Stakeholder Insight: Asthma - Combination Therapy Appropriate for Everyone?

Published by: Datamonitor

Published: Jan. 7, 2005 - 184 Pages

Table of Contents

ABOUT DATAMONITOR HEALTHCARE

About the Respiratory & Infectious Disease analysis team

CHAPTER 1 EXECUTIVE SUMMARY

Scope of the analysis

Datamonitor insight into the asthma market

Asthma prevalence rates are stabilizing within the seven major markets, and changing demographics, not increasing prevalence, will bear the greatest influence on the asthma burden in the coming years. By 2015, the total population diagnosed with asthma will increase to 35.1 million, a rise of 4.4% over 2005 estimates, with the proportion of elderly patients with asthma increasing substantially by 18%, especially in the US and Japan.

Five million adult asthmatics may have predominantly neutrophilic inflammation. Whilst this phenotype is most usually associated with severe asthma, it may be more common than currently appreciated across the range of disease severities. The emergence of an asthmatic phenotype where the inflammation is neutrophilic in nature raises important implications for treatment practice, in that these asthmatics may have a diminished or suboptimal sensitivity to corticosteroids. Alternative anti-inflammatory agents are needed for patients not responding to steroid therapy, including inhibition of targets such as IL-8 which may normalize the exaggerated accumulation of activated neutrophils in the airways. Additionally, the emerging interest in the role of airway smooth muscle cells, fibroblasts and stimuli arising from damaged epithelium, also suggests novel anti-fibrotic therapeutic targets that may be distinct from those involved in inflammation. Tools to identify noneosinophilic asthma to differentiate asthma therapy based on the predominating inflammatory phenotype are required.

There is considerable scope for expanding the patient base of combination inhaled steroid/long-acting bronchodilator products. This class can grow by 25% through product switching, increasing use as initial maintenance therapy across all disease severities, and by transferring patients receiving long-acting bronchodilator monotherapy to fixed combination inhalers. The appeal of fixed combinations lies in high patient compliance, the certainty that long-acting bronchodilators are always prescribed with inhaled corticosteroids, and the simplification of disease management.

Coverage of the Stakeholder Insight Survey

CHAPTER 2 EPIDEMIOLOGY AND PATIENT SEGMENTATION

Disease definition

Asthma classification

Changes in asthma severity over time

Epidemiology of asthma

Diagnosis rates

Population estimates

Future trends

Key patient segmentations

Childhood Asthma

Adult asthma

Elderly asthmatics

Severe asthma in adults

Severe asthma in children

Co-morbidities, complications and risk factors

Risk factors

Co-morbidities

CHAPTER 3 DIAGNOSIS AND TREATMENT OPTIONS

Presentation

Diagnosis

Disease awareness

Influences on diagnosis and treatment rates

Treatment options

Treatment guidelines

Current prescribing trends

Reliever versus preventer therapy

Initial maintenance therapy in mild-moderate persistent asthma

Maintenance therapies in persistent asthma

CHAPTER 4 PRESCRIBING TRENDS AND INFLUENCING FACTORS

Prescribing trends

Combination therapies

ICS/LABA growth as initial maintenance therapy

Switching opportunities

Anticholinergics in asthma

Factors influencing physician decision making

Choice of drug: combination v separate inhalers

Direct-to-consumer marketing

Generic versus branded prescribing

CHAPTER 5 IMPROVING TREATMENT OUTCOMES

Asthma control : impact of GOAL

Xolair indications

Emerging asthma therapies

Daxas (roflumilast)

Alvesco (ciclesonide)

New drug groups

Genetics

Genetic regulation of response to therapy

Genetic influences on disease severity

CHAPTER 6 OPINION LEADER AND STAKEHOLDER TRANSCRIPTS

UK opinion leader

German opinion leader

Japanese opinion leader

UK opinion leader

Spanish opinion leader

US opinion leader

US opinion leader

US opinion leader

APPENDIX A BIBLIOGRAPHY

Epidemiology

Bibliography

Key associations

APPENDIX B

Physician research methodology

Physician sample breakdown

Contributing experts

APPENDIX C

The survey questionnaire

Disclaimer

Abstract

• Comprehensive overview of asthma epidemiology by patient demographic and disease severity, with comments on future trends to 2015
• Analysis of drug treatment choice per line therapy per region for asthma, in particular the use of combination products
• Identification of key developmental compounds, with analysis of physicians' opinions on potential therapies

• Gain up-to-date understanding of current therapy usage and selection choices per region
• Review the risk factors, population size and clinical characteristics of asthmatics with predominantly neutrophilic inflammation
• Justify internal unmet needs assessment versus external viewpoint

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