Dysport - MB - November 2007 Innehåll 1 Sammanfattning och rekommendationer till ledningen 2 Projektbeskrivning 3 Resultatanalys

Dysport MB - in adult spasticity, secondary to stroke and juvenile cerebral palsy Kungsbacka in November 2007 SIFO Research International Navigare

Background and Objectives Dysport - MB - November 2007 Background and Objectives In Sweden, unlike the rest of Europe Botox is the market leader among Botulinum toxins with approx 90-95% market share. This market description study is conducted in order to evaluate the Swedish market of botulinum toxins and find the attitudes towards Botox vs Dysport. Other important issues are prescription habits, who takes the decisions regarding the choice of Btx and to find out what is required to switch Botox for Dysport.    Method The interviews were carried out during October and November 2007 and were performed as pre-arranged telephone interviews with 24 specialists. The interviews took approximately 20-25 minutes and were performed by medically trained interviewers. AS a member of ESOMAR (European Society for Opinion and Market Research) Navigare follows the ethical rules for marketing research. Among other things these rules mean that the respondents are guaranteed full anonymity.

Patient Flow and Frequencies Dysport - MB - November 2007 Patient Flow and Frequencies

Dysport - MB - November 2007 Source: QXa Base: All Drs

Dysport - MB - November 2007 Source: Q1a Base: All Drs

Dysport - MB - November 2007 Source: Q1aa Base: All Drs

Dysport - MB - November 2007 Source: Q1b Base: All Drs

Dysport - MB - November 2007 Source: Q2 Base: All Drs

Choice of Treatment - Initiation Dysport - MB - November 2007 Choice of Treatment - Initiation Initiation of Adult Spasticity and Juvenile Cerebral Palsy - Share of Patients Treated with Botulinum Toxins 11 22 17 39 33 5 10 15 20 25 30 35 40 45 50 none 1-20 21-40 41-60 61-80 81-100 don't know adult spasticity (n=18) juvenile cerebral palsy (n=9) % Drs adult spasticity (n=18) juvenile cerebral palsy (n=9) mean 51,7 56,9 median 50,0 min 0,0 33,0 max 100,0 Source: Q3a Base: All Drs

Initiation of Adult Spasticity and Juvenile Cerebral Palsy Dysport - MB - November 2007 Initiation of Adult Spasticity and Juvenile Cerebral Palsy - Treatment Alternatives to Botulinum Toxins 89 67 22 17 6 44 11 33 10 20 30 40 50 60 70 80 90 100 physiotherapy baclofen diazepam gabapentin surgery other adult spasticity (n=18) juvenile cerebral palsy (n=9) % Drs Source: Q3b+4b Base: All Drs

Dysport - MB - November 2007 Source: Q3c+4c Base: All Drs

Dysport - MB - November 2007 Source: Q3c+4c Base: All Drs

Dysport - MB - November 2007 Source: Q3d+4d Base: All Drs

Dysport - MB - November 2007 Source: Q3d Base: All Drs

Dysport - MB - November 2007 Source: Q4d Base: All Drs

Dysport - MB - November 2007 Source: Q5 Base: All Drs

Dysport - MB - November 2007 Source: Q5 Base: All Drs

Dysport - MB - November 2007 Source: Q5 Base: All Drs

Dysport - MB - November 2007 Source: Q6a Base: All Drs

Dysport - MB - November 2007 Source: Q6a Base: All Drs

Dysport - MB - November 2007 Source: Q6b Base: All Drs

Dysport - MB - November 2007 Source: Q6b Base: All Drs

Dysport - MB - November 2007 Source: Q6b Base: All Drs

Adult Spasticity Dysport - MB - November 2007 Source: Q7a Base: Adult spasticity

Dysport - MB - November 2007 Source: Q7b Base: Adult spasticity

Dysport - MB - November 2007 Source: Q8 Base: All Drs

Switch Treatment Dysport - MB - November 2007 Source: Q9a Base: All Drs

* Note low number of respondents Dysport - MB - November 2007 * * * Note low number of respondents adult spasticity (n=9) juvenile cerebral palsy (n=3) mean 4,6 13,3 median 0,0 10,0 min max 30,0 Source: Q9b Base: Drs who switched treatment

Dysport - MB - November 2007 Source: Q9c+d+e Base: Drs who switched treatment

Dysport - MB - November 2007 Source: Q9f Base: All Drs

Dysport - MB - November 2007 Source: Q9g+h Base: Drs who switched treatment

Dysport - MB - November 2007 Source: Q10a Base: All Drs

Opinion About Botulinum Toxins Dysport - MB - November 2007 Opinion About Botulinum Toxins Source: Q11 Base: All Drs

Dysport - MB - November 2007 Source: Q12a Base: All Drs

Dysport - MB - November 2007 Source: Q12a Base: All Drs

Dysport - MB - November 2007 Source: Q12a Base: All Drs

Dysport - MB - November 2007 Source: Q12b Base: All Drs

Dysport - MB - November 2007 Source: Q13a Base: All Drs

Dysport - MB - November 2007 Source: Q13b Base: All Drs

Dysport - MB - November 2007 Source: Q13b Base: All Drs

Dysport - MB - November 2007 Source: Q13b Base: All Drs

Dysport - MB - November 2007 Source: Q14a Base: All Drs

Dysport - MB - November 2007 Source: Q14a Base: All Drs

Dysport - MB - November 2007 Source: Q14a Base: All Drs

Dysport - MB - November 2007 Source: Q15a Base: All Drs

Dysport - MB - November 2007 Source: Q15a Base: All Drs

Dysport - MB - November 2007 Source: Q15a Base: All Drs

Dysport - MB - November 2007 Source: Q15b Base: All Drs

Dysport - MB - November 2007 Source: Q15b Base: All Drs

Dysport - MB - November 2007 Source: Q15b Base: All Drs

adult spasticity (n=18) juvenile cerebral palsy (n=9) mean 3,1 3,3 Dysport - MB - November 2007 adult spasticity (n=18) juvenile cerebral palsy (n=9) mean 3,1 3,3 median 3,0 min 1,0 max 5,0 Source: Q16a Base: All Drs

Dysport - MB - November 2007 Source: Q16b Base: All Drs

Dysport - MB - November 2007 Source: Q16b Base: All Drs

Dysport - MB - November 2007 Source: Q17a Base: All Drs

Dysport - MB - November 2007 Source: Q17b Base: Drs who prescribe “off-label”

Dysport - MB - November 2007 Source: Q18a+c Base: All Drs

Dysport - MB - November 2007 Source: Q18b Base: All Drs

Dysport - MB - November 2007 Source: Q18d Base: All Drs

Dysport - MB - November 2007 Company Source: Q19a Base: All Drs

Dysport - MB - November 2007 Source: Q19b Base: All Drs

Dysport - MB - November 2007 Source: Q19c Base: All Drs

Dysport - MB - November 2007 Source: Q19c Base: All Drs

Dysport - MB - November 2007 Source: Q19c Base: All Drs

Dysport - MB - November 2007 Source: Q19c Base: All Drs

Dysport - MB - November 2007 Source: Q19c Base: All Drs

Dysport - MB - November 2007 Source: Q19c Base: All Drs

Dysport - MB - November 2007 Source: Q19d Base: All Drs

Dysport - MB - November 2007 Source: Q19d Base: All Drs

Dysport - MB - November 2007 Source: Q19d Base: All Drs

Dysport - MB - November 2007 Source: Q19d Base: All Drs

Dysport - MB - November 2007 Source: Q19d Base: All Drs

Dysport - MB - November 2007 Source: Q19d Base: All Drs

Summary Patient flows and frequencies Dysport - MB - November 2007 Summary Patient flows and frequencies 1 Specialist involved in the care of patients with adult spasticity (AS) are, median figure, responsible for 40 patients and specialist in care of pats with juvenile cerebral palsy (JCP) are in care of 60 patients. Total amount of pats on Btx are for AS-drs 50 and 150 for JCP-drs. Drs in care of AS have 8 new patients per month and drs in care of pats with JCP have 2 new pats. Drs in care of JCP pats named possible Btx treatment for 90% of their patients and AS drs named possible treatment for 30% of their patients (median figures). (p 5-9) Choice of treatment – Initiation 2 Share of patients initiated with Btx is 50% for both specialist groups (median figure). (p 10) 3 A great majority, approx 90% of AS- and JCP- drs mention that in initiation treatment they use physiotherapy. 67% of AS-drs named that they use baclofen and specialists in care of JCP-pats use baclofen to 44% of their patients. (n=11) 4 When asked for allocation of treatment approx 100 % of both patient groups are treated with physiotherapy. (p 12) 5 Drs initiate with Btx mainly to increase patients’ function and when insufficient efficacy of physiotherapy/baclofen. 22% of JCP drs use Btx as soon as possible. (p 14)

Summary Choice of treatment – Initiation Dysport - MB - November 2007 Summary Choice of treatment – Initiation 6 Four out of nine drs in care of JCP patients mentioned insufficient efficacy as the main reason for patients not receiving treatment with Btx. Drs in care of AS-patients named limited personnel resources and price. Note that 5 AS-drs and 3 JCP-drs named that all pats receive treatment with Btx. (p17) 7 98 % of new AS patients and 96% of JCP patients receive Botox. Only 2% of new AS-patients and 4% JCP patients receive Dysport. (p 20) 8 Main reason for choosing Botox more often than Dysport is experience/tradition/habit, mentioned by 67% of AS-drs and 78% of JCP drs. Adult spasticity secondary to stroke 9 In median figure, patients with adult spasticity receive treatment with Btx after one year. The median age of that patient is 59 years. (p 25-26) Present treatment with Botulinum toxins 10 A great majority of patients with AS and JCP are treated with Botox 96% vs 93%. 4% of AS-pats and 7% of JCP are treated with Dysport. Xiomin is also named. (p 27)

Summary Switch treatment Dysport - MB - November 2007 Summary Switch treatment 11 Half of the drs in care of AS patients mentioned that they have switched treatment from one Btx to another Btx. 1/3 of drs in care of AS patients have switch treatment, (p 28). In average 5 AS patients are switched from one Btx to another while drs in care of JCP pats mentioned 13 pats. Dysport is mainly switched in. (p 29) 12 When drs have switched from Btx, in this case Botox, to other treatment it has mainly been due to insufficient efficacy. Mainly switched in treatments are baclofen, surgery and physyotherapy. (p 31-32) 13. People who influence the choice of Btx are primarily drs but also physiotherapists in a lower extent. (p 33) Opinion of Botulinum toxins 14. A majority of the drs do not have any opinion or seem that the products are equal. 17% of AS drs and 22% of JCP drs perceive Botox as more effective. 1 AS dr perceive Dysport as more effective. (p 34) 15. The main perceived advantages of Botox are experience, administration and the company’s education/service. The main advantage of Dysport is price. Note that half of the drs mentioned that they do not know Dysport’s advantage. (p 35-38)

Summary Switch treatment Dysport - MB - November 2007 Summary Switch treatment 16. Price is named as the main disadvantage with Botox compared to Dysport, mentioned by 50% of AS drs and 44% of drs in care of JCP patients. Half of the AS drs named administration as Dysport’s main disadvantage followed by lack of experience and diffusion. 44% of the drs in care of JCP patients mentioned lack of exp and 33% administration. (p 39-42) 17. AS drs: Patients mainly treated with Botox are those with spasticity (sec to stroke), dystonia and MS patients. JCP drs mentioned patients with JCP, children with spasticity and pats with moving toes. (p 43-45) Dysport 18. Both groups of drs mentioned price and insufficient efficacy as possible reasons to switch from Botox to Dysport. Information is also named by JCP drs. (p 46-48) 19. Considerable differences in drs’ answers about dosage proportion. (p 49) 20 Median figure 3 for importance evaluation about Dysport’s lower price, 28 % of AS drs vs 44% of JCP say that it is very important (p 52) 21 Doctors do not see ay reason for prescribe or increase prescription of Dysport. (p 57) Information and education are the factors demanded to influence prescription of Dysport. (p 58)

Leverage of Dysport efficacy (product group /Dysport is the best) Dysport - MB - November 2007 Key Findings Retain Low Price Aim to Leverage of Dysport efficacy (product group /Dysport is the best) Leverage of Education, support and service Leverage of pedagogical dosage schedule Increase awareness of low risk for diffussion and antibody formation Increase knowledge about Dysport – reps Increase of emotional dimensions Work with physiotherapists and clinical chiefs/buyers. Payers? Positioning ? Messages Dysport effective Btx mild side effects easy administration?

Dysport - MB - November 2007 Innehåll 1 Sammanfattning och rekommendationer till ledningen 2 Projektbeskrivning 3 Resultatanalys