Adverse reactions associated with key antipsychotic brands for schizophrenia
Table: Drugs currently in development for the treatment of cognitive symptoms of schizophrenia
Table: First-line recommendations of published schizophrenia treatment guidelines, 2012
Table: The aims of treatment and pharmacological recommendations from the APA for the acute, stabilization, and stable phases of schizophrenia
Table: Marketing strategies employed by the companies behind key antipsychotic brands, 2012
Table: Key messages communicated by product websites for key antipsychotic brands, 2012
Table: Representative formulary tier status in the US for leading brands in schizophrenia, 2012
Table: Representative formulary tier status in the US for long-acting injectable brands in schizophrenia, 2012
Table: Psychiatrists surveyed regarding schizophrenia across the seven major markets, 2012

List Of Figures

Figure: The importance of unmet needs in the treatment of schizophrenia, as ranked by surveyed psychiatrists across the seven major markets, 2012
Figure: Side effects reported by patients with schizophrenia taking medication
Figure: Percentage of patients taking atypical antipsychotics who discontinued treatment due to intolerability, over an 18-month period
Figure: Reasons for discontinuation of antipsychotic treatment over an 18-month period
Figure: The top five antipsychotics prescribed as monotherapy for first-line treatment of patients with schizophrenia across the seven major markets, January 2012
Figure: Schizophrenia patient care pathway in the US and EU, 2012
Figure: Choices in Recovery website, run by Janssen Pharmaceuticals
Figure: The key marketed messages for Invega Sustenna directed at healthcare professionals, 2012
Figure: Clinical factors influencing prescribing decisions for psychiatrists in schizophrenia across the seven major markets, 2012
Figure: First-line treatment of schizophrenia
Figure: Second-line treatment of schizophrenia
Figure: The PharmaVitae Explorer