Pipeline Insight: Antithrombotics - Reaching the untreated prophylaxis market
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- About the Disease pharmaceutical analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 4
- Scope of the analysis - page 4
- Datamonitor insight into the antithrombotics market - page 5
- Key metrics - page 6
- Datamonitor pipeline assessment summary - page 7
- Anticoagulants - page 7
- Antiplatelet Agents - page 8
- CHAPTER 2 PIPELINE OVERVIEW AND DYNAMICS - page 23
- Pipeline overview - page 23
- Antithrombotics segmented by mechanism of action - page 29
- Redesigning heparin: the race for ideal coagulation cascade target is still open - page 30
- Antiplatelet agents by drug class - page 31
- Antithrombotics segmented by developing company - page 34
- Japanese companies in the antithrombotics market - page 36
- Key companies involved in the antithrombotics pipeline - page 37
- Overview - page 37
- AstraZeneca - page 38
- Sanofi-Aventis - page 38
- CHAPTER 3 PATIENT POTENTIAL - page 39
- Definition of antithrombotic market - page 39
- Antithrombotic launch indications - page 43
- Venous thrombosis - page 43
- VTE prophylaxis in patients undergoing major orthopedic surgery - page 43
- Treatment and secondary prevention of acute venous thromboembolism - page 45
- Arterial thrombosis - page 49
- Coronary thrombosis - page 49
- Acute coronary syndromes - page 49
- Incidence of STEMI - page 50
- Incidence of UA and NSTEMI - page 50
- Cerebrovascular thrombosis - page 53
- Stroke treatment - page 53
- Stroke prevention in atrial fibrillation patients (SPAF) - page 55
- Peripheral thrombosis - page 58
- Peripheral arterial disease (PAD) - page 58
- Venous thrombosis - page 43
- Marketing considerations: unmet needs, barriers to market entry and uptake - page 63
- Anticoagulants - page 63
- Unmet needs: parenteral anticoagulants - page 63
- Unmet needs: oral anticoagulants - page 64
- Unmet need: increased physician awareness of VTE - page 67
- Points of consideration: factors influencing market entry and uptake - page 67
- Unmet needs summary - page 72
- Antiplatelets - page 73
- Unmet needs - page 73
- Unmet need for rapid onset of action in interventional cardiology - page 77
- Unmet need: increased physician awareness for the need of therapy for PAD - page 78
- Points of consideration: factors influencing market entry and uptake - page 79
- Unmet needs summary - page 82
- Anticoagulants - page 63
- CHAPTER 4 R&D APPROACH - page 84
- Classification of pipeline products - page 84
- Anticoagulants - page 84
- Hemostasis and the coagulation cascade - page 84
- Indirect thrombin inhibitors - page 87
- Unfractionated heparin (UFH) - page 87
- Low molecular weight heparin (LMWH) - page 88
- Direct thrombin inhibitors (DTIs) - page 89
- Factor IXa inhibitors - page 91
- Factor Xa inhibitors - page 92
- Factor VIIa inhibitors/tissue factor pathway inhibitors - page 99
- Anticoagulant activity - page 100
- Antiplatelet Agents - page 102
- Cyclo-oxygenase (COX) inhibitors: aspirin - page 103
- ADP antagonists - page 106
- GPIIb/IIIa inhibitors - page 111
- PGE-1 antagonists - page 113
- PI3-kinase antagonists - page 114
- PGH2/TXA2 (TP) receptor antagonists - page 114
- Anticoagulants - page 84
- Clinical trial design for antithrombotics - page 133
- Phase III sample size - page 134
- Choice of control drug - page 134
- Patient exclusion - page 135
- Patient exclusion from efficacy analysis - page 136
- Duration of drug intervention - page 136
- Pre-operative or post-operative initiation of prophylaxis? - page 137
- Dosing interval - page 138
- Dose timing - page 138
- Clinical trial endpoints for antithrombotics - page 139
- Efficacy endpoints - page 139
- VTE incidence - page 140
- Diagnosis of VTE events - page 141
- Central versus local adjudication - page 141
- Safety endpoints - page 142
- Efficacy endpoints - page 139
- Classification of pipeline products - page 84
- CHAPTER 5 ANTICOAGULANTS LATE-STAGE DRUG ANALYSIS AND FORECASTS - page 144
- Overview of the key anticoagulants in late-stage development - page 144
- Pipeline summary - page 144
- Datamonitor drug assessment summary - page 146
- Comparative forecasts - page 148
- Rivaroxaban (BAY-59-7939) - page 149
- Drug overview - page 149
- Clinical data - page 149
- Patient potential - page 150
- Marketing factors - page 151
- Forecasts to 2016 - page 152
- Dabigatran etexilate (BIBR-1048) - Rendix - page 153
- Drug overview - page 153
- Clinical data - page 154
- Pharmacokinetics of dabigatran etexilate - page 155
- Phase II clinical trial of Dabigatran etexilate in MOS versus enoxaparin: BISTRO II - page 155
- Patient potential - page 156
- SPAF - greatest potential for dabigatran etexilate - page 156
- Potential device competitor for SPAF indication for high-risk patients? - page 157
- Marketing factors - page 159
- Forecast to 2016 - page 160
- Idraparinux - page 161
- Drug overview - page 161
- Clinical data - page 163
- PERSIST trial - page 163
- No significant effect on liver enzymes - page 164
- Phase III VAN GOGH trial in PE patients - page 165
- Phase III AMADEUS trial - page 166
- Patient potential - page 167
- Marketing factors - page 168
- Strong presence and experience in the AF market - page 168
- High price may pose a barrier to uptake - page 169
- Lack of antidote raises concerns - page 169
- Forecast to 2016 - page 173
- ART-123 - page 174
- Drug overview - page 174
- Clinical data - page 174
- Phase III trials - page 174
- Phase I trials - page 175
- Prevention of VTE after total hip replacement - page 176
- Patient potential - page 177
- Marketing factors - page 178
- Forecast to 2016 - page 179
- Overview of the key anticoagulants in late-stage development - page 144
- CHAPTER 6 OTHER ANTICOAGULANTS - page 181
- Antithrombin aptamers - NU-172 and ARC1779 - page 181
- Drug overview - page 181
- Preclinical data - page 181
- Clinical data - page 181
- Apixaban (BMS-562247) - page 182
- Drug overview - page 182
- Clinical data - page 182
- AVE-5026 - page 183
- Drug overview - page 183
- Clinical data - page 183
- AZD-0837 - page 183
- Drug overview - page 183
- Clinical data - page 183
- AZD-9684 - page 184
- Drug overview - page 184
- Preclinical data - page 184
- Biotinylated Idraparinux (SSR-126517) - page 184
- Drug overview - page 184
- Clinical data - page 185
- DU-176b - page 185
- Drug overview - page 185
- Clinical data - page 185
- E-5555 - page 186
- Drug overview - page 186
- Preclinical data - page 186
- Clinical data - page 186
- Elaprin (Oral heparin) and Oral LMWH - page 186
- Drug overview - page 186
- Clinical data - page 187
- Datamonitor comment - page 187
- Flovagatran (TGN-255) - page 188
- Drug overview - page 188
- Clinical data - page 188
- Datamonitor comments - page 189
- GSK-813893 - page 190
- Drug overview - page 190
- LY-517717 - page 190
- Drug overview - page 190
- Clinical data - page 190
- Odiparcil (SB-424323) - page 191
- Drug overview - page 191
- Clinical data - page 191
- Otamixaban (XRP-0673) - page 192
- Drug overview - page 192
- Clinical data - page 192
- PD-348292 - page 193
- Drug overview - page 193
- Pegmusirudin (SPP-200; LU-57291) - page 193
- Drug overview - page 193
- Clinical data - page 193
- PRT-54021 - page 194
- Drug overview - page 194
- Clinical data - page 194
- REG-1 - page 195
- Drug overview - page 195
- Clinical data - page 195
- SCH-530348 - page 195
- Drug overview - page 195
- Preclinical data - page 196
- Clinical data - page 196
- Sofigatran (MCC-977) - page 196
- Drug overview - page 196
- SR-123781 - page 197
- Drug overview - page 197
- Preclinical data - page 197
- Clinical data - page 197
- Tanogitran (BIBT-986) - page 198
- Drug overview - page 198
- Clinical data - page 198
- TGN-167 - page 198
- Drug overview - page 198
- Clinical data - page 199
- TTP-889 - page 199
- Drug overview - page 199
- Clinical data - page 199
- Datamonitor comment - page 200
- YM-150 - page 200
- Drug overview - page 200
- Clinical data - page 200
- Antithrombin aptamers - NU-172 and ARC1779 - page 181
- CHAPTER 7 ANTIPLATELET AGENTS: LATE-STAGE ANALYSIS AND FORECASTS - page 202
- Overview of the key antiplatelets in late-stage development - page 202
- Pipeline summary - page 202
- Datamonitor drug assessment summary - page 203
- Comparative forecasts - page 204
- Prasugrel (CS-747) - page 205
- Drug overview - page 205
- Clinical data - page 206
- Phase IIa: Randomized two-way cross-over, open-label study in healthy subjects - page 206
- Phase IIa : Randomized, partially blind, parallel group dose-ranging study - page 207
- Patient potential - page 213
- Marketing factors - page 214
- Forecast to 2016 - page 216
- Cangrelor (AR-C69931) - page 217
- Drug overview - page 217
- Clinical Data - page 217
- Patient potential - page 218
- Marketing factors - page 219
- Forecast to 2016 - page 220
- Ticagrelor (AZD-6140) - page 221
- Drug overview - page 221
- Clinical data - page 221
- Patient Potential - page 223
- Marketing Factors - page 224
- Forecast to 2016 - page 224
- Overview of the key antiplatelets in late-stage development - page 202
- CHAPTER 8 OTHER ANTIPLATELET AGENTS - page 227
- DA-697b - page 227
- Drug overview - page 227
- Preclinical data - page 227
- DG-041 - page 227
- Drug overview - page 227
- Preclinical data - page 227
- Clinical data - page 228
- Ecraprost - page 228
- Drug overview - page 228
- Clinical data - page 228
- Datamonitor comment - page 229
- Liprostin - page 229
- Drug overview - page 229
- Clinical data - page 230
- Parogrelil (NM-702) - page 230
- Drug overview - page 230
- Clinical data - page 230
- PR-15 - page 231
- Drug overview - page 231
- Preclinical data - page 232
- Clinical data - page 232
- Datamonitor comment - page 232
- S-18886 - page 232
- Drug overview - page 232
- Clinical data - page 233
- SL-650472 - page 234
- Drug overview - page 234
- Preclinical data - page 234
- Clinical data - page 235
- DA-697b - page 227
- BIBLIOGRAPHY - page 236
- Epidemiology - page 236
- National hospital discharge data - page 238
- Epidemiology - page 236
- APPENDIX A - page 251
- Methodology - page 251
- Datamonitor forecast methodology - page 251
- Product forecasts - page 251
- Estimated 2006 sales revenue - page 251
- Definition of a standard unit (only use if ForeSight model used to forecast) - page 251
- Datamonitor drug assessment summary - page 252
- Datamonitor forecast methodology - page 251
- Contributing experts - page 253
- Methodology - page 251
- APPENDIX B - page 254
- About Datamonitor - page 254
- About Datamonitor Healthcare - page 254
- Datamonitor Healthcare's therapy area capabilities - page 255
- About the Disease analysis team - page 256
- Key therapy team members - page 257
- Disclaimer - page 257
- About Datamonitor - page 254
- List of Tables
- Table 1: Forecast key pipeline products in Antithrombotics in 2016 ($m) - page 6
- Table 2: Anticoagulant agents in the R&D pipeline, 2007 - page 24
- Table 3: Antiplatelet agents in the R&D pipeline, 2007. - page 27
- Table 4: Key players in antithrombotic drug development, 2007 - page 37
- Table 5: Incidence of arthroplastic knee surgery in the seven major markets (000s), 2007-2017 - page 44
- Table 6: Incidence of arthroplastic hip surgery in the seven major markets (000s), 2007-2017) - page 44
- Table 7: Incidence of deep vein thrombosis, pulmonary embolism and venous thromboembolism in the seven major markets(000s), 2007-2017 - page 48
- Table 8: Incidence of ST-segment elevation myocardial infarction (000s), 2007-2017 - page 51
- Table 9: Incidence of unstable angina and non-ST segment elevation myocardial infarction in the seven major markets (000s), 2007-2017 - page 52
- Table 10: Incidence of percutaneous coronary intervention in the seven major markets (000s), 2007-2017 - page 53
- Table 11: Incidence of stroke in the seven major markets (000s), 2007-2017 - page 55
- Table 12: Proportion of atrial fibrillation patients at risk of developing stroke - page 56
- Table 13: Prevalence of chronic atrial fibrillation in the seven major markets (000s), 2007-2017 - page 58
- Table 14: Prevalence of peripheral arterial disease in the seven major markets (000s), 2007-2017 - page 62
- Table 15: Resistance to key oral antiplatelets - page 74
- Table 16: Advantages of direct thrombin inhibitors over heparin - page 89
- Table 17: OASIS-5/Michelangelo trial: efficacy - page 98
- Table 18: OASIS-5/Michelangelo trial: safety - page 98
- Table 19: Key results of CURE substudy - page 116
- Table 20: CLARITY/TIMI-28: efficacy outcomes on angiography - page 120
- Table 21: CLARITY/TIMI-28: safety outcomes - page 121
- Table 22: COMMIT/CCS-2 trial: efficacy endpoints - page 123
- Table 23: COMMIT/CCS-2 trial: safety endpoints - page 124
- Table 24: COMMIT/CCS-2 trial: time to treatment - page 124
- Table 25: COMMIT/CCS-2 trial: thrombolytic background therapy - page 124
- Table 26: ARMYDA-2: number of events at 30 days - page 126
- Table 27: ARMYDA-2: postprocedural peak biomarker levels - page 127
- Table 28: ARMYDA-2: percentage of patients with an elevation of CKMB/troponin I - page 127
- Table 29: ARMYDA-2: number of bleeding events at 30 days - page 127
- Table 30: Key efficacy endpoints used in anticoagulant clinical trials - page 140
- Table 31: Key safety endpoints used in anticoagulant clinical trials - page 142
- Table 32: Key anticoagulants in late-stage development, 2007 - page 144
- Table 33: Sales forecasts for late-stage anticoagulants in the seven major markets ($m), 2007-2016 - page 148
- Table 34: Proportion of AF patients receiving antithrombotic therapy by level of risk of experiencing stroke - page 157
- Table 35: Comparison of fondaparinux with idraparinux - page 162
- Table 36: PERSIST trial results - page 164
- Table 37: Result of dose-response trial examining ART-123 - page 177
- Table 38: Key pipeline antiplatelets, 2007 - page 202
- Table 39: Comparative Sales Forecast for late-stage antiplatelet agents - page 205
- Table 40: JUMBO-TIMI 26: number of adverse events - page 208
- Table 41: JUMBO-TIMI 26: patient characteristics - page 209
- Table 42: JUMBO-TIMI 26: primary endpoint (significant bleeding) - page 210
- Table 43: JUMBO-TIMI 26: TIMI major bleeding - page 210
- Table 44: JUMBO-TIMI 26: total bleeding episodes (TIMI major/minor and minimal) - page 211
- Table 45: JUMBO-TIMI 26: secondary endpoint (MACE) - page 211
- Table 46: JUMBO-TIMI 26: MACE components - page 212
- Table 47: Datamonitor drug assessment parameters - page 252
- List of Figures
- Figure 1: Datamonitor drug assessment summary of pipeline anticoagulants, , 2007-2016 - page 7
- Figure 2: Datamonitor drug assessment summary of pipeline antiplatelets, 2007-2016 - page 8
- Figure 3: The antithrombotics pipeline by development stage, 2007 - page 29
- Figure 4: Antithrombotics development pipeline segmented by mechanism of action, 2007 - page 30
- Figure 5: Pipeline antithrombotics segmented by developing company, 2007 - page 34
- Figure 6: Key players in the antithrombotics pipeline with products segmented by phase of development, 2007 - page 35
- Figure 7: Overlap of ischemic cardiovascular conditions - page 41
- Figure 8: Frequency of disease with symptoms in the three organ systems and their overlap, from the CAPRIE trial - page 42
- Figure 9: Risk of stroke increases with age - page 57
- Figure 10: Breakdown of the peripheral arterial disease population by classification - page 60
- Figure 11: The targets of developmental anticoagulants and selected thrombolytics - page 86
- Figure 12: Aspirin inhibits platelet COX-1 irreversibly - page 105
- Figure 13: The role of purinergic receptors as targets for antiplatelets - page 107
- Figure 14: GPIIb/IIIa receptor antagonists act directly on the receptor - page 111
- Figure 15: CLARITY/TIMI-28: study design - page 119
- Figure 16: COMMIT/CCS-2 trial: dual antiplatelet therapy in acute myocardial infarction - page 123
- Figure 17: ARMYDA-2: trial design - page 126
- Figure 18: Datamonitor drug assessment summary of pipeline anticoagulants, 2007-2016 - page 147
- Figure 19: Comparative sales forecast for late-stage anticoagulants in the seven major markets, 2007-2016 - page 148
- Figure 20: Datamonitor's projected sales for rivaroxaban (BAY-59-7939) in across the seven major markets ($m), 2007-2016 - page 152
- Figure 21: Datamonitor's projected sales for Rendix (dabigatran etexilate, BIBR-1048) in across the seven major markets ($m), 2007-2016. - page 160
- Figure 22: PERSIST trial design - page 163
- Figure 23: Idraparinux Phase III program: VAN GOGH - page 166
- Figure 24: Idraparinux Phase III program: AMADEUS - page 167
- Figure 25: Is recombinant factor VIIa a valid antidote to idraparinux? - page 171
- Figure 26: Datamonitor's projected sales for idraparinux in across the seven major markets ($m), 2007-2016 - page 173
- Figure 27: Datamonitor's projected sales for ART-123 in across the seven major markets ($m), 2007-2016 - page 179
- Figure 28: Datamonitor drug assessment summary of pipeline antiplatelet agents, 2007-2016 - page 203
- Figure 29: Comparative sales forecast for late-stage antiplatelet agents - page 204
- Figure 30: JUMBO-TIMI 26: prasugrel in the setting of percutaneous coronary intervention - page 209
- Figure 31: TRITON-TIMI-38: trial design - page 212
- Figure 32: Datamonitor's projected sales for prasugrel in across the seven major markets ($m), 2007-2016 - page 216
- Figure 33: Datamonitor's projected sales for cangrelor in across the seven major markets ($m), 2007-2016 - page 220
- Figure 34: Ticagrelor (AZD-6140) is a potent inhibitor of platelet aggregation - page 223
- Figure 35: Datamonitor's projected sales for ticagrelor in across the seven major markets ($m), 2007-2016 - page 225
- Figure 36: Datamonitor drug assessment summary of pipeline molecular targeted therapies in development for hematological malignancies, 2007 - page 253
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