Osteoarthritis - The Wait for a DMOAD Continues
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- About the CNS, Arthritis and Pain pharmaceutical analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Scope of the analysis - page 3
- Datamonitor insight into the osteoarthritis market - page 4
- Summary - page 6
- Key metrics - page 7
- Datamonitor pipeline assessment summary - page 8
- CHAPTER 2 PATIENT POTENTIAL - page 23
- Definition of osteoarthritis - page 23
- Segmentation of osteoarthritis - page 23
- Primary (idiopathic) osteoarthritis - page 23
- Secondary osteoarthritis - page 24
- Epidemiology of osteoarthritis - page 24
- Country calculations - page 27
- OA affects 11% of the adult US population - page 27
- OA will be a growing problem as the elderly European population increases - page 29
- OA of the knee affects 70% of the Japanese OA population - page 32
- Country calculations - page 27
- Unmet need in OA - page 33
- Disease modification is the key unmet need in OA - page 34
- OA drugs require a reduced side effect profile - page 37
- Quality of life and patient education should be addressed for all treatments - page 38
- OA awareness and perception in society requires improvement - page 39
- Emerging imaging and biomarker research will impact both on diagnosis and trial endpoints - page 41
- CHAPTER 3 R&D APPROACH - page 43
- Classification of marketed and pipeline OA drugs - page 43
- Non-steroidal anti-inflammatory drugs (NSAID) - page 43
- Disease modifiers (DM) - page 44
- DMOADs - page 44
- Growth factors and hormones - page 44
- Cell therapy and gene therapy - page 45
- Analgesics - page 45
- Corticosteroids (CS) - page 45
- Hyaluronic acids (HA) - page 46
- Nutriceuticals - page 47
- Clinical trial design in osteoarthritis - page 50
- Comparator Drugs - page 50
- The choice of comparator drug is vital to ensure OA trial reliability - page 50
- The FDA requires the use of naproxen as the comparator drug in long-term safety studies in OA - page 51
- Comparator Drugs - page 50
- Clinical trial endpoints in OA - page 51
- Pain scale endpoints - page 52
- Western Ontario and McMaster Osteoarthritis (WOMAC) Index remains the most widely used clinical trial endpoint - page 52
- Australian/Canadian (AUSCAN) Index is used specifically in clinical trials of hand OA - page 53
- Lequesne's Algofunctional Indices - page 53
- OARSI/OMERACT Response Criteria aim to improve responder criteria in clinical trials but needs better validation - page 53
- Disease modification endpoints - page 54
- Radiography remains the most widely used endpoint in DMOAD trials but accuracy is questionable - page 54
- Magnetic Resonance Imaging is a powerful but costly tool for monitoring disease progression in articular joints - page 55
- Biomarkers are still under investigation and require further validation - page 56
- Other endpoints - page 58
- Anti-Platelet Trialists' Collaboration (APTC) is a useful endpoint to assess the CV risk of COX-2s - page 58
- Pain scale endpoints - page 52
- Classification of marketed and pipeline OA drugs - page 43
- CHAPTER 4 OSTEOARTHRITIS PIPELINE ANALYSIS - page 59
- Pipeline overview - page 59
- Pre-registration - page 59
- Phase III - page 60
- Phase II - page 61
- Key companies involved in the osteoarthritis pipeline - page 64
- Pfizer dominates the OA market with Celebrex, but will it be first to market with a DMOAD? - page 64
- Celebrex is the market leading COX-2 inhibitor and has achieved blockbuster status - page 65
- Pfizer has two DMOAD candidates in Phase II development - page 67
- Pfizer buys Rinat Neuroscience to extend neuroscience research and in doing so acquires a product candidate for OA - page 67
- NicOx expects naproxcinod to compete with COX-2 inhibitors - page 67
- NicOx has developed clear strategies for success - page 68
- Overview of strategies for success - page 70
- Pfizer dominates the OA market with Celebrex, but will it be first to market with a DMOAD? - page 64
- Pipeline overview - page 59
- CHAPTER 5 NSAID LATE-STAGE DRUG ANALYSIS & FORECASTS - page 71
- Overview for NSAIDs - page 71
- Pipeline summary - page 71
- Definition of current NSAID comparator therapy - page 71
- Lumiracoxib - page 75
- Drug overview - page 75
- Clinical trial data - page 75
- Study 1 - page 75
- Study 2 - page 77
- Study 3 - page 79
- Patient potential - page 81
- Prexige will be an attractive treatment option for OA, and has been shown to be as safe as ibuprofen and naproxen - page 81
- Marketing factors - page 81
- Novartis is in a good position to market Prexige with strong safety data and significant market experience - page 81
- Satisfaction of unmet needs - page 82
- The FDA has concluded that Prexige carries only a moderate CV risk, similar to Pfizer's Celebrex - page 83
- Forecasts to 2015 - page 83
- Etoricoxib - page 87
- Drug overview - page 87
- Clinical trial data - page 88
- Study 1 - page 88
- Study 2 - page 89
- Study 3 - page 91
- Patient potential - page 92
- Merck is enrolling unprecedented numbers of OA patients on the MEDAL trial to investigate the CV safety of Arcoxia - page 92
- Arcoxia has a limited patient potential, however, there is a possibility that a niche market for Arcoxia exists in patients who found relief from Vioxx - page 93
- Marketing factors - page 93
- It would be inadvisable for Merck to market Arcoxia in a similar fashion as seen previously with Vioxx - page 93
- Satisfaction of unmet needs - page 94
- Arcoxia carries a high cardiac risk and the EMEA recommends that Arcoxia be contra-indicated in patients with hypertension - page 94
- Forecasts to 2015 - page 95
- Naproxcinod (AZD3582) - page 98
- Drug overview - page 98
- Clinical trial data - page 99
- Study 1 - page 99
- Study 2 - page 100
- Study 3 - page 102
- Patient potential - page 103
- Naproxcinod will gain from the anxieties that surround the COX-2s - page 103
- Marketing factors - page 104
- NicOx needs to secure a marketing partner for naproxcinod - page 104
- Satisfaction of unmet needs - page 104
- Naproxcinod has an improved safety profile over other NSAIDs and COX-2s - page 104
- Naproxcinod may have a niche market in OA patients with hypertension and increased CV risk - page 105
- Forecasts to 2015 - page 106
- Licofelone - page 109
- Drug overview - page 109
- Clinical trial data - page 109
- Study 1 - page 109
- Study 2 - page 110
- Patient potential - page 112
- Licofelone has similar efficacy to NSAIDs and COX-2s but its long-term safety still needs to be assessed - page 112
- Marketing factors - page 112
- EuroAlliance need to secure a new global marketing agreement to ensure the success of licofelone - page 112
- Satisfaction of unmet needs - page 113
- Hepatic tolerability could help differentiate Licofelone from Celebrex - page 113
- Forecasts to 2015 - page 114
- IDEA-033 - page 116
- Drug overview - page 116
- Clinical trial data - page 117
- Study 1 - page 117
- Study 2 - page 118
- Patient potential - page 119
- Topical IDEA-033 could be a safe and effective alternative to oral NSAIDs and COX-2s - page 119
- Marketing factors - page 120
- Idea Therapeutics lacks experience of the OA market and requires a marketing partner - page 120
- Satisfaction of unmet needs - page 120
- IDEA-033 has a reduced potential for side effects because of low systemic concentrations of ketoprofen - page 120
- Forecasts to 2015 - page 121
- GW-406381 - page 124
- Drug overview - page 124
- Clinical trial data - page 124
- Study 1 - page 124
- Patient potential - page 127
- As measured by WOMAC subscore, GW-406381 is more effective than Celebrex at improving pain in OA - page 127
- Marketing factors - page 127
- GW-406381 has a similar effect on blood pressure as Celebrex - page 127
- Satisfaction of unmet needs - page 127
- The commercial attractiveness of GW-406381 will be significantly reduced because it will have fourth to market status - page 128
- Forecasts to 2015 - page 129
- LAS-34475 - page 131
- Drug overview - page 131
- Clinical trial data - page 131
- Study 1 - page 131
- Patient potential - page 132
- The patient potential for LAS-34475 will not be as great as the potential seen with previous COX-2 inhibitors - page 132
- Marketing factors - page 133
- LAS-34475 will benefit from Almirall's previous experience of the OA market - page 133
- Satisfaction of unmet needs - page 133
- LAS-34475 requires a long-term safety study - page 133
- Fifth to market status will damage LAS-34475's commercial attractiveness - page 134
- Forecasts to 2015 - page 134
- Other late stage NSAIDs - page 136
- Efipladib - page 136
- Phospholipase inhibitors are not specific and would be more interesting in truly inflammatory arthritis - page 136
- PN 100 - page 137
- Combination therapies, such as PN 100, ensure patient compliance - page 137
- SFPP - page 138
- Mitsubishi Pharmaceuticals pulls out of SFPP development - page 138
- Efipladib - page 136
- Late-stage development compounds recently discontinued - page 138
- Tilmacoxib - page 138
- AZD-9056 - page 139
- Overview for NSAIDs - page 71
- CHAPTER 6 DISEASE MODIFIER LATE-STAGE DRUG ANALYSIS - page 140
- Overview for disease modifiers - page 140
- Definition of current comparator therapy - page 140
- ChondroCelect - page 141
- Overview - page 141
- ChondroCelect is a cell therapy for the treatment of cartilage damage in OA - page 141
- ChondroCelect began the TiGenix Phase III clinical trial (TIGACT-01) in 2005 - page 141
- Overview - page 141
- Salmon Calcitonin - page 142
- Drug overview - page 142
- Salmon calcitonin could prevent the enhanced turnover of bone that is associated with OA progression but osteoporosis appears to be the primary indication - page 142
- Salmon calcitonin has a good safety profile and is not carcinogenic - page 143
- Clinical trial data - page 144
- Drug overview - page 142
- Doxycycline - page 145
- Drug overview - page 145
- Clinical trial data - page 146
- Other disease modifiers - page 147
- Anakinra - page 147
- Anakinra improves WOMAC pain subscore but the improvement is not statistically significant - page 147
- Adalimumab - page 148
- Pilot studies at Universities are underway for Humira in OA - page 148
- SD-6010 - page 149
- Pfizer sees iNOS as a potential therapeutic target - page 149
- CP-544439 - page 149
- Pfizer's CP-544439 specifically targets MMP-13 - page 149
- AZD-8955 - page 150
- CPA-926 - page 150
- Anakinra - page 147
- Late-stage development compounds recently discontinued - page 151
- Pralnacasan - page 151
- AMG-108 - page 151
- S-3536 - page 152
- ONO-4817 - page 152
- ICE Inhibitors - page 152
- AD-729 - page 152
- CHAPTER 7 ANALGESICS LATE-STAGE DRUG ANALYSIS & FORECASTS - page 153
- Overview for analgesics - page 153
- Pipeline summary - page 153
- Current comparator therapy: Acetaminophen - page 153
- Zucapsaicin - page 154
- Drug overview - page 154
- Clinical trial data - page 155
- Patient potential - page 155
- Zucapsaicin will be limited to OA patients who do not tolerate or whose pain is not controlled by NSAIDs or COX-2s - page 155
- Marketing factors - page 156
- Winston Laboratories does not have experience in the OA market and requires a partner for zucapsaicin - page 156
- Satisfaction of unmet needs - page 156
- The future long-term safety trial for zucapsaicin will help clarify a reduced side effect profile - page 156
- Forecasts to 2015 - page 157
- Other analgesic drugs - page 159
- AT-1022 - page 159
- AT-1022 is a hydromorphone patch that has been specifically designed to provide sustained levels of analgesia - page 159
- RN-624 - page 160
- RN-624 is a first in class biologic therapy for the treatment of the pain associated with OA - page 160
- Clinical trial data - page 161
- Bicifadine - page 161
- With sustained release bicifadine, OA patients will experience less frequent daily dosing and an increased tolerability of the drug - page 161
- Clinical trial data - page 162
- MK-0686 - page 162
- Merck has not disclosed the mode of action of MK-0686 - page 162
- Icatibant - page 162
- Icatibant is a selective bradykinin B2 receptor antagonist - page 162
- AT-1022 - page 159
- Overview for analgesics - page 153
- CHAPTER 8 CORTICOSTEROID LATE-STAGE DRUG ANALYSIS & FORECASTS - page 164
- Overview for corticosteroids - page 164
- Definition of current comparator therapy - page 164
- CRx-102 - page 165
- Drug overview - page 165
- Clinical trial data - page 166
- Study 1 - page 166
- Patient potential - page 168
- CRx-102 will have a greater patient potential than the gold standard corticosteroid prednisolone - page 168
- Marketing factors - page 168
- CombinatoRx has collaborations and agreements with pharmaceutical companies for some of its product candidates but requires a partner for CRx-102 - page 168
- Satisfaction of unmet needs - page 169
- CRx-102 is a well tolerated drug, which has a reduced side effect profile - page 169
- Forecasts to 2015 - page 171
- CHAPTER 9 INNOVATIVE EARLY-STAGE PROJECTS - page 173
- Overview for innovative early-stage projects - page 173
- Phase I - page 174
- Preclinical - page 174
- MMP inhibitors - page 176
- MMP-1 and MMP-13 are key targets for future OA therapies - page 176
- Most early-stage DMOADs are directed against MMPs but side effects are an issue - page 176
- Tumor necrosis factor and Interleukin-1 - page 177
- TNF-alpha and IL-1 antagonists offer promise but problems such as short half life remain an issue - page 177
- Cathepsin K inhibitors - page 178
- Cathepsin K inhibitors are being developed by GSK and Medivir - page 178
- Bone modulators - page 179
- Preventing the loss of bone in OA could slow or stop disease progression - page 179
- c-fms inhibitors - page 180
- GSK is looking to treat OA by inhibiting inflammatory cells - page 180
- Botox - page 181
- Intra-articular Botox injections might provide pain relief in OA but unwanted effects on surrounding muscle might become evident - page 181
- NFKappaB modulators and IKK beta inhibitors - page 181
- Therapies targeting gene transcription raise concerns over potential side effects - page 181
- Key research impacts on osteoarthritis - page 183
- Overview for innovative early-stage projects - page 173
- APPENDIX A - page 184
- Methodology - page 184
- Datamonitor forecast methodology - page 184
- ICD10 code definition of OA indication - page 184
- Product forecasts - page 185
- Definition of a standard unit - page 186
- Datamonitor forecast methodology - page 184
- Contributing experts - page 187
- Bibliography - page 187
- Websites - page 193
- Datamonitor reports - page 194
- Report methodology - page 195
- Methodology - page 184
- APPENDIX B - page 196
- About Datamonitor - page 196
- About Datamonitor Healthcare - page 196
- Datamonitor Healthcare's therapy area capabilities - page 197
- About the CNS, Arthritis and Pain analysis team - page 198
- Disclaimer - page 199
- About Datamonitor - page 196
- List of Tables
- Table 1: Estimated adult OA populations in the seven major markets, by age group, 2006 (000s) - page 25
- Table 2: OA sufferers who present with the disease in specific parts of the body (%): US, Japan and 5EU markets, 2003 - page 26
- Table 3: US OA patient population by age group and gender, 2006 (000s) - page 27
- Table 4: Breakdown of arthritis population from NHIS survey and estimated OA percentages, 2003 - page 28
- Table 5: Adult OA population in five major EU countries, by age and gender, 2006 (000s) - page 29
- Table 6: Combined sample of northern England studies, radiographic knee OA by age and gender - page 31
- Table 7: Estimated symptomatic knee OA prevalence: UK adults - page 31
- Table 8: Spanish EPISER study showing breakdown of hand and knee OA by age group, 2001 - page 32
- Table 9: Adult OA population (000s) in Japan, by age and gender, 2006 - page 33
- Table 10: GAIT study response rates by treatment group and pain level, 2005, % - page 48
- Table 11: Baseline Lequesne and WOMAC, with 6-month ITT changes and % of OARSI-A responders in the GUIDE study - page 49
- Table 12: Biomarkers in OA - page 56
- Table 13: Pipeline drugs in pre-registration development for OA, 2006 - page 59
- Table 14: Pipeline drugs in Phase III development for OA, 2006 - page 60
- Table 15: Pipeline drugs in Phase II development for OA, 2006 - page 61
- Table 16: Number of key OA therapies by class and phase of development, 2006 - page 62
- Table 17: Pipeline OA therapies by mode of delivery, 2006 - page 64
- Table 18: NicOx R&D pipeline, 2006 - page 69
- Table 19: Key NSAIDs in late-stage R&D pipeline for OA, 2006 - page 71
- Table 20: Aleve's key facts, 2006 - page 73
- Table 21: Lumiracoxib TARGET study: summarized GI safety results - page 76
- Table 22: Lumiracoxib TARGET study: summarized CV safety results, - page 78
- Table 23: Lumiracoxib vs celecoxib: WOMAC total score. - page 80
- Table 24: Lumiracoxib vs celecoxib: VAS total score. - page 80
- Table 25: Factors having an impact on Prexige's sales revenue across the seven major markets, 2006-15 - page 84
- Table 26: Cost per standard unit for COX-2s in the UK - page 86
- Table 27: Factors having an impact on Arcoxia's revenue 2006-15 - page 95
- Table 28: Difference between groups in the change in WOMAC pain subscale score (mm) from baseline to the mean of weeks 4 and 6. - page 101
- Table 29: Factors having an impact on naproxcinod's revenue from launch-2015 - page 106
- Table 30: Change from baseline in liver enzyme levels at week 12 for licofelone and celecoxib - page 111
- Table 31: Factors having an impact on licofelone's revenue from launch-2015 - page 115
- Table 32: Factors impacting IDEA-033's revenue from launch-2015 - page 122
- Table 33: GW-406381 vs celecoxib: Effect on systolic blood pressure - page 126
- Table 34: Factors having an impact on GW-406381's revenue from launch-2015 - page 129
- Table 35: LAS-34475: OARSI criteria results, EULAR 2003 - page 132
- Table 36: Factors having an impact on LAS-34475's revenue from launch-2015 - page 135
- Table 37: Discontinued R&D projects in NSAIDs, 2003-06 - page 138
- Table 38: Key disease modifiers in late-stage R&D pipeline for OA, 2006 - page 140
- Table 39: Results of a Phase II efficacy trial for oral salmon calcitonin - page 144
- Table 40: Results of doxycycline vs placebo on JSN - page 146
- Table 41: Discontinued R&D projects in DMOADs, 2003-06 - page 151
- Table 42: Key analgesics in late-stage R&D pipeline for OA, 2006 - page 153
- Table 43: Factors having an impact on zucapsaicin's revenue from launch-2015 - page 158
- Table 44: RN-624: Results of Phase I study - page 161
- Table 45: Key products in late-stage R&D pipeline for corticosteroids, 2006 - page 164
- Table 46: CRx-102: Phase II clinical trial results, 2006 - page 167
- Table 47: Factors having an impact on CRx-102's revenue from launch-2015 - page 171
- Table 48: Phase I and preclinical molecular targets for disease modifying therapies, 2006 - page 173
- Table 49: Pipeline drugs in Phase I development for OA, 2006 - page 174
- Table 50: Pipeline drugs in preclinical development for OA, 2006 - page 175
- Table 51: Datamonitor's definition of OA market by ICD10 code - page 184
- Table 52: Datamonitor's forecast OA revenues of pipeline drugs across the seven major markets ($m) - page 185
- Table 53: Calculation of the $/SU of Celebrex and Arcoxia for Japan based on average historic sales in Pacific Rim from 2002 - 2005 - page 186
- List of Figures
- Figure 1: The OA market, 2006-2015 - page 6
- Figure 2: Comparative sales revenue for key OA pipeline products in the seven major markets, US$, m, 2006-2015 - page 7
- Figure 3: Drug OA drug assessment summary - page 8
- Figure 4: Adult (15+) OA population in the seven major markets, 2006 - page 25
- Figure 5: Adult OA population, five major EU countries, by age group, 2006 - page 30
- Figure 6: Key unmet needs in OA, 2006 - page 34
- Figure 7: Number of key OA therapies by class and phase of development, 2006 - page 63
- Figure 8: Pfizer's therapeutic focus, 2005 - page 65
- Figure 9: Total vs OA-specific historical sales of Celebrex in the US - page 66
- Figure 10: Total historic sales and OA-specific sales of Bayer's Aleve in the US, 2002 - 2005 - page 74
- Figure 11: Datamonitor's competitive positioning analysis of Prexige for OA, 2006 - page 82
- Figure 12: Comparison of IC50s of NSAIDs and COX-2 inhibitor - page 83
- Figure 13: Datamonitor's forecast of OA sales for Prexige across the seven major markets (US$m), 2006-2015 - page 84
- Figure 14: Datamonitor's competitive positioning analysis of Arcoxia for OA, 2006 - page 94
- Figure 15: Datamonitor's forecast of OA sales for Arcoxia across the seven major markets (US$m), 2006-2015 - page 95
- Figure 16: Datamonitor's competitive positioning analysis of naproxcinod for OA, 2006 - page 105
- Figure 17: Datamonitor's forecast of OA sales for naproxcinod across the seven major markets (US$m), 2006-2015 - page 106
- Figure 18: Datamonitor's competitive positioning analysis of licofelone for OA, 2006 - page 113
- Figure 19: Datamonitor's forecast of OA sales for licofelone across the seven major markets (US$m), 2006-2015 - page 114
- Figure 20: Datamonitor's competitive positioning analysis of IDEA-033 for OA, 2006 - page 121
- Figure 21: Datamonitor's forecast of OA sales for IDEA-033 across the seven major markets (US$m), 2006-2015 - page 122
- Figure 22: GW-406381: Phase II study design - page 125
- Figure 23: GW-406381: Improvement in WOMAC subscore - page 126
- Figure 24: Datamonitor's competitive positioning analysis of GW-406381 for OA, 2006 - page 128
- Figure 25: Datamonitor's forecast of OA sales for GW-406381 across the seven major markets (US$m), 2006-2015 - page 129
- Figure 26: Datamonitor's competitive positioning analysis of LAS-34475 for OA, 2006 - page 134
- Figure 27: Datamonitor's forecast of OA sales for LAS-34475 across the seven major markets (US$m), 2006-2015 - page 135
- Figure 28: Datamonitor's competitive positioning analysis of zucapsaicin for OA, 2006 - page 157
- Figure 29: Datamonitor's forecast of OA sales for zucapsaicin across the seven major markets (US$m), 2006-2015 - page 158
- Figure 30: CRx-102: Primary endpoint results for Phase II study - page 167
- Figure 31: Datamonitor's competitive positioning analysis of CRx-102 for OA, 2006 - page 170
- Figure 32: Datamonitor's forecast of OA sales for CRx-102 across the seven major markets (US$m), 2006-2015 - page 171
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