Multiple System Atrophy (MSA) Market Insight, Epidemiology and Market Forecast -2030

DelveInsight’s ‘Multiple System Atrophy (MSA)-Market Insights, Epidemiology, and Market Forecast–2030’ report deliver an in-depth understanding of the MSA, historical and forecasted epidemiology as well as the MSA market trends in the United States, EU5 (Germany, France, Italy, Spain, and the United Kingdom) and Japan.

The MSA market report provides current treatment practices, emerging drugs, and market share of the individual therapies, current and forecasted 7MM MSA market size from 2017 to 2030. The Report also covers current MSA treatment practices, market drivers, market barriers, unmet medical needs, SWOT analysis to curate the best of the opportunities, and assesses the underlying potential of the market.

Geography Covered
• The United States
• EU5 (Germany, France, Italy, Spain, and the United Kingdom)
• Japan

Study Period: 2017–2030
Multiple System Atrophy (MSA) Disease Understanding and Treatment Algorithm
Multiple System Atrophy (MSA) Overview

Multiple System Atrophy (MSA), formerly known as Shy-Drager Syndrome, is a rare, degenerative neurological disorder affecting the body's involuntary (autonomic) functions, including blood pressure, breathing, bladder function, and motor control. The term multiple system atrophy was first introduced in the medical literature in 1969. It encompasses three presentations of a single disease formerly thought to be separate disorders, specifically Shy-Drager syndrome (which emphasized autonomic dysfunction), striatonigral degeneration (which emphasized parkinsonian symptoms), and sporadic olivopontocerebellar atrophy (which emphasized cerebellar symptoms).

MSA is broken down into two main subtypes based on the predominant symptom: MSA-predominant Parkinsonism (MSA-P) and MSA-predominant cerebellar ataxia (MSA-C). A patient diagnosed with MSA-P may over time appear to have MSA-C and vice versa, so these categorizations are not always set in stone.

Multiple System Atrophy (MSA) Diagnosis
A detailed clinical evaluation, including medical history, physical, and neurological examinations with special attention to gait, coordination, and muscle tone, is the most important step in evaluating a patient with suspected MSA.

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Multiple System Atrophy (MSA) Treatment
There is no specific treatment for MSA. Treatment is aimed at controlling the symptoms of the disease with the help of supportive therapies (physiotherapy, occupational therapy, and speech therapy) and treatment of autonomic symptoms. Drugs that are used to treat people with Parkinson’s disease, most notably levodopa, may also be prescribed for individuals with MSA. However, the effectiveness of such medications varies significantly among affected individuals. In many cases, individuals do not respond or respond poorly to such therapy. Approximately one-third of affected individuals respond to levodopa therapy. However, in most cases, the effectiveness of this therapy decreases over time. In addition, these drugs must be used with caution because they may lower blood pressure.
Certain medications are designed to treat certain symptoms. There are some medications for MSA, which primarily lessen orthostatic hypotension, parkinsonism, urinary incontinence, urinary retention, constipation, and erectile dysfunction.

Multiple System Atrophy (MSA) Epidemiology
The disease epidemiology covered in the report provides historical as well as forecasted epidemiology segmented by Total Prevalent Cases of MSA, Diagnosed Prevalent Patient Population of MSA, Gender-specific Diagnosed Prevalent Population of MSA, Age-specific Diagnosed Prevalent Population of MSA, and Type-specific Diagnosed Prevalent Population of MSA scenario of MSA in the 7MM covering the United States, EU5 countries (Germany, France, Italy, Spain, and the United Kingdom), and Japan from 2017 to 2030.

Key Findings
• In 2017, the prevalent cases of MSA in the 7MM was 41,033.
• The diagnosed patient pool in the 7MM comprised of 22,568 patients in 2017.
• In the case of the United States, the prevalent population of MSA was 14,496 in 2017.
• It has been observed that males accounted for more prevalent cases of MSA than females. In 2017, out of the total diagnosed prevalent cases of MSA, 4,784 cases accounted for males and 3,189 for females, in the US.
• In the epidemiology model of MSA, for age-specific cases, the categorization is done in the following age group, i.e., 30–39 Years, 40–49 Years, 50–59 Years, 60–79 Years, and 80+ Years. In the US, the majority of the cases are observed in the age group, 50–59 Years (51.52%), whereas, in EU-5, and Japan, the majority of the cases are observed in the age group 60–79 Years.
• MSA is broken down into two main subtypes based on the predominant symptom: MSA-predominant Parkinsonism (MSA-P), and MSA-predominant cerebellar ataxia (MSA-C).
• In the US and EU-5 countries, MSA-P type is more prevalent as compared to MSA-C type, but in Japan, the trend is the opposite. In Japan, MSA-C type (70%) is more prevalent as compared to MSA-P (30%).
• In the EU5, the highest prevalent cases were reported to be in Italy followed by Germany, and the United Kingdom whereas the lowest prevalence rates were reported in Spain during the period of 2017–2030.
• Japan was reported to have 10,360 prevalent cases of MSA in 2017.
Multiple System Atrophy (MSA) Epidemiology
The epidemiology segment also provides the MSA epidemiology data and findings across the United States, EU5 (Germany, France, Italy, Spain, and the United Kingdom), and Japan.

Multiple System Atrophy (MSA) Drug Chapters
The drug chapter segment of the MSA report encloses the detailed analysis of MSA current therapies, mid-phase, and late-stage pipeline drugs. It also helps to understand the MSA clinical trial details, expressive pharmacological action, agreements and collaborations, approval and patent details of each included drug, and the latest news and press releases.

Multiple System Atrophy (MSA) Marketed Drugs
Northera/DOPS (Droxidopa): Chelsea Therapeutics/Sumitomo Dainippon Pharma
Northera (droxidopa) is an oral medicine used to treat sensations of dizziness, light-headedness, and a feeling of being on the verge of passing out or fainting — all symptoms that may result from a neurological disorder like Parkinson’s disease. Northera is in a class of medications called alpha and beta-adrenergic agonists, which work by increasing norepinephrine levels. Norepinephrine is a natural circulating chemical that helps to regulate blood pressure. Northera is directly metabolized to norepinephrine by a naturally occurring enzyme called dopa-dexarboxylase. Droxidopa has been marketed in Japan since 1989. In 2014, it was approved in the US.

Products detail in the report…
Multiple System Atrophy (MSA) Emerging Drugs
Verdiperstat (AZD3241; BHV-3241): Biohaven Pharmaceuticals
Verdiperstat is a first-in-class, oral, potent, selective, brain-penetrant, and irreversible myeloperoxidase (MPO) enzyme inhibitor. Since MPO is a key driver of oxidative and inflammatory processes and is significantly increased in a range of brain disorders, it is thought that inhibiting MPO activity may be a promising therapeutic strategy for neuroinflammatory and neurodegenerative conditions, including MSA.

Verdiperstat was progressed through Phase II clinical trials by AstraZeneca. Seven clinical studies were completed by AstraZeneca, including four Phase I studies in healthy subjects, two Phase IIa studies in subjects with Parkinson’s disease, and one phase IIb study in subjects with MSA. These Phase II clinical studies provide evidence that verdiperstat achieves peripheral target engagement (i.e., reduces MPO specific activity in plasma) and central target engagement in the brain and offer proof of its mechanism of action (i.e., reduce microglial activation and neuroinflammation).

A Phase III clinical trial to evaluate the efficacy of verdiperstat in MSA is currently ongoing. The trial’s topline results are expected in the fourth quarter of 2021. The China IND approval to join the Phase III clinical trial of verdiperstat for the treatment of MSA was obtained in the fourth quarter of 2019.

In addition, Phase II/III trial to evaluate the efficacy of verdiperstat in amyotrophic lateral sclerosis (ALS) is currently ongoing as part of the HEALEY ALS platform trial.

Products detail in the report…
Ampreloxetine (TD-9855): Theravance Biopharma
Ampreloxetine is an investigational, once-daily norepinephrine reuptake inhibitor (NRI) in development for the treatment of patients with symptomatic orthostatic hypotension (nOH). It has a high affinity for binding to norepinephrine transporters. By blocking the action of these transporters, ampreloxetine causes an increase in extracellular concentrations of norepinephrine.

Ampreloxetine showed positive 4-week results from a Phase II study in patients with nOH, including durable improvements in patients’ disease symptom severity after 4 weeks of treatment with ampreloxetine, as measured by orthostatic hypotension symptom assessment question #1 (“OHSA #1”). OHSA #1 is a measure of dizziness, lightheadedness, or the sensation of being about to blackout. Ampreloxetine is currently being evaluated in the registrational Phase III program in patients with symptomatic nOH, and the company is expecting 4-week efficacy data in 2021. The ongoing Phase 3 registrational program includes two studies, one designed to assess treatment benefit over 4 weeks and the other to assess the response’s durability.

Products detail in the report…
List to be continued in the report…
Multiple System Atrophy (MSA) Market Outlook
The current treatment only offers symptomatic relief. The symptomatic treatment options include medications for orthostatic hypotension, parkinsonism, urinary incontinence, urinary retention, constipation, and erectile dysfunction. No disease-modifying treatment option is currently available in the market.

The fainting and lightheadedness from orthostatic hypotension may be treated with simple interventions such as wearing compression stockings, adding extra salt and/or water to the diet, and avoiding heavy meals. The drugs fludrocortisone and midodrine sometimes are prescribed. Northera/DOPS (droxidopa) is approved in the US and Japan to treat neurogenic orthostatic hypotension seen in MSA. ProAmatine/Gutron (midodrine hydrochloride) is also approved in the US and some EU countries. ProAmatine, developed by Shire Plc – now acquired by Takeda, is discontinued in the US; however, generic versions are available in the US market.

Bladder control problems are treated according to the nature of the problem. Anticholinergic drugs, such as oxybutynin or tolterodine, may help reduce the sudden urge to urinate. Fixed abnormal muscle postures (dystonia) may be controlled with injections of botulinum toxin, and sleep problems such as REM sleep behavior disorder can be treated with medicines including clonazepam, melatonin, or some antidepressants. Some individuals with MSA may have significant difficulties with swallowing and may need a feeding tube or nutritional support. Also, speech therapy may help identify strategies to address swallowing difficulties.

Physical therapy helps maintain mobility, reduce contractures (chronic shortening of muscles or tendons around joints, preventing the joints from moving freely), and decrease muscle spasms and abnormal posture. Individuals may eventually need assistive devices such as walkers and wheelchairs. Occupational therapists help with home safety and teach new ways to address daily living activities such as dressing and eating.

Low-dose clonazepam at bedtime can be considered a treatment for a severe rapid-eye-movement sleep behavior disorder, but it may aggravate nocturnal stridor or sleep apnea. Preliminary evidence suggests that melatonin may be an alternative treatment in this situation. Cognitive impairment in patients with MSA does not usually require treatment, but pharmacologic intervention may be needed for those with severe depression, anxiety, or emotional incontinence.

Acetylcholinesterase inhibitors, such as pyridostigmine, indirectly activate muscarinic acetylcholine receptors in autonomic pathways, thus enhancing the force of bladder contractions and reducing PVR volumes. Treatment with acetylcholinesterase inhibitors can also improve postural hypotension symptoms, presumably by enhancing nicotinic acetylcholine receptor activation in the sympathetic ganglia.
The pipeline of MSA possesses potential drugs as monotherapies as well as combination therapies. Overall, the MSA therapeutics market is further expected to grow in the forecast period (2020–2030).

Key Findings
• The market size of MSA in the 7MM was USD 81.41 million in 2017.
• In 2017, the market size of MSA in the US was USD 39.63 million.
• Among the EU-5 countries, Italy has the highest market size of USD 5.84 million followed by Germany and the UK. The lowest market size was estimated in Spain with USD 2.89 million in 2017.
• Of the emerging therapies, Verdiperstat (AZD 3241; BHV-3241): Biohaven Pharmaceuticals and Ampreloxetine (TD-9855): Theravance Biopharma are expected to enter the market in the 7MM, during the forecast period [2020–2030]. Among these therapies, Verdiperstat is a disease-modifying therapy so it is expected to generate a major market share. This drug is expected to launch in the year 2022 in the US and 2023 in the EU-5 and Japan market.
• Another therapy Ampreloxetine (TD-9855) is expected to enter in 2023 in the US and 2024 in the EU-5 and Japan market. This drug will compete with an already approved drug (Droxidopa) for neurogenic orthostatic hypotension, due to its high safety profile and once-daily doses, it is anticipated to capture a decent market share in the upcoming years.
• The market size of MSA in Japan was USD 19.14 million in 2017.

The United States Market Outlook
This section provides the total MSA market size and; market size by therapies in the United States.
EU-5 Market Outlook
The total MSA market size and market size by therapies in Germany, France, Italy, Spain, and the United Kingdom are provided in this section.
Japan Market Outlook
The total MSA market size and market size by therapies in Japan are provided.

Multiple System Atrophy (MSA) Drugs Uptake
This section focuses on the rate of uptake of the drugs expected to get launched in the market during the study period 2017–2030. The analysis covers MSA market uptake by drugs; patient uptake by therapies; and sales of each drug.

This helps in understanding the drugs with the most rapid uptake, reasons behind the maximal use of new drugs, and allows the comparison of the drugs based on market share and size which again will be useful in investigating factors important in market uptake and in making financial and regulatory decisions.

Multiple System Atrophy (MSA) Development Activities
The report provides insights into different therapeutic candidates in phase II, and phase III stage. It also analyzes key players involved in developing targeted therapeutics.

Pipeline Development Activities
The report covers the detailed information of collaborations, acquisition, and merger, licensing, and patent details for MSA emerging therapies.
Reimbursement Scenario in Multiple System Atrophy (MSA)
Approaching reimbursement proactively can have a positive impact both during the late stages of product development and well after product launch. In the report, we consider reimbursement to identify economically attractive indications and market opportunities. When working with finite resources, the ability to select the markets with the fewest reimbursement barriers can be a critical business and price strategy.

Competitive Intelligence Analysis
We perform competitive and market Intelligence analysis of the MSA market by using various competitive intelligence tools that include–SWOT analysis, PESTLE analysis, Porter’s five forces, BCG Matrix, Market entry strategies, etc. The inclusion of the analysis entirely depends upon the data availability.

Scope of the Report
• The report covers the descriptive overview of MSA, explaining its signs and symptoms, pathophysiology, and currently available therapies.
• Comprehensive insight has been provided into the MSA epidemiology and treatment.
• Additionally, an all-inclusive account of both the current and emerging therapies for MSA is provided, along with the assessment of new therapies, which will have an impact on the current treatment landscape.
• A detailed review of the MSA market; historical and forecasted is included in the report, covering the 7MM drug outreach.
• The report provides an edge while developing business strategies, by understanding trends shaping and driving the 7MM MSA market.

Report Highlights
• The increasing prevalence of the disease along with promising emerging pipeline therapies will positively drive the MSA market.
• The companies and academics are working to assess challenges and seek opportunities that could influence MSA R&D.
• Major players are involved in developing therapies for MSA. The launch of emerging therapies will significantly impact the MSA market.
• Our in-depth analysis of the pipeline assets across different stages of development (phase III and phase II), different emerging trends and comparative analysis of pipeline products with detailed clinical profiles, key cross-competition, launch date along with product development activities will support the clients in the decision-making process regarding their therapeutic portfolio by identifying the overall scenario of the research and development activities.

Multiple System Atrophy (MSA) Report Insights
• Patient Population
• Therapeutic Approaches
• MSA Pipeline Analysis
• MSA Market Size and Trends
• Market Opportunities
• Impact of Upcoming Therapies
Multiple System Atrophy (MSA) Report Key Strengths
• Eleven Years Forecast
• 7MM Coverage
• MSA Epidemiology Segmentation
• Key Cross Competition
• Highly Analyzed Market
• Drugs Uptake
Multiple System Atrophy (MSA) Report Assessment
• Current Treatment Practices
• Unmet Needs
• Pipeline Product Profiles
• Market Attractiveness
• Market Drivers and Barriers
• SWOT Analysis
• Market Access and Reimbursement

Key Questions
Market Insights:
• What was the MSA market share (%) distribution in 2017 and how it would look like in 2030?
• What would be the MSA total market size as well as market size by therapies across the 7MM during the forecast period (2020–2030)?
• What are the key findings pertaining to the market across the 7MM and which country will have the largest MSA market size during the forecast period (2020–2030)?
• At what CAGR, the MSA market is expected to grow at the 7MM level during the forecast period (2020–2030)?
• What would be the MSA market outlook across the 7MM during the forecast period (2020–2030)?
• What would be the MSA market growth till 2030 and what will be the resultant market size in the year 2030?
• How would the market drivers, barriers, and future opportunities affect the market dynamics and subsequent analysis of the associated trends?

Epidemiology Insights:
• What are the disease risk, burdens, and unmet needs of MSA?
• What is the historical MSA patient pool in the United States, EU5 (Germany, France, Italy, Spain, and the UK), and Japan?
• What would be the forecasted patient pool of MSA at the 7MM level?
• What will be the growth opportunities across the 7MM with respect to the patient population pertaining to MSA?
• Out of the above-mentioned countries, which country would have the highest prevalent population of MSA during the forecast period (2020–2030)?
• At what CAGR the population is expected to grow across the 7MM during the forecast period (2020–2030)?
Current Treatment Scenario, Marketed Drugs, and Emerging Therapies:
• What are the current options for the treatment of MSA along with the approved therapy?
• What are the MSA emerging drugs and their MOA, product development activities, advantages, disadvantages, safety, and efficacy, etc.?
• How many companies are developing therapies for the treatment of MSA?
• How many emerging therapies are in the mid-stage and late stages of development for the treatment of MSA?
• What are the key collaborations (Industry–Industry, Industry-Academia), Mergers and acquisitions, licensing activities related to the MSA therapies?
• What are the recent novel therapies, targets, mechanisms of action, and technologies developed to overcome the limitation of existing therapies?
• What are the clinical studies going on for MSA and their status?
• What are the key designations that have been granted for the emerging therapies for MSA?
• What are the 7MM historical and forecasted market of MSA?

Reasons to buy
• The report will help in developing business strategies by understanding trends shaping and driving the MSA.
• To understand the future market competition in the MSA market and Insightful review of the key market drivers and barriers.
• Organize sales and marketing efforts by identifying the best opportunities for MSA in the US, Europe (Germany, Spain, Italy, France, and the United Kingdom), and Japan.
• Identification of strong upcoming players in the market will help in devising strategies that will help in getting ahead of competitors.
• Organize sales and marketing efforts by identifying the best opportunities for the MSA market.
• To understand the future market competition in the MSA market.