Osteoarthritis - Preconceptions Damage Awareness and Treatments
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- About the CNS, Arthritis and Pain pharmaceutical analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Datamonitor insight into the osteoarthritis market - page 3
- High unmet need and a large patient population are key drivers towards research and innovation in osteoarthritis (OA), but ageist perceptions and low awareness have a substantial negative impact on the market. - page 3
- The need for a paradigm shift in the way osteoarthritis is treated has been suggested in the wake of drug controversy and the failure of disease modifying approaches. Treatment currently centers on NSAID use, but following recent controversies, there is demand for an alternative. However, many alternatives are battling against their own preconceptions. This currently adds to the drive for a disease-modifying treatment, but would be more successfully directed towards a holistic approach. - page 6
- Clinical trials for disease-modifying products for OA are increasingly regulated and require careful design. However, the best design for disease modification assessment has not yet been decided upon by experts. Advances in imaging offer promise for clinical trial end-points, but interpretation of results must be unified and new biomarkers are being identified but are often difficult to utilize. - page 8
- Datamonitor insight into the osteoarthritis market - page 3
- CHAPTER 2 INTRODUCTION AND EPIDEMIOLOGY - page 15
- Classifications - page 15
- Primary (idiopathic) osteoarthritis - page 15
- Secondary osteoarthritis - page 15
- Epidemiology of osteoarthritis - page 16
- Country calculations - page 20
- US population - page 20
- European population - page 22
- Japanese population - page 26
- Radiographic hugely outweighs symptomatic joint involvement - page 26
- Changes in the osteoarthritis population as the "baby boomer" generation reaches retirement age - page 29
- Knee osteoarthritis usually assessed in trials and epidemiology studies but hip OA may offer an easier assessment target - page 30
- Additional international osteoarthritis epidemiology studies - page 31
- Beijing OA study, China - page 32
- Joint-replacement study, 2004, and the Australian National Health Survey, 1995 - page 32
- Prevalence of Rheumatic diseases in Greece: A cross-sectional, population-based epidemiological study: The ESORDIG Study, Andrianakos et al., 2003, 2005 - page 32
- Risk factors and patient-group segmentation are key in OA definition - page 33
- Age - page 33
- Gender - page 34
- Mechanical stress - page 35
- Obesity - page 35
- Country calculations - page 20
- Treatment - page 36
- Classifications - page 15
- CHAPTER 3 UNMET NEEDS - page 38
- Disease Modification is the key unmet need in OA - page 38
- Restraints outweigh the current drivers for DMOAD development - page 38
- Clinical-trial design is challenging for both DMOADs and symptom-modifying treatments as "gold-standard methods" are rapidly changing - page 41
- Patient-group segmentation in clinical trials offers a way to gain approval, but risks restricted use - page 43
- Quality of life and patient education should be addressed for all treatments - page 44
- Osteoarthritis awareness and perception in society reduces treatment uptake - page 45
- Collaboration and dedicated government-funded research organization to aid this are the key to successful future OA treatment - page 47
- The role of pharmaceutical companies - page 48
- Direct to consumer advertising must be responsible in order to change public perception - page 49
- Emerging imaging and biomarker research will impact both diagnosis and trial endpoints - page 51
- Whole-organ MRI scoring system (WORMS): not perfect but a step forward - page 54
- Biomarker research offers promise - page 56
- Disease Modification is the key unmet need in OA - page 38
- CHAPTER 4 CURRENT TREATMENT CONTROVERSIES - page 59
- The Vioxx withdrawal is old news, but it still affects physician perception of osteoarthritis treatments - page 59
- What is a Cox-2 inhibitor and should it still command a higher price? - page 63
- Opioid use in osteoarthritis offers a good alternative to NSAIDs, but "opioid-phobia" prevents high uptake - page 65
- Topical opioids appear to break down perceptual barriers - page 68
- The impact of "professional patients" is increasing in industry and government - page 70
- Non-pharmacological treatments are the first and the last resort in osteoarthritis - page 73
- Physiotherapy - page 74
- Joint replacement - page 75
- Nutraceuticals, supplements and alternative therapy invade the market - page 79
- The Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) - page 79
- The Glucosamine Unum In Die Efficacy Trial (GUIDE) - page 81
- So does glucosamine work? - page 81
- What can medical foods offer OA patients? - page 82
- Is the competitive and profitable hyaluronic-acid market based on the placebo effect? - page 83
- The Vioxx withdrawal is old news, but it still affects physician perception of osteoarthritis treatments - page 59
- CHAPTER 5 PIPELINE DRUGS - page 86
- Pain- and inflammatory-relief pipeline treatments are particularly diverse in mechanism - page 87
- HCT 3012 - page 88
- Sativex - page 88
- Licofelone - page 89
- Botox - page 90
- Disease modifiers in OA are yet to progress past Phase II - page 91
- Matrix Metalloproteinase (MMP) inhibition - page 91
- IL-1 inhibition - page 92
- Enhancing cartilage repair - page 93
- Autologous chondrocytes transplantation - page 93
- Pain- and inflammatory-relief pipeline treatments are particularly diverse in mechanism - page 87
- CHAPTER 6 OPINION LEADER TRANSCRIPTS - page 95
- Contributing experts - page 95
- Professor Howard Bird - page 96
- Dr. Felix Eckstein - page 104
- Dr. Robin Poole - page 112
- Jane Tadman, Arthritis Research Campaign (ARC) - page 121
- Professor Paul Dieppe - page 128
- Cheryl Koehn, Arthritis Consumer Expert - page 137
- Contributing experts - page 95
- CHAPTER 7 APPENDIX - page 150
- Bibliography - page 150
- Websites - page 153
- The knee injury and osteoarthritis outcome score (KOOS) - page 153
- About Datamonitor - page 157
- About Datamonitor Healthcare - page 157
- Datamonitor Healthcare's research and analysis methodologies - page 158
- Datamonitor Healthcare's therapy area capabilities - page 158
- Disclaimer - page 160
- Bibliography - page 150
- List of Tables
- Table 1: Estimated adult OA populations in the seven major markets, by age group, 2006 (000s) - page 17
- Table 2: OA sufferers who present with the disease in specific parts of the body (%): US, Japan and 5 EU markets, 2003 - page 19
- Table 3: US OA patient population by age group and gender, 2006 (000s) - page 20
- Table 4: Breakdown of arthritis population from NHIS survey and estimated OA percentages, 2003 - page 21
- Table 5: Adult OA population in five major EU countries, by age and gender, 2006 (000s) - page 22
- Table 6: Combined sample of northern England studies, radiographic knee OA by age and gender - page 24
- Table 7: Estimated symptomatic knee OA prevalence: UK adults - page 24
- Table 8: Spanish EPISER study showing breakdown of hand and knee OA by age group, 2001 - page 25
- Table 9: Adult OA population in Japan, by age and gender, 2006 (000s) - page 26
- Table 10: Results of Framingham Heart Study/knee OA cohort, 1983-85 - page 28
- Table 11: Results of Framingham Heart Study/knee OA cohort Follow-Up, 1992-93 - page 28
- Table 12: Estimated US adult population and projected prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitations, among adults aged 18 years and older, US, 2005-2030 - page 30
- Table 13: Hip and knee OA patients in seven major markets (millions), 2006 - page 31
- Table 14: WHO statistics for obesity and average systolic blood pressure in the seven major markets - page 36
- Table 15: Duragesic (fentanyl) trial results in OA, 2005 - page 69
- Table 16: GAIT study response rates by treatment group and pain level, 2005 - page 80
- Table 17: Pain and anti-inflammatory products in clinical trials for OA, 2006 - page 87
- Table 18: Disease-modifying treatments for OA, 2006 - page 91
- List of Figures
- Figure 1: Adult (15+) OA population in the seven major markets, 2006 - page 18
- Figure 2: Adult OA population, five major EU countries, by age group, 2006 - page 23
- Figure 3: Relationship between radiographic and symptomatic OA - page 27
- Figure 4: Drivers of and impediments to DMOAD development and their comparative importance and difficulty - page 39
- Figure 5: Opportunities and threats to companies wishing to enter the Cox-2 market - page 59
- Figure 6: Guidelines for selecting the appropriate NSAID in various clinical situations, 2006 - page 61
- Figure 7: Effects of various NSAIDs on the concentration of Cox-1 and Cox-2 in vitro - page 64
- Figure 8: US and UK knee and hip replacements, 2000-2002 - page 76
- Figure 9: Knee and hip replacement procedures per 100,000 population, by country, 2000 - page 77
- Figure 10: The knee injury and osteoarthritis outcome score - page 154
- Figure 11: The knee injury and osteoarthritis outcome score (cont.) - page 155
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