Pipeline and Commercial Insight: Neuropathic Pain

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Publication Date: 2008-06-16

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Introduction
The neuropathic pain market is forecast to almost triple to over $6.3 billion by the end of the forecast period in 2017. The growth in the market is spurred on by the uptake of Pfizer's Lyrica (pregabalin), forecast to reach almost $3 billion in sales by 2017. Vimpat is the most promising pipeline drug, forecast to take some $480m by 2017.

Scope of this report

Report Highlights

UCB's Vimpat (lacosamide) demonstrates the most potential in the pipeline and is well suited to compete in this market. Datamonitor has forecast Vimpat to generate over $480m, over a third of the total pipeline sales by 2017.

Neuropathic pain offers diverse market opportunities, with niche underserved neuropathic pain indications (e.g. HIV associated neuropathic pain) offering a good market entry point.

Following the recent negative FDA advice on Cephalon's Fentora, Datamonitor has forecast that the drug will not launch for neuropathic pain. This is a blow to the development of a niche breakthrough neuropathic pain market.

Reasons to Purchase

  • Benchmark key late-stage pipeline neuropathic pain drugs against current market leading brands.
  • Assess country-specific (US, Japan, France, Germany, Italy, Spain and the UK) sales forecasts of key late-stage pipeline drugs and marketed brands.
  • Understand unmet needs and opportunities in the neuropathic pain market based on key opinion leader comments.

Table of Contents

ABOUT DATAMONITOR HEALTHCARE

2

About the Central Nervous System pharmaceutical analysis team

2

CHAPTER 1 EXECUTIVE SUMMARY

3

Scope of the analysis

3

Datamonitor insight into the Neuropathic pain market

4

Key metrics

6

Datamonitor pipeline assessment summary

10

Related reports

10

CHAPTER 2 NEUROPATHIC PAIN - MARKET OVERVIEW AND POTENTIAL

12

Definition of neuropathic pain

13

Segmentation of neuropathic pain

14

Segmentation of neuropathic pain differs depending on the geographic market

14

General neuropathic pain provides a broader customer base in the EU

15

US approval requires evidence in each neuropathic pain subtype

15

Major neuropathic pain subtypes

16

Diabetic neuropathic pain

16

Post-herpetic neuralgia

16

HIV neuropathic pain

17

Neuropathic low-back pain

17

Other subtypes

18

Epidemiology

18

Diabetic neuropathic pain

20

Post-herpetic neuralgia

21

HIV neuropathic pain

22

Post-operative pain

22

Current market overview

23

Five treatments are currently marketed for neuropathic pain

23

Off-label prescribing

24

US dominated market

27

Unmet need in neuropathic pain

28

Clinical unmet need

28

1. Improved efficacy

29

2. Improved side-effect profile

30

3. Reduced time to onset of action

30

4. Fewer drug-drug interactions

31

5. Pill burden

31

Clinical trial design in neuropathic pain

32

Choice of endpoint is the key clinical trial design factor in neuropathic pain

32

Head-to-head trials of increasing importance

32

Lyrica is the ideal choice of comparator drug for head-to-head clinical trials

32

Length of trial should indicate titration period for physician ease of use

32

The Initiative on Methods, Measurements and Pain Assessments in Clinical trials (IMMPACT)

33

European Federation of Neurological Societies assessment

35

Clinical trial endpoints in neuropathic pain

35

50% reduction in pain is a primary measure of efficacy

35

Multiple pain and quality of life assessment questionnaires should be used in trials

35

Clinical trial drop-out as an endpoint

40

CHAPTER 3 BRAND DYNAMICS AND LEADING COMPARATOR THERAPIES

41

Marketed brands overview

42

Lyrica (pregabalin)

42

Drug overview

42

Forecasts to 2017

43

SWOT

44

Datamonitor drug assessment summary

45

Clinical trial data

45

Lyrica clinical trial 1

46

Lyrica clinical trial 2

46

Lyrica clinical trial 3

47

Neurontin (gabapentin)

48

Drug overview

48

Forecasts to 2017

49

SWOT

50

Clinical trial data

50

Lidoderm (lidocaine)

51

Drug overview

51

Forecasts to 2017

52

Clinical trial data

53

Lidoderm clinical trial 1

53

Lidoderm clinical trial 2

54

Cymbalta (duloxetine)

55

Drug overview

55

Forecasts to 2017

56

SWOT

57

Clinical trial data

57

Tegretol (carbamazepine)

58

Drug overview

58

SWOT

59

CHAPTER 4 FORECAST ANALYSIS

60

Key events

61

New product launches

62

Product launches in Japan

62

Patent expiries

63

Cymbalta

63

Lidoderm

63

Data definitions, limitations and assumptions

65

Standard units

65

Japanese market data

65

Derivation of sales forecasts and pricing trends

65

Forecast methodology

65

CHAPTER 5 STRATEGIES FOR SUCCESS

66

Key R&D company strategies

67

Reformulation strategies: Gabapentin

67

Gabapentin GR

67

XP13512

68

Patient subgroups

68

CHAPTER 6 PIPELINE OVERVIEW AND DYNAMICS

72

Pipeline overview

73

Classification of pipeline products

74

Glutamate receptor modulators

74

NMDA

74

AMPA

75

Kainate

75

Ion channel modulators

76

Sodium channels

76

Calcium channels

76

GABA modulators

76

Others

77

SNRIs

77

Dopamine modulators

78

Cannabinoid agonists

78

Vanilloid receptor agonists

78

Substance P release modulators

79

ACh receptor agonists

79

NGF modulators

79

TNF alpha antagonists

79

Adrenoceptor modulation

79

Adenosine A2 agonists

80

Free radicals

80

Phase II and above

80

Key companies involved in the neuropathic pain pipeline

84

Pfizer

84

Neurontin

85

Lyrica

86

Eli Lilly

89

Cymbalta

89

UCB

90

Vimpat

91

Brivaracetam

91

Discontinued and suspended projects

92

Projects recently suspended or discontinued

92

ACV-1

92

Pristiq

92

Radafaxine (353162)

94

Lamictal XR

95

Namenda (memantine)

97

Traxoprodil

97

AZD-4282

98

CHAPTER 7 LATE-STAGE DRUG ANALYSIS & FORECASTS

99

Glutamate receptor modulators

100

Pipeline summary

100

Comparative forecasts

102

Definition of current comparator therapy

102

Pfizer's Lyrica is Datamonitor's comparator therapy

102

Lidoderm is the topical comparator therapy

106

Zenvia (dextromethorphan & quinidine sulfate)

107

Drug overview

107

Forecasts to 2017

108

Datamonitor drug assessment summary

109

Patient potential

110

Marketing factors

111

Satisfaction of unmet needs

112

Clinical trial data

113

NP-1 (ketamine & amitriptyline)

114

Drug overview

114

Forecasts to 2017

114

Datamonitor drug assessment summary

116

Patient potential

117

Marketing factors

118

Satisfaction of unmet needs

119

Clinical trial data

119

Other glutamate receptor modulators

121

CNS-5161

121

V3381

124

RGH-896

128

EVT 101

128

NS-1209

129

NGX-426

129

Ion channel modulators

130

Pipeline summary

130

Comparative forecasts

132

Definition of current comparator therapy

132

Vimpat (lacosamide)

133

Drug overview

133

Forecasts to 2017

133

Datamonitor drug assessment summary

134

Patient potential

135

Marketing factors

136

Satisfaction of unmet needs

137

Clinical trial data

138

Ralfinamide

141

Drug overview

141

Forecasts to 2017

142

Datamonitor drug assessment summary

143

Patient potential

144

Marketing factors

145

Satisfaction of unmet needs

145

Clinical trial data

146

Other ion channel modulators

149

Retigabine

149

Bupivacaine (Eladur)

150

Lidocaine patch KN-48

151

Brivaracetam

151

GABA receptor modulators

152

Pipeline summary

152

Comparative forecasts

154

Definition of current comparator therapy

154

XP13512

154

Drug overview

154

Forecasts to 2017

155

Datamonitor drug assessment summary

157

Marketing factors - improved duration of action

158

Patient potential

159

Satisfaction of unmet needs

159

Clinical trial data

159

Gabapentin GR

161

Drug overview

161

Forecasts to 2017

161

Datamonitor drug assessment summary

162

Clinical trial data

163

Other therapies

167

Pipeline summary

167

Comparative forecasts

169

Transacin (NGX-4010)

170

Drug overview

170

Forecasts to 2017

170

Datamonitor drug assessment summary

172

Patient potential

173

Marketing factors

173

Satisfaction of unmet needs

174

Clinical trial data

175

Other drugs

178

Sativex (GW-1000)

178

Fentora (fentanyl buccal transmucosal)

184

BVT.115959

184

Bicifadine

186

NSD-644

187

Reboxetine (+)-(S,S)

187

F13640

187

AS-3201

188

KD7040

188

Ibudilast (AV411)

188

IP 751/CT-3 (ajulemic acid)

189

ADL5859

190

KDS-2000

190

AGN 203818

190

681323

190

Liposomal galantamine

191

TAK-583

191

Botulinum toxin type A-hemagglutinin complex (Dysport)

191

Zucapsaicin

191

2PX

191

CHAPTER 8 INNOVATIVE EARLY-STAGE PROJECTS

192

Key Phase I and preclinical compounds in neuropathic pain

193

Selective sodium channel blockers

196

Vanilloid TRPV1 antagonists

197

Preclinical trial data

197

NGX-1998

198

GRC-6211

198

SAR-115740

198

N-type calcium channel blockers

198

Spinal cord and peripheral nerve stimulation

199

BIBLIOGRAPHY

200

Journals

200

Websites

206

Datamonitor reports

216

APPENDIX A

218

Methodology

218

Datamonitor forecast methodology

218

ICD-10 codes

218

Product forecasts

219

Definition of a standard unit

220

Datamonitor drug assessment summary

221

Contributing experts

222

Biographies

222

APPENDIX B

224

About Datamonitor

224

About Datamonitor Healthcare

224

Datamonitor Healthcare's therapy area capabilities

225

About the Disease analysis team

226

Disclaimer

227

List of Tables

 

Table 1: Neuropathic pain market size across the seven major markets ($m), 2007 and 2017

6

Table 2: Sales forecasts ($m) of key pipeline products in neuropathic pain, 2007-2017

8

Table 3: Abbreviations for neuropathic pain subtypes

14

Table 4: Diabetic neuropathic pain patient populations across the seven major markets, 2008

20

Table 5: Post-herpetic neuralgia patient population across the seven major markets, 2008

21

Table 6: HIV neuropathic pain patient population across the seven major markets, 2008

22

Figure 7: Key unmet needs in neuropathic pain, 2008

29

Table 7: Recommended core outcomes measures for clinical trials of chronic pain treatment efficacy

34

Table 8: Forecast launch dates for neuropathic pain drugs in the US and 5EU, 2008-2012

62

Table 9: Forecast launch dates for neuropathic pain drugs in Japan, 2010-2012

62

Table 10: Pivotal patent expiries for key marketed neuropathic pain drugs in the US and 5EU, 2012-16

63

Table 11: Neuropathic pain market sub-type definition by ICD-10 codes

71

Table 12: Number of key neuropathic pain drugs by class and phase of development, 2008

74

Table 13: Phase II & III R&D pipeline for neuropathic pain, 2008

80

Table 14: Key glutamate receptor modulators in the late-stage R&D pipeline for neuropathic pain, 2008

100

Table 15: Lyrica: key facts

105

Table 16: Estimated key events, approvals and launch dates impacting Zenvia's revenue forecast, 2008-2017

109

Table 17: Estimated key events, approvals and launch dates impacting NP-1's revenue forecast, 2008-2017

116

Table 18: Key ion channel modulators in the late-stage R&D pipeline for neuropathic pain, 2008

130

Table 19: Estimated key events, approvals and launch dates impacting Vimpat's revenue forecast, 2008-2017

134

Table 20: Estimated key events, approvals and launch dates impacting ralfinamide's revenue forecast, 2008-2017

143

Table 21: Key GABA modulators in the late-stage R&D pipeline for neuropathic pain, 2008

152

Table 22: Estimated key events, approvals and launch dates impacting XP13512's revenue forecast, 2008-2017

157

Table 23: Other drugs in late-stage R&D pipeline for neuropathic pain, 2008

167

Table 24: Estimated key events, approvals and launch dates impacting Transacin's revenue forecast, 2008-2017

172

Table 25: Key drugs in Phase I development for neuropathic pain, 2008

193

Table 26: Key drugs in preclinical development for neuropathic pain, 2008

194

Table 27: Neuropathic pain market definition by ICD-10 codes

218

Table 28: Datamonitor drug assessment parameters

221

List of Figures

 

Figure 1: Forecast of the neuropathic pain market value across the seven major markets, 2007-2017

7

Figure 2: Key neuropathic pain pipeline drug historical sales and forecasts, 2004-2017

9

Figure 3: Datamonitor drug assessment summary of pipeline therapies in development for neuropathic pain, 2008

10

Figure 4: Sales of molecules for neuropathic pain ($m), 2007

23

Figure 5: Total neuropathic pain sales across the seven major markets by region, 2004-07

27

Figure 6: Total neuropathic pain sales in the six major markets($m), 2007

28

Figure 8: Historical and forecast neuropathic pain-specific sales revenue for key brand and pipeline drugs across the seven major markets, 2004-2017

42

Figure 9: Sales forecast for Lyrica in neuropathic pain across the seven major markets to 2017

43

Figure 10: Lyrica SWOT analysis

44

Figure 11: Datamonitor's competitive positioning analysis of Lyrica, 2008

45

Figure 12: Historical and forecast sales for Neurontin in neuropathic pain across the seven major markets, 2004-2017

49

Figure 13: Neurontin SWOT analysis

50

Figure 14: Historical and forecast sales for Lidoderm in neuropathic pain across the seven major markets, 2004-2017

52

Figure 15: Lidoderm SWOT analysis

53

Figure 16: Sales forecast for Cymbalta

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