03.05.2023 | Insight
The line crossers: drugs discussed and prescribed by multiple physician specialties
Almost nine years ago, in January 2014, dapagliflozin (an SGLT2 inhibitor) was approved by the FDA to treat type 2 diabetes. Even though healthcare professional (HCP) activity on social media was relatively small compared to now, there was some interest from HCPs leading up to the approval.
First time been asked by PW #diabetes to try #Dapagliflozin in place of #Victoza. Interesting!
— David Kerr MD (@GoDiabetesMD) October 1, 2013
Using CREATION Pinpoint®, the online voice of HCPs in the United States has been isolated to enable us to explore the nature of any correlation between sentiment expressed in the evolving online conversation, and actual prescribing behaviours.
Fast forward many years later to 2022; dapagliflozin is well established for the treatment of type two diabetes, and has been trialled and approved for two new indications; chronic heart failure (with reduced ejection fraction) and chronic kidney disease (CKD).
HCPs’ online dapagliflozin conversations are increasing
Now we can see that the online buzz among HCPs caused by the first FDA approval of dapagliflozin in 2014 was fairly inconsequential compared to these new indications. This is most likely a reflection of the increased value HCPs are finding from interacting on social media, rather than reflecting the relative interest they have in the dapagliflozin indications.
As trials have been completed and released at various intervals since 2019, HCPs have been sharing and commenting on these on social media. While a great deal of focus is given to the endpoints of these trials, trial design, patient participation and cost-effectiveness of treatments have also featured in the discussion.
#SGLT2 inhibitors improve outcomes in HFrEF but are they value for 💵?? (Many new CV drugs are not!)
Cost-effectiveness analysis of #dapagliflozin out today in @JAMANetworkOpen!@pcalvachi1 @InbarRaber @ihdezdelso @ReshadGaranMD @kardiologykazi https://t.co/J6zxdPhERE
— Nicolas Isaza (@NicolasIsazaMD) July 28, 2021
It's a great discussion! If we follow that logic, we'd only use empa for risk reduction in T2D (EMPA-REG had CV death reduction; DECLARE didn't) and dapa only for HF care. It comes down to if one believes it's explainable due to trial design or differences in patient populations.
— James Januzzi Jr MD (@JJheart_doc) January 12, 2021
How does the online HCP conversation compare to written prescriptions?
Prescription data from US HCPs between January 2021 and March 2022 acquired by Healio, shows that the first scripts for dapagliflozin were written in the third quarter of 2021. The level of interest generated online by the key trials in 2021 DAPA-CKD and DAPA-HF was relatively similar – there were 255 dapagliflozin posts in Q2 2021 that used renal language and 260 posts in Q3 2021 using cardiovascular language.
Cardiovascular disease is more prevalent than chronic kidney disease: according to the American Heart Association approximately 82.6 million people in the United States currently have one or more forms of cardiovascular disease, while 37 million US adults are estimated to have CKD and 37.3 million people in the US have diabetes. However, normalising this data to the size of the potential patient population reveals the trend is consistent, if a little less pronounced.
A very similar type of response to the data from HCPs online was seen. When trials that achieve primary endpoints are released or a new product receives marketing approval the online conversation among HCPs is typically very positive.
Examining the eHCP conversation prior to launch and scripts being written can be useful in determining how they might use the treatment. It can also be a tool to find unmet needs to reassure concerns or answer the outstanding questions. For example, subsequent to the major trial results there was data to inform eHCPs of dapagliflozin’s cost-effectiveness which could be a factor in translating a positive eHCP response into prescriptions in the real world.
Apixaban not just for cardiologists
Apixaban is an anticoagulant which can be used in various settings with comorbid patients such as those with gastrointestinal cancers, cancer-associated venous thromboembolism, renal impairment or chronic kidney disease.
The oncology and nephrology roles are a small group of prescribers and represent a small social conversation but in this instance these conversations reveal where eHCPs are going for information online, which trials they are following and and which results are capturing their interest.
While the majority of physicians prescribing apixaban would be cardiologists and indeed much of the conversation online among eHCPs is driven by cardiologists there are other smaller groups of other specialist eHCPs who have an interest in new apixaban data in other areas. For example, while a post-hoc analysis of the AVERT trial looking at the efficacy and safety of apixaban in GI cancers was shared on social media by two cardiologists in Rochester, NY and Pittsburgh, PA, it was also shared by three GI oncologists, two in Cleveland, OH , one in Phoenix, AZ.
In sharing this paper originally published in Thrombosis Research from ScienceDirect, the posts from the two cardiologists received 3,634 impressions compared with 13,881 for the three GI oncologists’.
Later that year AJKD blog, the official blog of the American Journal of Kidney Diseases, published an article comparing apixaban and warfarin for chronic kidney disease progression using the data from various trials.
Is New Always Better? Apixaban vs. Warfarin and CKD Progression
The original post on AJKD blog was prepared by Baani Singh and Edgar V. Lerma whose highly influential Twitter account was referenced. On this occasion Dr Lerma shared the blog on his Twitter and all the engagement from eHCPs in the form of reposts came from other nephrologists and clinical researchers in the field.
AJKD shared the blog article on their Twitter account and tagged Dr Lerma in the post which was shared by eHCPs, this coupled with Dr Lerma himself posting to his more than 25,000 followers, gave this article 47,822 impressions from eHCP posts.
Clues from social data match prescribing data
We’ve examined dapagliflozin moving from a singular endocrinology focus into cardiology and nephrology and apixaban being the treatment of a cardiologist to capturing the interest of oncologists and nephrologists. In both of these areas we have seen conversations on social media in the same therapy areas and from the same roles as the prescription data.
In a data-crowded world, looking for insights from a niche group can be a challenge. However, as we have seen here, classifying prescribing data and conversations data by therapy area and role of the physician can surface valuable information for potentially new target areas and groups for companies producing important treatment options for patients.