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Pipeline/Commercial Insight: Antihypertensives New class opportunity offset by key patent expiries

Published by: Datamonitor

Published: Jul. 12, 2007 - 261 Pages


Table of Contents



ABOUT DATAMONITOR HEALTHCARE

About the cardiovascular pharmaceutical analysis team

CHAPTER 1 EXECUTIVE SUMMARY

Objective of the analysis

Datamonitor insight into the hypertension market

Contributing experts

Related reports

CHAPTER 2 MARKET DEFINITION AND OVERVIEW

Definition of drug classes included

Current market situation

The antihypertensives market segmented by class

The antihypertensives market segmented by country

Antihypertensive market landscape

Market growth and market restraint

Factors driving growth of the antihypertensives market

Factors restraining growth of the antihypertensives market

Strategic scope and report focus

US antihypertensives market dynamics

Consideration of market unmet needs

Conflicting evidence from clinical trials and guideline alterations

Paradigm shift in antihypertensive R&D

Defining the unmet need in the antihypertensives market

Need beyond cosmetic blood pressure reduction

Improved diagnosis

Improved blood pressure management

Increased uptake of fixed-dose combination therapies

Targeting global cardiovascular risk and target organ damage

Patient and primary care physician education

CHAPTER 3 COUNTRY MARKET ASSESSMENTS

Seven major market level assessment, opportunities and threats

Market level assessment

Opportunities

Demographic and lifestyle trends continue to dominate the agenda, and have the potential to increase the hypertensive patient population

Big Pharma cannot ignore the emerging markets of India and China

Novel products are expected, but innovation is lacking in antihypertensive R&D

Growing awareness of the metabolic syndrome

Increasing co-operation between regulatory bodies

Threats

Increased generic competition

Parallel trade

Ongoing cost-containment measures

Increasingly conservative regulatory environments

Restrictive pricing and reimbursement policies

Reduced periods of market exclusivity

Mandatory registration of all clinical trial results

US: market level assessment, opportunities and threats

Market level assessment

Opportunities

Direct-to-consumer (DTC) advertising is legal in the US and has been shown to influence patient prescription choice and increase diagnosis rates

Leveraging the JNC7 guidelines to maximize pharmacotherapy

Price of drugs

Threats

The changing healthcare environment in the US will drive future generic use

Medicare Part D is expected to lead to greater generic use

Patient power

Pharmaceutical re-importation issues continue to dog Big Pharma

Formularies promote quality, but restrict choice

Pricing and reimbursement issues

Curbing of DTC advertising will lead to greater emphasis on risk of products

Wal-Mart $4 a day generic program introduces further cost competition

Japan: market level assessment, opportunities and threats

Market level assessment

Opportunities

Ageing population

An underdeveloped generics market slows brand erosion

Possible introduction of direct-to-consumer advertising

Multiple patent extensions and labeling regulations

Opening up the Japanese market

Drug approval lag-time being targeted by the Japanese Ministry of Health, Labor and Welfare

Reduced product approval time

Harmonization of approval process

The Internet is an effective means to reach out to patients

Threats

Despite being underdeveloped, generics are expected to evolve into a significant player in the Japanese healthcare market in the future

Flat sum reimbursement

Complex regulatory process

Biannual price cuts still threaten market growth

New healthcare reforms under debate

France: market level assessment, opportunities and threats

Market level assessment

Opportunities

Innovation encouraged in the pharmaceutical industry

Demographic changes provide opportunity for market expansion of chronic illnesses

Consumers in France readily recognize the Internet as a source of high-quality medical information

Generic consumption in France is particularly low

Threats

Continuation of cost-control measures

Formulary access

Take-off of generic sector

Limitations on prescriptions dispensed from hospitals to patients in the community

Pharmacists are being mandated to drive generic dispensing

Germany: opportunities and threats

Market level assessment

Opportunities

Pricing freedom which supports innovation

ePharmacy and mail-order drugs legalized

Threats

Cost-containment measures in Germany have led to a healthy generics market

German doctors set to receive bonuses for prescribing generics

Italy: market level assessment, opportunities and threats

Market level assessment

Opportunities

Single agency holds regulatory authority

Negligible impact of generics is set to continue

Threats

Stringent reference pricing system

Restructured reimbursement categories

Intellectual property to conform with rest of EU

Spain: market level assessment, opportunities and threats

Market level assessment

Opportunities

Underdeveloped generics market both an opportunity and a threat

Threats

R&D activity expected to decline

Reference pricing systems (RPS) likely to have an impact on branded revenues

UK: market level assessment, opportunities and threats

Market level assessment

Opportunities

NICE guidance advises against the use of beta-blockers

GMS contact improvements

Threats

Pharmaceutical Price Regulation Scheme (PPRS) implements periodic price cuts

Cost containment measures encourage continued high use of generics

Summary of environmental issues affecting antihypertensive market size

CHAPTER 4 PIPELINE DYNAMICS ANALYSIS

Outlook for developmental antihypertensives

Pipeline overview

Pipeline agents by phase of development

Pipeline antihypertensives segmented by mechanism of action

Pipeline activity segmented by company

Companies developing key novel antihypertensive agents

Novartis

Daiichi Sankyo

Gilead

Takeda

CHAPTER 5 COMPARATIVE ASSESSMENT OF KEY PIPELINE PRODUCTS

Overview

Key pipeline product positioning

Darusentan

Mechanism of action

Clinical assessment

Commercial assessment

Exforge (valsartan/amlodipine)

Mechanism of action

Clinical assessment

Commercial Assessment

Olmesartan/amlodipine

Mechanism of action

Clinical assessment

Commercial Assessment

Zanipress (enalapril/lercanidipine)

Mechanism of action

Clinical assessment

Commercial assessment

CYT006-AngQb

Mechanism of action

Clinical assessment

Commercial assessment

CHAPTER 6 FORECAST ANALYSIS

Overview

Changes in medical practice

Increased use of ambulatory BP monitoring and home BP monitoring

Assessment of overall cardiovascular risk

Physician incentives to control blood pressure

Pressure to increase compliance through the use of single-pill combination products

Major clinical trials

ONTARGET

DREAM

TROPHY

Outcomes program for Rasilez: ALTITUDE, AVIATOR

New product launches

Tekturna/Rasilez (aliskiren) marketed by Novartis

Exforge (valsartan+ amlodipine) marketed by Novartis

Additional indications

Irbesartan gains congestive heart failure indication

Valsartan gains additional diabetes indication

Micardis (telmisartan) gains type 2 diabetic nephropathy indication

Patent expiries

ARB patent expiries

CCB patent expiries

Betablocker patent expiries

ACE inhibitor patent expiries

Other patent expiries

Data definitions, limitations and assumptions

Standard units

Japanese market data

Derivation of sales forecasts and pricing trends

Forecasts

Forecast methodology

CHAPTER 7 COMMERCIAL IMPACT AND LIFECYCLE MANAGEMENT: CASE STUDIES

Introduction

Case Study 1: Aliskiren - up to the hype?

Introduction

Mechanism of action

Aliskiren

Clinical development of aliskiren

Key Phase III Trials with aliskiren

Aliskiren in combination with a diuretic

Aliskiren versus CCB and their combination

Aliskiren versus ACEI and their combination

Efficacy - As good, but no better

Benign side-effect profile - Not good enough

Long duration of action - The saving grace?

The negative-feedback conundrum

End organ protection

Prevention of organ damage with ACEIs and ARBs

Additional benefit from renin inhibition?

Summary of key advantages:

Can Novartis justify price premium?

Datamonitor assessment

Case study 2: ESC/ESH GUIDELINES

Emphasis on the assessment of total cardiovascular risk

Consideration of absolute risk versus relative cardiovascular risk

Targeting end-organ damage

Recommendation for lifestyle modification

First-line treatment strategy

Managing hypertension and comorbidities

Treatment of specific patient groups

Opinion leader SWOT analysis

Strengths:

Weaknesses:

Potential barriers to uptake:

Commercial implications and further work

Implication for clinical trial design

CHAPTER 8 BIBLIOGRAPHY AND REFERENCES

Bibliography

References

APPENDIX A - MARKET DATA AND MAJOR BRAND FACTS

Mechanisms of action

Beta blockers

Abstract

Introduction

Datamonitor expects the antihypertensives market to reach almost $40 billion, across the seven major markets, by 2016. The growth will be driven by the uptake of Novartis's Tekturna, as well as increased use of ARBs, and their combinations. However, the expiries of some key patents, particularly Pfizer's Norvasc and Merck's Cozaar, will restrain market growth.

Scope

Event-driven sales forecasts for 2007-16 across the seven major markets: US, France, Germany, Italy, Spain, UK and Japan. Country and market specific issues that will impact sales opportunities and market landscape, including key patent expiries and product launches. Case studies assessing the blockbuster potential of Novartis's direct renin inhibitor, Tekturna, and the impact of ESC/ESH guideline reform in Europe. Comprehensive analysis of the current antihypertensives pipeline, including a clinical and commercial assessment of all key emerging therapies.

Highlights

The growth rate of the antihypertensive market is declining. The market is mature and does not present an attractive opportunity for R&D expenditure; consequently Big Pharma are shying away from the pursuit of novel mechanisms of action in favour of developing more efficacious combination therapies. Cozaar's patent expiry in the US, has the potential to alter the structure of the antihypertensive market dramatically. Threats of generic substitution and money-saving healthcare strategies which have plagued other markets, are now approaching the successful ARB class, and will have an impact on the whole antihypertensive market. Novartis is set to strengthen its position in the antihypertensives arena; Tekturna is expected to achieve international blockbuster status and Exforge will achieve sales of at least $800m, set back slightly by the premature expiry of Pfizer's Norvasc patent.

Reasons to Purchase

Quantify the future size of the antihypertensives market and identify opportunities for new products. Learn how recent European healthcare reforms and guideline updates will shape the antihypertensives market. Understand the barriers to uptake for novel antihypertensive agents, and the need for paradigm shift in clinical trial design.

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