Chronic Kidney Disease (CKD) is a disease area with high unmet need and opportunity for pharmaceutical manufacturers. In the United States, ~40% of those with Type 2 diabetes mellitus (T2D) develop CKD2 and CKD is responsible for nearly half of all cases of kidney failure requiring replacement therapy1. Until recently, there have been no treatments for CKD, so prevention has been the main strategy.
The care of CKD is disjointed; multiple specialties are involved from before the point of diagnosis (i.e., diabetes management) through the clinical stages of CKD itself, with nephrologists traditionally involved in the later stages (CKD Stage 38 onwards). For Bayer, Kerendia (finerenone) has the advantage of being the first in class, but needs to stand out from the established SGLT-2 inhibitors. For SGLT-2 inhibitor marketeers the challenge is different. CVOT studies hint that SGLT-2 inhibitors could prevent and delay development of CKD in people with or without T2D. However, there is a clear class effect, meaning that subtle differences in clinical trial data will need to be leveraged to distinguish one SGLT-2 inhibitor from others in the category.
Furthermore, prescribing SGLT-2 inhibitors has not traditionally been within the remit of nephrologists. SGLT-2 inhibitor manufacturers have not necessarily had access to a designated and sizeable field force of medical reps experienced in renal therapies. Janssen have now entered a commercial partnership with renal specialist Vifor Pharma but all manufacturers in this field will need to establish relationships with new types of healthcare professionals and quickly.
The integration of digital into overall sales strategy will be paramount as to deciding which, if any of the SGLT-2 inhibitors comes out on top. This is due to pre-existing trends and recent developments in customer expectations resulting from the pandemic.
Bryter conducted a survey with over 240 nephrologists in Europe to determine how each of the SGLT-2 inhibitor brands is performing. This research also evaluates customer digital experience in terms of virtual/ remote interactions and provides an assessment of the digital content.
The majority (7-in-ten) of nephrologists are already prescribing SGLT-2 inhibitors to their CKD patients, with Farxiga (65%) being slightly ahead of Jardiance (59%) and lnvokana coming in third (54%).
There is a difference between the US and Europe. The latter favors Farxiga, with over two thirds prescribing it. Meanwhile in the US there is much less discrimination, with around six-in-10 prescribing each of the three agents.
A recent study has shown that of CKDpatients meeting the criteria for treatment with SGLT-2 inhibitors two-thirds are not being prescribed them. Clinicians are focusing SGLT-2 inhibitor prescription on younger patients with poor glycemic control, rather than targeting those with a high estimated eGFR4. Our findings show that nephrologists are prescribing SGLT-2 inhibitors for CKD, but there is opportunity to increase prescriptions. The benefits of SGLT-2 inhibitors in CKD must be communicated more effectively, and digital presents a solution to this.
Our data demonstrates that digital communication from manufacturers is essential. Just over half {51%) of physicians agree that having good information provided digitally by pharma companies is now essential for them to consider products.
With this knowledge, it's unsurprising that there is a clear correlation between the proportion of physicians prescribing an agent, and those that recall receiving recent digital content about the agent. For example, in Europe under half received digital content from Forxiga (45%) compared to around a quarter for lnvokana and Jardiance (28%).
Even more importantly, as many as 45% do not recall receiving any information on specific SGLT-2 inhibitors, with this rising to almost half of nephrologists in the US (48%) and over half of nephrologists in the UK (55%).
Pharma companies need to understand how the recent digital transformation is having lasting changes on the way physicians want, and now expect pharma to engage with them. Companies need to ensure they are better at understanding the needs of their customers; delivering a targeted digital mix in terms of frequency, format, and content that informs and engages their audience.
The traditional method for assessing the needs of physicians is to ask stated importance questions. However, applied to this topic stated important questions have traditionally yielded unhelpful insights. HCPs struggle to give meaningful answers directly, and scores often come out predictably and similar.
At Bryter, we use innovate methods to assess physician needs. One way is to conduct driver analysis to assess what attributes are driving overall levels of satisfaction with the content that HCPs are receiving. In the context of this study, Bryter analyzed what factors are driving physician satisfaction with the digital content they receive from pharma companies, and the underlying factors driving their satisfaction.
Among nephrologists, the most important driver of satisfaction is receiving information that helps to inform treatment decision making. While this may appear obvious, it points to a need for pharma companies to provide information that helps physicians differentiate these agents in an indication. Demonstrating a benefit in CKDcould be the way of achieving this.
The next two most important drivers are information that is easily digestible and provided proactively. Effective online content in any capacity is easily digestible and accessible with minimal effort, if not provided proactively by the algorithm. Anyone used to navigating online spaces will expect information to be available with minimal effort and this is intensified by physician time-scarcity and the expectation that pharma companies should be proactively reaching out.
The final key-driver is provision of content that allows physicians to better manage treatment side effects. Many nephrologists may still feel trepidation around prescribing SGLT-2 inhibitors, with particular concern about managing diabetes patients who usually fall under the care of primary care physicians and/or endocrinologists. As a result, it is essential for manufacturers in this space to provide practical information that can support nephrologists learning to manage patients on SGLT-2 inhibitors.
A consistent pattern can be observed when assessing individual manufacturer performance against these key drivers of satisfaction. Across all four of these key drivers Forxiga consistently performs the best across the board, closely followed by Jardiance, while lnvokana falls further behind.
The exception to this is the delivery of easily digestible content, where all three manufacturers are felt to perform fairly well. The starkest difference in performance is provision of information to help manage side-effects, where just one third (34%) rate lnvokana as good, compared to more than half for Forxiga and Jardiance (54% and 52%).
However, there is clear scope for improvement. Only half of nephrologists score content about Forxiga well for helping to inform their treatment decision making, which is the most important driver of satisfaction. Even the top performing company has a way to go in optimizing the content they are delivering to physicians.
Having the right content is still not enough if this content is not being effectively delivered to physicians. At Bryter, we not only assess the content they receive, but also how effectively it is being delivered. When nephrologists were asked which company is utilizing various digital channels best, AstraZeneca (Farxiga) was the clear winner.
AstraZeneca outperformed both Boehringer lngelheim (Jardiance) and Janssen (lnvokana) in all digital communication channels except emails from sales reps. They utilize digital channels most effectively out of the three manufacturers and this might contribute towards the greater recall of digital information, higher levels of satisfaction with digital content, and ultimately the higher levels of prescribing.
In a post-pandemic landscape, physicians are expecting a blended approach of digital and personal interactions with pharma going forward. There is increasing expectation that interactions will be digital, but companies are also battling expectations formed by prior experience. Many physicians are still reluctant to start prescribing a product unless they have sales representative contact first. Companies should be aware of future trends but also current reality.
As a result, the digital transformation within pharmaceutical marketing is rapidly shifting towards an omnichannel model, where HCPs can access information as and when they need it, but the same messaging is also supported by personalized interactions. To execute this effectively, pharma companies must ensure they are designing and delivering digital content that resonates with their specific HCP audience and utilizing digital channels effectively to deliver their digital content.
Conclusion
These findings demonstrate that there is more to digital communication than delivering content regularly. Content must also suit the needs of physicians and reflect today's changing post-COVID landscape. For nephrologists this means providing content that can be easily consumed and is proactively delivered directly to physicians. This content should offer practical information and support in an indication which will continue to see changes within the near future. Within the field of SGLT-2 inhibitor manufacturers, there is still clear scope for pharma companies to differentiate themselves in the ways they are communicating and supporting nephrologists.
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Learn more about how Bryter helps healthcare and pharmaceutical brands by reading our guide 'digital marketing to physicians' to learn how research and insights can help to shape digital strategy