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Published by: Datamonitor
Published: Nov. 18, 2008 - 179 Pages
Table of Contents
- CHAPTER 1 EXECUTIVE SUMMARY
- Scope of the analysis
- Datamonitor insight into the systemic lupus erythematosus market
- Contributing experts
- Related reports
- Upcoming related reports
- CHAPTER 2 INTRODUCTION, SCOPE AND RESPONDENT DEMOGRAPHICS
- Coverage of the Stakeholder Insight Survey
- Treatment trees
- Epidemiology
- Diagnosis presentation and referral options
- Patient segmentation
- Treatment trends
- Measuring and improving treatment outcomes
- Assumptions and caveats
- Terminology
- Physician demographics
- Rheumatologists in Japan show almost 20 years experience in specialist practice
- Future trends
- CHAPTER 3 COUNTRY TREATMENT TREES
- Introduction to treatment trees
- Overview
- US
- Japan
- France
- Germany
- Italy
- Spain
- UK
- CHAPTER 4 EPIDEMIOLOGY
- Etiology and symptoms
- Lupus affects less than 1% of the population in the seven major markets
- US rheumatologists see at least twice as many systemic lupus erythematosus patients compared to the other major markets
- US rheumatologists see more new systemic lupus erythematosus sufferers than other major markets
- Key studies investigating systemic lupus erythematosus
- US
- Datamonitor estimates almost 250,000 systemic lupus erythematosus patients in the US
- Estimated systemic lupus erythematosus prevalent population in the US can be split by race
- Japan
- Estimating systemic lupus erythematosus population in Japan is a challenge due to lack of recent prevalence data
- EU
- France
- Systemic lupus erythematosus prevalence data from Spain can be applied to France
- Germany
- German systemic lupus erythematosus prevalence calculated by applying UK estimates
- Italy
- Italian systemic lupus erythematosus prevalence based on robust study from the Ferrara region
- Spain
- Systemic lupus erythematosus population in Spain is low in comparison to northern European countries
- UK
- Systemic lupus erythematosus population split by sex in the UK
- Rest of the world
- Systemic lupus erythematosus prevalence in Northern European countries is high with immigration considered an important contributor
- Large systemic lupus erythematosus patient potential in Asian region, but more epidemiology studies required
- CHAPTER 5 DIAGNOSIS, PRESENTATION AND REFERRAL OPTIONS
- Presentation and diagnosis
- Rheumatologists are the main systemic lupus erythematosus care-givers
- Time to systemic lupus erythematosus diagnosis shortest in Japan, longest in the UK
- Total time to diagnosis more than a year and a half in the UK and Germany
- Average time from onset of symptoms to presentation over 10 months in the UK, but less than 5 months in Japan
- Longer time from initial presentation to diagnosis seen for ‘gatekeeper’ primary care systems
- Largest proportion of systemic lupus erythematosus sufferers present to a primary care physician
- Half of systemic lupus erythematosus sufferers diagnosed by a rheumatologist
- Treatment rates
- Patient and physician education key to earlier diagnosis and treatment
- CHAPTER 6 PATIENT SEGMENTATION
- Patient segmentation for systemic lupus erythematosus is a significant challenge
- Kidney and CNS specific involvement increases with systemic lupus erythematosus severity
- US and Japan show high lupus nephritis patient volume
- Total
- US
- Japan
- France
- Germany
- Italy
- Spain
- UK
- CHAPTER 7 TREATMENT TRENDS
- Overview of treatment guidelines for systemic lupus erythematosus
- ACR Guidelines for the referral and management of systemic lupus erythematosus in adults
- EULAR recommendations for the management of systemic lupus erythematosus
- Pharmacological and non-pharmacological therapy use
- Pharmacological treatment essential for major organ involvement
- Lupus subsets by organ-specific involvement
- Nearly all systemic lupus erythematosus sufferers with major organ involvement are drug-treated
- Multiple organ involvement
- Multiple organ disease treated predominantly with corticosteroids
- Cutaneous lupus
- Antimalarials used to treat cutaneous lupus
- Blood involvement
- Over half of sufferers receive systemic corticosteroids
- Neuropsychiatric
- Treatment mainly with systemic corticosteroids
- Lupus nephritis
- Over 40% of patients treated with cytotoxic agents
- Joint involvement
- Joint manifestation commonly treated with antimalarials
- Drug classes used in systemic lupus erythematosus treatment
- Corticosteroids
- Corticosteroids are the foundation of systemic lupus erythematosus therapy and are used in over half of sufferers
- Topical corticosteroids appropriate for cutaneous lupus treatment
- Immunosuppressants
- Highest immunosuppressant use seen for major organ involvement
- CellCept development halted, but off-label use expected to continue
- Antimalarials
- Antimalarials used to treat systemic lupus erythematosus across the broad spectrum of disease involvement
- Cytotoxic agents
- Cytotoxics target neuropsychiatric and renal involvement
- NSAIDs and COX-2s
- NSAIDS treat milder inflammation and pain
- Biologics
- Uptake of biologics highest for patients with lupus nephritis
- Rituxan/MabThera (rituximab)
- Opinion leaders seek to treat systemic lupus erythematosus sufferers with Rituxan/MabThera
- Rituxan/MabThera poorly perceived in Japan but popular in the US
- CHAPTER 8 MEASURING AND IMPROVING TREATMENT OUTCOMES
- Measuring disease activity and damage
- SLICC/ACR Damage Index
- Four major indices used to measure systemic lupus erythematosus disease activity
- Systemic Lupus Erythematosus Disease Activity Index (SLEDAI and SELENA-SLEDAI)
- The British Isles Lupus Assessment Group (BILAG)
- European Consensus Lupus Activity Measure (ECLAM)
- Systemic Lupus Erythematosus Activity Index (SLAM)
- Over half of rheumatologists use SLEDAI to measure activity
- Variation in disease activity index use is a potential obstacle to clinical trial success
- One-third of rheumatologists use more than one systemic lupus erythematosus activity index
- A small proportion of rheumatologists in the US and France prefer not to use a recognized disease activity index
- Extent of organ damage is critical to assessing global systemic lupus erythematosus disease activity
- Rheumatologists moderately satisfied with treatment efficacy measurement
- Challenges and unmet needs in systemic lupus erythematosus
- Development of effective, steroid-sparing therapies seen as highest priority
- Moderate satisfaction shown with current systemic lupus erythematosus treatments
- BIBLIOGRAPHY
- Journal papers
- Books
- Websites
- Datamonitor reports
- APPENDIX A
- Physician research methodology
- Physician sample breakdown
- Contributing experts
- APPENDIX B
- The survey questionnaire
- Screener
- 1 Epidemiology
- 2 Diagnosis and patient segmentation
- 3 Treatment
- 4 Treatment Outcomes
- 5 Prescribing Factors for Rheumatological Disease
- About Datamonitor
- About Datamonitor Healthcare
- About the Immunology and Inflammation (I&I) analysis team
- Disclaimer
AbstractIntroduction
Lupus is a chronic, autoimmune disorder, characterized by unpredictable flares and remissions. Affected areas can include the joints, skin, kidneys, heart, lungs, blood vessels and the brain. There are currently only three medications approved for the treatment of lupus; hydroxychloroquine, aspirin, and prednisone, highlighting the significant unmet need.
Scope
- Analysis of the lupus market based on a survey of 180 rheumatologists supported by key opinion leader interviews
- Detailed overview of epidemiology in lupus benchmarked against physician perception
- Patient segmentation by both disease severity and organ involvement (multiple organ disease, skin, joints, blood, CNS, and kidney)
- Assessment of treatment trends and outcome measures
Highlights
Rheumatologists provide the long-term management for two-thirds of lupus patients. 40% of patients present to a primary care physician, and most are referred to a rheumatologist for diagnosis. Long-term care is also linked to the major organ involved, for example 10% of patients receive long term management from a nephrologist.
The development of effective, steroid-sparing therapies is the highest priority for pharmaceutical companies to address. Biologics will play a prominent therapeutic role over the next few years. Current biologic use by involvement varies between 2% and 10%, whilst steroid uptake varies between 37% and 69%.
Four major indices are predominantly used, creating a hindrance to the application of clinical trial data, and one third of rheumatologists actually use more than one index in clinical practice. The extent of organ damage was considered the most important issue of disease activity assessment, followed by antibody and inflammatory marker levels.
Reasons to Purchase
- Gain competitive advantage with one of the most extensive primary research reports available in lupus, with data from 180 prescribing rheumatologists
- Identify with prescribers more effectively, through an understanding of referral patterns based on data-rich treatment numbers
- Validate new product forecasting based on diagnosis rates and treatment by patient segmentation and drug therapy class
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