Bipolar Disorder | Treatment Algorithms | Claims Data Analysis | US | 2014

Bipolar disorder (BPD) is a chronic illness characterized by recurrent episodes of aberrant mood, and treatment must be tailored to each patient’s current disease stage (i.e., acute manic episode, acute depressive episode, or maintenance phase). Historically, mood stabilizers such as lithium and antiepileptic drugs (AEDs) were the mainstay of treatment; at present, atypical antipsychotics also play a large role owing to their regulatory approval for bipolar depression and bipolar mania and as maintenance therapies. Within the atypical antipsychotic drug class, Bristol-Myers Squibb/Otsuka’s Abilify (aripiprazole) and quetiapine (AstraZeneca’s Seroquel, generics) continue to dominate BPD treatment; among newly diagnosed patients, Abilify and quetiapine are almost tied for first-line patient share. Thought leaders consider Abilify to have a lower propensity to cause weight gain and metabolic side effects compared with quetiapine and olanzapine (Eli Lilly’s Zyprexa, generics) but also believe it is less effective than quetiapine and olanzapine for certain phases of treatment. Quetiapine’s approval for treatment of both poles of BPD—mania and depression—sets this agent apart from other atypical antipsychotics and has helped make it a key market leader in this drug class. Emerging atypical antipsychotics such as lurasidone (Sumitomo Dainippon Pharma/Sunovion/Takeda’s Latuda) will compete in a crowded and genericized market. It is not enough for emerging agents to offer a better weight-gain profile over current agents; they must also demonstrate efficacy for more than just the treatment of mania to make an impact on the market.

This report uses national patient-level claims data to explore the position of the leading maintenance therapies in the treatment of newly diagnosed bipolar disorder patients with a quantitative analysis of treatment patterns and share by line of therapy, as well as progression between lines, duration of treatment on each line, and use of concomitant treatment. The report also quantifies a drug’s source of business among recently treated bipolar disorder patients compared with its competitors and details which drugs precede others through an analysis of add-versus-switch patterns. Additional analyses explore persistency and compliance by brand.