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Published by: Datamonitor
Published: Jun. 25, 2008
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE
- About the Infectious Disease and Respiratory (ID&R) pharmaceutical analysis team
- CHAPTER 1 EXECUTIVE SUMMARY
- Scope of the analysis
- Datamonitor insight into the asthma market
- Contributing experts
- Related reports
- Upcoming related reports
- CHAPTER 2 COUNTRY TREATMENT TREES
- Introduction to treatment trees
- US
- 5EU
- Japan
- France
- Germany
- Italy
- Spain
- UK
- CHAPTER 3 PATIENT SEGMENTATION AND EPIDEMIOLOGY
- Disease definition: the importance of inflammation
- Asthma is caused by a combination of exogenous and genetic factors
- Exogenous factors
- Genetic factors
- The role of airway inflammation, airway hyper-responsiveness and airway remodeling
- Co-morbidities
- Allergic rhinitis is the most common co-morbidity of asthma
- Asthma and COPD can co-exist but true interaction between these diseases is unclear
- Obesity may become even more important in the future of asthma
- Disease classification - asthma control
- Disease classification - asthma phenotypes
- Allergic asthma is by far the most common phenotype
- Asthma can be irreversible with chronic airflow obstruction
- Awareness of nocturnal asthma as a phenotype may be low
- Is exercise-induced asthma a separate phenotype?
- Patients with steroid-resistant asthma have highest unmet needs
- Why are phenotypes (not) used?
- Asthma prevalence
- Difference between physician's impression and publicized data is related to asthma definition
- Asthma prevalence seems to be stabilizing
- US
- Japan
- Europe
- France
- Germany
- Italy
- Spain
- UK
- CHAPTER 4 DIAGNOSIS AND DIAGNOSTIC TESTS
- Presentation of asthma - symptoms
- Diagnosis of asthma
- Spirometry and PEF measurements are still underused
- Allergen skin tests mostly used for initial diagnosis
- Airway responsiveness challenges are mainly useful for difficult-to-diagnose patients
- Upcoming diagnostic tests: sputum eosinophil count and fraction exhaled nitric oxide (FENO)
- CHAPTER 5 TREATMENT OPTIONS AND TRENDS
- Treatment options
- Bronchodilators (relievers)
- Beta2-agonists
- Anticholinergics
- Combination beta2-agonist/anticholinergic
- Methyl xanthines
- Anti-inflammatories (controllers)
- Inhaled corticosteroids
- Systemic corticosteroids
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- ICS/LABA combinations
- Biologicals
- Inhaler device options
- The ideal inhaler device
- Treatment guidelines
- The Global Initiative for Asthma (GINA) guidelines are most important international guidelines
- The National Heart, Lung, and Blood Institute (NHLBI) guidelines follow GINA's focus on control
- American Thoracic Society (ATS) and the European Respiratory Society (ERS) do not have specific asthma guidelines
- National guidelines can supersede international guidelines
- Most guidelines are now evidence-based
- Treatment trends
- Almost all patients receive some type of controller medication
- Mild asthma is over-treated with long-term reliever medication
- ICS/LABA combinations even used in mildest forms of asthma
- Inhaled corticosteroids are less used as severity progresses
- Long-acting bronchodilators mainly used in conjunction with an ICS
- Antileukotriene drugs are especially popular in Japan
- Short-acting bronchodilators is the most often used drug class in most severities
- Theophylline is still prominent in Japanese treatment regimen
- Omalizumab is reserved for the most severe asthma patients
- CHAPTER 6 KEY PRESCRIBING INFLUENCES AND BRAND ASSESSMENT
- Factors influencing physician decision making
- Symptomatic improvement
- Duration of action
- Side-effect profile
- Speed of onset
- Recommended in treatment guidelines
- Cost
- Once-daily dosing
- Flexible dosing
- Device/mode of administration
- Patient age
- Physician perception of key products
- Total scores per drug per country
- Interpreting a brand map
- The ICS/LABA combination class
- The ICS/LABA combination products
- The inhaled corticosteroid class
- The inhaled corticosteroid products
- The long-acting bronchodilator class
- The long-acting bronchodilator products
- The antileukotriene class
- The antileukotriene products
- Short-acting bronchodilators
- Biologics - Xolair (omalizumab)
- CHAPTER 7 TREATMENT OUTCOMES AND NEW PRODUCT DEVELOPMENT
- Treatment outcomes
- Unmet needs
- Increase access to safe and effective immunotherapy
- Improve therapeutic response by phenotyping
- Reduce cost of medication
- Reduce over-treatment of asthma
- Develop ICS without side effects
- Other unmet needs
- New product development
- Awareness of pipeline products
- Combination products
- LABAs and LAMAs
- Novel mechanisms of action
- Future use of pipeline products
- Novel ICS/LABA combinations
- Novel LABA/LAMA combinations
- Novel LAMAs
- Novel LABAs
- Novel mechanisms of action
- BIBLIOGRAPHY
- Journal papers
- Websites
- Datamonitor reports
- APPENDIX A
- Physician research methodology
- Physician sample breakdown
- US
- Japan
- France
- Germany
- Italy
- Spain
- UK
- Contributing experts
- APPENDIX B
- The survey questionnaire
- Section 1 - Patient Segmentation
- Section 2 - Diagnosis
- Section 3 - Treatment
- Section 4 - Treatment Outcomes
- Section 5 - Product Profiles
- Section 6 - Products in Development
- APPENDIX C
- About Datamonitor
- About Datamonitor Healthcare
- About the Infectious Disease and Respiratory (ID&R) analysis team
- Disclaimer
- List of Tables
- Table 1: Percentage of physicians using each asthma classification system for each of the seven major markets, 2008
- Table 2: Prevalence of adult asthma, by severity and country in the seven major markets, 2008
- Table 3: Prevalence of asthma per country, according to Datamonitor's research among physicians and published literature, 2008
- Table 4: Country totals for 12-month prevalence of asthma in both phases, average change per year and SE of the change by age, 2006
- Table 5: Comparative analysis of the definition of the levels of evidence used in the asthma guidelines considered
- Table 6: Primary endpoints of some of the ICS drugs used in asthma treatment
- Table 7: Number and percentage of physicians able to rate each asthma drug, 2008
- Table 8: Total scores (out of 100) of each asthma drug for each of the individual seven major markets
- Table 9: Price differences between ICS/LABA* combination products in countries where Foster was available, 2007
- Table 10: Price differences between ICS products in countries where all four products were available in 2007
- Table 11: Mean percentage of asthma patients experiencing each number of exacerbations per year, by disease severity, across the seven major markets, 2008
- Table 12: US physician sample breakdown, 2008
- Table 13: Japan physician sample breakdown, 2008
- Table 14: France physician sample breakdown, 2008
- Table 15: Germany physician sample breakdown, 2008
- Table 16: Italy physician sample breakdown, 2008
- Table 17: Spain physician sample breakdown, 2008
- Table 18: UK physician sample breakdown, 2008
- Table 19: Percentage of all your current (diagnosed) asthma patients with each of the disease severities
- Table 20: Classification that you primarily use to characterize your asthma patients
- Table 21: Percentage of all your asthma patients presenting with each of the types of asthma
- Table 22: Co-morbidities that your asthma patients present with and at which percentage
- Table 23: Percentage of your asthma patients suffering from each number of exacerbations per year
- Table 24: Percentage of all your current asthma patients receiving each of the following tests in order to facilitate diagnosis and track their status
- Table 25: Percentage of all your current asthma patients receiving each of the following drug therapies as baseline therapy
- Table 26: Relative importance of the factors when prescribing each of the drug classes for asthma
- Table 27: Challenges in the management of asthma
- Table 28: Rate of the performance or predicted performance of each of the ICS and ICS/LABA combinations
- Table 29: Rate of the performance or predicted performance of each of the oral antileukotrienes and biologic
- Table 30: Rate of the performance or predicted performance of each of the long-acting bronchodilators
- Table 31: Points allocated to the importance of characteristics of a device
- Table 32: Preference of device type per each drug class
- Table 33: Awareness of pipeline products and how they would be prescribed
- List of Figures
- Figure 1: Diagrammatic overview of the coverage of the Stakeholder Insight: Asthma survey, 2008
- Figure 2: US treatment tree (ICS/LABA combination and steroids), 2008
- Figure 3: US treatment tree (others), 2008
- Figure 4: 5EU treatment tree (ICS/LABA combination and steroids), 200
- Figure 5: 5EU treatment tree (others), 2008
- Figure 6: Japan treatment tree (ICS/LABA combination and steroids), 2008
- Figure 7: Japan treatment tree (others), 2008
- Figure 8: France treatment tree (ICS/LABA combination and steroids), 2008
- Figure 9: France treatment tree (others), 2008
- Figure 10: Germany treatment tree (ICS/LABA combination and steroids), 2008
- Figure 11: Germany treatment tree (others), 2008
- Figure 12: Italy treatment tree (ICS/LABA combination and steroids), 2008
- Figure 13: Italy treatment tree (others), 2008
- Figure 14: Spain treatment tree (ICS/LABA combination and steroids), 2008
- Figure 15: Spain treatment tree (others), 2008
- Figure 16: UK treatment tree (ICS/LABA combination and steroids), 2008
- Figure 17: UK treatment tree (others), 2008
- Figure 18: Effect of the interaction between various types of exposures and various genetic backgrounds through pathways involving atopy, airway inflammation, airway hyperresponsiveness (AHR) or other, unknown factors
- Figure 19: Mean percentage of patients with each co-morbidity across the seven major markets, 2008
- Figure 20: Levels of asthma control
- Figure 21: Mean percentage of asthma patients with each asthma phenotype across the seven major markets, 2008
- Figure 22: Familiarity with asthma phenotypes among physicians and their use in clinical practice, 2008
- Figure 23: Severity of asthma as reported by physicians in the US (n=36) in the 2004 and 2008 Datamonitor surveys
- Figure 24: Severity of asthma as reported by physicians in Japan (n=24) in the 2004 and 2008 Datamonitor surveys
- Figure 25: Severity of asthma as reported by physicians in France (n=24) in the 2004 and 2008 Datamonitor surveys
- Figure 26: Severity of asthma as reported by physicians in Germany (n=24) in the 2004 and 2008 Datamonitor surveys
- Figure 27: Severity of asthma as reported by physicians in Italy (n=24) in the 2004 and 2008 Datamonitor surveys
- Figure 28: Severity of asthma as reported by physicians in Spain (n=24) in the 2004 and 2008 Datamonitor surveys
- Figure 29: Severity of asthma as reported by physicians in the UK (n=24) in the 2004 and 2008 Datamonitor surveys
- Figure 30: Utilization per test for initial asthma diagnosis and to track a patient's disease status (n=180), 2008
- Figure 31: Advantages and disadvantages of the main three types of portable inhaler devices
- Figure 32: Relative importance of each inhaler device characteristic for treating asthma patients (n=180), 2008
- Figure 33: Factors influencing inhaler choice
- Figure 34: Percentage of physicians following each guideline, 2004
- Figure 35: GINA asthma management approach based on control, 2007 guidelines
- Figure 36: NHLBI asthma management approach, 2007 guidelines
- Figure 37: The prescription of different drug classes for the treatment of asthma on average in the seven major markets, 2008
- Figure 38: Overview of the prescription of controller medications across the seven major markets, per asthma severity, 2008
- Figure 39: Overview of the prescription of reliever medications across the seven major markets, per asthma severity, 2008
- Figure 40: Overview of the prescription of ICS/LABA combinations across asthma severities, per country, 2008
- Figure 41: Overview of the prescription of ICS across asthma severities, per country, 2008
- Figure 42: Overview of the prescription of long-acting bronchodilators across asthma severities, per country, 2008
- Figure 43: Overview of the prescription of antileukotrienes across asthma severities, per country, 2008
- Figure 44: Overview of the prescription of short-acting bronchodilators across asthma severities, per country, 2008
AbstractIntroduction
Asthma is managed using a step-wise approach, with bronchodilators to relieve symptoms of airflow limitation and controller medications to target underlying inflammation. Datamonitor’s research shows that almost all patients (even those with mild intermittent asthma) receive some type of controller medication as their baseline treatment, which is in line with international management guidelines.
Scope
Patient segmentation with regards to disease severity, asthma phenotypes, co-morbidities and exacerbations
Treatment choice split by line of therapy and disease severity
Performance of asthma therapies in terms of factors such as efficacy, onset and duration of action, side effect profile, delivery method and cost
Physician awareness and perception of drugs in development
Report Highlights
Recently, the classification of asthma has shifted to the concept of disease control in order to acknowledge the variability of the disease. Datamonitor research showed that around half of the physicians have taken on this new asthma classification, which may illustrate the transition away from the traditional severity classification.
The ICS class as a whole scored rather low on speed of onset, which may indicate an unmet need in this class. The traditional products Flixotide/Flovent (fluticasone) and Pulmicort (budesonide) scored consistently higher than the novel products Asmanex (mometasone) and Alvesco (ciclesonide).
Of the combination products in development, physicians were most aware of GSK’s Beyond Advair, probably due to the fact that GSK already has had Advair/Seretide on the market. The other four ICS/LABA combinations were less well-known since they all come from companies without a current combination product on the market.
Reasons to Purchase
Target physicians more effectively through an understanding of prescribing behavior and its influences.
Validate new product forecasting based on diagnosis and treatment rates, and the likely rate of uptake for new products.
Benchmark brand awareness and perceptions surrounding product positioning in order to formulate competitive lifecycle management strategies.
Please Note: This product is delivered as a zip file, which contains Excel and PDF files.
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