Evrysdi risdiplam

GI tolerability is the single biggest switch-prevention and switch-trigger lever: fix the diarrhea narrative and you protect share; ignore it and Spinraza inertia wins.

• Oral at-home dosing is Evrysdi's dominant equity driver, cited across every SMA type as transformative versus injection-based alternatives, yet GI side effects threaten adherence for a meaningful minority who have tried extensive dietary workarounds without resolution.
• Insurance denials and appeal fatigue represent the highest-friction access barrier, with patients spending months fighting incorrect rejection reasons and some internationally resorting to crowdfunding just to initiate therapy.
• Patients consistently struggle to interpret stabilization as success, creating a silent adherence risk as adults on later-onset SMA question whether a drug that does not produce visible gains is worth continuing given side-effect burden.
• The emugrobart MANATEE discontinuation signals no near-term add-on combination option for Evrysdi, but real-world adherence data from Spain and Czech/Slovak registries reinforce Evrysdi's long-term tolerability and persistence story for commercial messaging.