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Stakeholder Opinions: Fibromyalgia - Potentially lucrative market soon to become reality

Published by: Datamonitor

Published: May. 16, 2007 - 163 Pages


Table of Contents


ABOUT DATAMONITOR HEALTHCARE

Datamonitor's therapeutic area studies comprise the following features:

CHAPTER 1 EXECUTIVE SUMMARY

Scope of the analysis

Datamonitor insight into the fibromyalgia market

Key metrics

Datamonitor Pipeline Assessment Summary

Contributing experts

CHAPTER 2 DISEASE OVERVIEW

Definition and etiology

The cause and underlying mechanisms of fibromyalgia remain unknown

Research finds various chemical imbalances in patients

Comorbidities

There are significant overlaps with other conditions

Epidemiology of fibromyalgia

Prevalence and incidence

Fibromyalgia is around seven times more common in women than men and increases with age

Experts and patient groups believe fibromyalgia is more common

Diagnosis and treatment rates

Over half of the fibromyalgia population remain undiagnosed

Nearly all diagnosed patients receive drug therapy of some sort

Market sizing calculations

Assumptions and caveats

Clinical unmet needs

Need for a better understanding of disease etiology and pathophysiology

Need to improve pain reduction and control

Need to reduce sleep disturbances

CHAPTER 3 CURRENT TREATMENT CONTROVERSIES

Pharmacological treatment - review of published clinical trial data

Antidepressants

Tricyclic antidepressants (TCAs)

Serotonin and noradrenaline reuptake inhibitors

Selective serotonin reuptake inhibitors

Analgesics

Tramadol

Anticonvulsants

Alpha 2 delta antagonists

Hormones

Other medications

Treatment guidelines

US guidelines - the 2004 American Pain Society Guidelines will soon be outdated

APS guidelines developed by an interdisciplinary panel of 13 pain management experts

APS guidelines recommend physicians start patients with a TCA or cyclobenzaprine

New guidelines need to include new possible first-line options

European guidelines - EULAR evidence-based guidelines due in mid to late 2007

Objectives - to provide evidence-based recommendations for the treatment of fibromyalgia

Methodology - developed by a multidisciplinary fibromyalgia task force representing 11 European countries

Results - 145 pharmacologic and non-pharmacologic studies were evaluated

Conclusion - Lyrica, Cymbalta and milnacipran are recommended therapies

Datamonitor's physician survey

Referral patterns - rheumatologists are key target physicians

US

Japan

France

Germany

Italy

Spain

UK

Prescribing patterns - physicians adopt a 'trial and error' approach

US

Japan

France

Germany

Italy

Spain

UK

CHAPTER 4 ASSESSMENT CRITERIA AND CLINICAL TRIAL DESIGN

Assessment criteria

American College of Rheumatology (1990) research criteria for fibromyalgia

1. History of widespread pain has been present for at least 3 months

2. Pain in 11 of 18 tender point sites on digital palpation

Clinical trial design

Limitations of previous clinical trials in fibromyalgia

Current FDA requirements for fibromyalgia claims

Trials need to show improvements in both pain scores and function

The FDA will require more mechanism-based outcomes as more is known about the disease

OMERACT aims to standardize fibromyalgia endpoint requirements and measures

Agencies will review their clinical trial requirements based on OMERACT findings

Function endpoints and measures will be assessed

CHAPTER 5 PIPELINE ANALYSIS AND FORECASTS

Pipeline overview

Pipeline mainly consists of drugs indicated for other CNS indications

Eli Lilly and Pfizer in race to be first to market

Market will expand rapidly following drug approvals

A defined regulatory pathway will attract future investors

Innovative early stage pipeline

Opinion leaders are encouraged by dopamine modulators

Comparative forecasts

Comparative Datamonitor drug assessment summaries

Key late-stage R&D product profiles

Lyrica (pregabalin)

Drug overview

Clinical trial data

Patient potential

Marketing factors

Forecasts to 2016

Datamonitor drug assessment summary

Cymbalta (duloxetine)

Drug overview

Clinical trial data

Patient potential

Marketing factors

Forecasts to 2016

Datamonitor drug assessment summary

Milnacipran

Drug overview

Clinical trial data

Patient potential

Marketing factors

Forecasts to 2016

Datamonitor drug assessment summary

Other pipeline drugs

Desvenlafaxine (Pristiq)

Sodium oxybate (Xyrem)

Lacosamide

Rotigotine (Neupro)

Reboxetine

Radafaxine

Eszopiclone (Lunesta)

Neurotropin

Ibutamoren mesylate (MK-0677)

Interferon-alpha (buccal lozenge)

Tropisetron (Navoban)

Buspirone (transdermal spray)

Casopitant

CR-3124

AD-337

Eplivanserin

NC-003

CHAPTER 6 INCREASING FIBROMYALGIA MARKET OPPORTUNITIES

Summary of market opportunities

Improving public awareness

There are regional variations in fibromyalgia awareness

Current information available to the public is of mixed quality

DTC advertising will play a big part in increasing US public awareness

Fibromyalgia patient groups and associations

The National Fibromyalgia Association is considered the most influential US group

Recruitment through patient group websites can be beneficial

Educating primary care physicians

Supporting education initiatives is beneficial

Combination therapy

Opinion leaders predict combination therapy will be commonplace

Combination of Lyrica with an antidepressant or a sleep aid will be popular

BIBLIOGRAPHY

Journal articles

Websites

APPENDIX

Methodology

Datamonitor forecast methodology

Market sizing

Product forecasts

Definition of a standard unit

Datamonitor drug assessment summary

Contributing experts

About Datamonitor

Datamonitor Healthcare's research and analysis methodologies

Datamonitor Healthcare's therapy area capabilities

Disclaimer

List of Tables

Table 1: Forecast sales of key pipeline products for fibromyalgia in the US and 5EU ($m), 2006-2016

Table 2: Prevalence of symptoms in fibromyalgia patients

Table 3: Key fibromyalgia epidemiology study results, 1995-2006

Table 4: Prevalence of fibromyalgia across the seven major markets, 2007

Table 5: Fibromyalgia prevalence as quoted by various fibromyalgia organizations/associations, 2007

Table 6: The total fibromyalgia market value across the six major markets, 2003-05

Table 7: Stepwise fibromyalgia management as recommended by the 2004 APS treatment guidelines

Table 8: Summary of findings from pharmacological studies in fibromyalgia according to Arnold (2006)

Table 9: Fibromyalgia referral patterns across the seven major markets, 2003

Table 10: Comparison of three late-stage fibromyalgia clinical trial designs

Table 11: Randomized controlled trials of pregabalin, milnacipran, and duloxetine in fibromyalgia

Table 12: Pipeline drugs in clinical development for fibromyalgia, 2007

Table 13: Lyrica: key facts

Table 14: Baseline characteristic of patients* enrolled in the Crofford et al. (2005) pregabalin trial

Table 15: Key events, approval and launch dates impacting Lyrica revenue forecasts for fibromyalgia in the US and 5EU, 2007-2016

Table 16: Cymbalta: key facts

Table 17: Results of the Arnold et al. (2005) duloxetine trial

Table 18: Key events, approval and launch dates impacting Cymbalta revenue forecasts for fibromyalgia in the US and 5EU, 2007-2016

Table 19: Milnacipran: key facts

Table 20: Key events, approval and launch dates impacting milnacipran revenue forecasts for fibromyalgia in the US and 5EU, 2007-2016

Table 21: Weightings of research and clinical factors used for pipeline drug assessment

Table 22: Weightings of commercial factors used for pipeline drug assessment

List of Figures

Figure 1: Datamonitor's competitive positioning analysis for Cymbalta, Lyrica and milnacipran in the fibromyalgia market, 2007-2016

Figure 2: Summary of fibromyalgia treatment in the US, 2003

Figure 3: Summary of fibromyalgia treatment in Japan, 2003

Figure 4: Summary of fibromyalgia treatment in France, 2003

Figure 5: Summary of fibromyalgia treatment in Germany, 2003

Figure 6: Summary of fibromyalgia treatment in Italy, 2003

Figure 7: Summary of fibromyalgia treatment in Spain, 2003

Figure 8: Summary of fibromyalgia treatment in the UK, 2003

Figure 9: The fibromyalgia 'tender points'

Figure 10: Datamonitor's comparative forecast of total US and 5EU sales of Cymbalta, Lyrica and milnacipran for fibromyalgia ($m), 2007-2016

Figure 11: Datamonitor's competitive positioning analysis for Cymbalta, Lyrica and milnacipran in the fibromyalgia market, 2007-2016

Figure 12: SWOT analysis of Lyrica in the fibromyalgia market, 2007

Figure 13: Diagram of patient flow in the Crofford et al. (2005) pregabalin trial

Figure 14: Datamonitor's total US and 5EU forecast sales of Lyrica for fibromyalgia ($m), 2006-2016

Figure 15: Datamonitor's competitive positioning analysis for Lyrica in the US and 5EU fibromyalgia market, 2007-2016

Figure 16: SWOT analysis of Cymbalta in the fibromyalgia market, 2007

Figure 17: Diagram of patient flow in the Arnold et al. (2005) duloxetine trial

Figure 18: Cymbalta home page, 2007

Figure 19: Datamonitor's total US and 5EU forecast sales of Cymbalta for fibromyalgia ($m), 2006-2016

Figure 20: Datamonitor's competitive positioning analysis for Cymbalta in the US and 5EU for fibromyalgia market, 2007-2016

Figure 21: SWOT analysis of milnacipran in the fibromyalgia market, 2007

Figure 22: Diagram of patient flow in the Vitton et al. (2004) milnacipran trial

Figure 23: Datamonitor's total US and 5EU forecast sales of milnacipran for fibromyalgia ($m), 2006-2016

Figure 24: Datamonitor's competitive positioning analysis for milnacipran in the US and 5EU fibromyalgia market, 2007-2016

Figure 25: The Forest/Cypress sponsored Fibromyalgia Resource Center homepage, 2007

Abstract

Introduction

Mainly affecting women, fibromyalgia syndrome affects six million people in the US alone. This relatively common yet poorly understood syndrome is characterized by widespread muscle pain and fatigue and remains substantially underserved by the medical profession and the pharmaceutical industry. Currently, there are no drugs licensed to treat fibromyalgia in the US, Japan or Europe.

Scope

Analysis of the patient potential, main unmet needs, and clinical trial design in fibromyalgia, with an estimation of market size. Insight into current treatment controversies, including referral and prescribing patterns across the seven major markets. Detailed profiles of Cymbalta, Lyrica, and milnacipran for use in fibromyalgia, with indication-specific sales forecasts of these drugs to 2016. Discussion of key fibromyalgia market drivers, such as strategies that improve public awareness and physician education.

Highlights

Following FDA approvals, Datamonitor foresees a dramatic rise in market value resulting from an upsurge in diagnosis and treatment rates. Estimated at $367m in 2006 in the US and 5EU, the market is forecast to grow to $1.7 billion in 2016. Commercial success of new fibromyalgia brands will encourage other companies to consider investment, and will see the R&D pipeline for new therapies increase over the coming years. A defined regulatory pathway will also attract future investors. Polypharmacotherapy will become commonplace in fibromyalgia management and Lyrica with Cymbalta will be a popular combination. This is good news for Lilly and Pfizer as it will effectively expand their market by reducing competition.

Reasons to Purchase

Quantify the future market size in order to weigh up the risk of investing in fibromyalgia or to validate internal forecasts for pipeline products. Gain insight into opinion leaders' thoughts on the major opportunities and challenges facing the fibromyalgia market. Assess the six major market (US and 5EU) sales forecasts of key late-stage pipeline drugs to 2016; and examine their clinical and commercial potential

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