In a Market Dominated by Well-Entrenched, Effective Psychostimulants, What Do Physicians and Payers Identify as Areas for Differentiation?
Attention-deficit/hyperactivity disorder (ADHD) is a common childhood condition that can continue through adolescence and into adulthood. The key treatment goals for pediatric and adult ADHD include controlling the core symptoms of the condition—inattention and/or hyperactivity/impulsivity—as well improving patients’ overall functioning and quality of life. Pharmacological treatment of both pediatric and adult ADHD is dominated by psychostimulants, which boast robust efficacy (research suggests and interviewed experts report that over 70% of patients respond to psychostimulant treatment) and an acceptable balance of safety and tolerability. Nonstimulant therapies are common second- or third-line treatment options; several nonstimulant therapies are available in the United States, while only one is currently available in Europe and Japan. Nevertheless, given the sizable drug-treated ADHD population (we estimate over 6.4 million drug-treated pediatric and adult patients, combined, in 2013 across the seven major markets under study), as well as the fact that there is still a proportion of patients who cannot tolerate or who do not respond adequately to currently available treatments, opportunity exists for emerging agents to achieve commercial success. Moreover, psychostimulants’ risks for abuse and dependence as well as their inability to fully alleviate secondary symptom domains such as executive functioning present areas of opportunity for emerging therapies to be differentiated from competitors.