Drug Treatment in End-Stage Renal Disease
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- About the cardiovascular pharmaceutical analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Objective of the analysis - page 3
- Datamonitor insight into the ESRD market - page 3
- CHAPTER 2 ESRD DEFINITIONS & SCOPE - page 9
- Strategic scoping and focus - page 11
- CHAPTER 3 ESRD MARKET ASSESSMENT - page 12
- ESRD: a clearly defined disease - page 12
- Treatment of ESRD - page 13
- Renal replacement therapy (RRT) - page 15
- Hemodialysis (HD) - page 15
- Peritoneal dialysis (PD) - page 15
- Key factors influencing the ESRD market - page 16
- The increasing prevalence of ESRD - page 17
- ESRD occurrence is increasing in an aging population - page 17
- Increasing causal risk factors - diabetes and hypertension - page 18
- Comparative use of RRT - page 20
- Increasing costs of treating ESRD - page 21
- Healthcare payors concerns in reimbursing dialysis treatment - page 22
- Drug treatment of dialysis patients - page 22
- Prevention is better than cure - page 23
- Comorbidities, symptoms and side effects drive drug treatment costs - page 24
- CHAPTER 4 COMORBIDITIES WITH ESRD - page 25
- Introduction - page 25
- Hypertension - page 25
- Congestive heart failure - page 26
- Hypertension-related drug usage in ESRD comorbidities - page 26
- ACE inhibitors and ARBS are used to treat hypertension - page 26
- Calcium channel blockers - page 40
- Diuretics - page 43
- Dyslipidemia - page 46
- Drugs for dyslipidemia (lipid-lowering drugs) - page 46
- Coronary artery disease (linked to dyslipidemia) - page 46
- Statins - page 47
- Fibrates - page 50
- Niacin (nicotinic acid, vitamin B3) - page 52
- Ion-exchange resins/bile-acid sequestrants - page 53
- Cholesterol uptake inhibitors - page 53
- Sevelamer - page 54
- Drugs for dyslipidemia (lipid-lowering drugs) - page 46
- Diabetes - page 55
- Myocardial damage - page 56
- Respiratory diseases (e.g. COPD) - page 56
- CHAPTER 5 DRUGS TREATING ESRD SYMPTOMS - page 57
- Introduction - page 57
- The ESRD anemia market - page 58
- An overview of anemia - page 58
- The role of erythropoietin in ESRD-induced anemia - page 58
- Importance of managing serum levels of iron prior to EPO treatment - page 59
- Patient treatment patterns - page 59
- The erythropoietin market - page 60
- Epogen/Procrit (epoietin alpha) - page 61
- Aranesp (darbepoietin alpha) - page 61
- NeoRecormon (epoietin beta) - page 62
- CERA - page 62
- Dynepo (epoietin delta) - page 62
- Epomax (epoietin omega) - page 63
- Competitive environment in the EPO market - page 64
- Patent expiries and new entrants - page 68
- Future dynamics in the ESRD erythropoietin market - page 72
- The intravenous (IV) iron market - page 73
- INFeD (iron dextran) - page 73
- Ferrlecit (iron gluconate) - page 74
- Venofer (iron sucrose) - page 75
- Competitive environment in the IV iron market - page 75
- Patent expiries and new entrants - page 81
- Opportunities in the IV iron market - page 82
- An overview of anemia - page 58
- The ESRD secondary hyperparathyroidism market - page 82
- An overview of secondary hyperparathyroidism - page 82
- ESRD's impact - page 83
- Vitamin D and the secondary hyperparathyroidism market - page 84
- Patient treatment patterns - page 84
- Competitive environment in the vitamin D market - page 89
- Patent expiries and new entrants - page 98
- Future dynamics in the ESRD vitamin D market - page 99
- Hyperphosphatemia in ESRD patients - page 99
- Patient treatment patterns - page 101
- Competition in the ESRD phosphate binder market - page 103
- Patent expiries - page 107
- Future dynamics in the phosphate binders market - page 108
- An overview of secondary hyperparathyroidism - page 82
- APPENDIX A - page 109
- Usual doses of antihypertensive medication - page 109
- APPENDIX B - page 112
- Bibliography - page 112
- Report methodology - page 114
- About Datamonitor - page 115
- About Datamonitor Healthcare - page 115
- About the Cardiovascular Disease analysis team - page 116
- Disclaimer - page 117
- List of Tables
- Table 1: The growth and distribution of the risk causal factors in ESRD in the seven major nations - page 19
- Table 2: Biogeneric epoietin products - page 70
- Table 3: Percent of the usual recommended dose of antihypertensive medication - page 109
- List of Figures
- Figure 1: The causes of ESRD in the US - page 13
- Figure 2: The ESRD patient treatment pathway - page 14
- Figure 3: Peritoneal dialysis - page 16
- Figure 4: Increasing prevalence of ESRD in the developed world - page 17
- Figure 5: Age distribution and growth of prevalent ESRD patients - page 18
- Figure 6: The increasing prevalence of diabetes and hypertension in the major seven nations - page 19
- Figure 7: Hemodialysis is preferred over peritoneal dialysis in all markets - page 20
- Figure 8: The cost of treating dialysis patients in the US is increasing and now is estimated at over $60,000 per patient per year - page 21
- Figure 9: Four key elements of drug treatment in dialysis patients - page 23
- Figure 10: ESRD cardiovascular comorbidities in the US - page 25
- Figure 11: Contributors to congestive heart failure in ESRD - page 26
- Figure 12: The kidneys and the cardiovascular system - page 27
- Figure 13: US ACE inhibitor market - page 29
- Figure 14: Estimated ACE inhibitor usage within the US ESRD population (54,540 patients) - page 30
- Figure 15: EU ACE inhibitor market - page 32
- Figure 16: US ARB market - page 33
- Figure 17: Estimated ARB usage within the US ESRD population (21,210 patients) - page 34
- Figure 18: EU ARB market - page 35
- Figure 19: US beta-blocker market - page 37
- Figure 20: Estimated beta-blocker usage within the US ESRD population (112,780 patients) - page 38
- Figure 21: EU beta-blocker market - page 39
- Figure 22: US calcium channel blocker market - page 41
- Figure 23: Estimated calcium channel blocker usage within the US ESRD population (85,017 patients) - page 42
- Figure 24: EU calcium channel blocker market - page 43
- Figure 25: Estimated loop diuretics usage within the US ESRD population - page 45
- Figure 26: Distribution of US lipid-control drugs by usage - page 47
- Figure 27: US statin market - page 48
- Figure 28: Distribution of EU lipid-control drugs by usage - page 49
- Figure 29: EU statin market - page 50
- Figure 30: EU fibrates market - page 52
- Figure 31: Diabetes comorbid patients use more insulin and less drugs - page 55
- Figure 32: Contributors to myocardial damage in ESRD - page 56
- Figure 33: Erythropoietin action - page 59
- Figure 34: ESRD anemia EPO market drivers - page 60
- Figure 35: The US EPO market - page 65
- Figure 36: Pricing in the US EPO market - page 66
- Figure 37: The EU EPO market - page 67
- Figure 38: Pricing in the EU EPO market - page 68
- Figure 39: Major EPO patent expiries - page 69
- Figure 40: ESRD anemia IV iron market drivers - page 73
- Figure 41: Differentiation of IV iron treatments by side effects - page 74
- Figure 42: The US IV iron market - page 76
- Figure 43: Pricing in the US IV iron market - page 77
- Figure 44: The German IV iron market - page 78
- Figure 45: The Italian IV iron market - page 79
- Figure 46: The UK, Spanish and French IV iron markets - page 80
- Figure 47: The pricing of IV iron in the EU - page 81
- Figure 48: The mechanism of action of vitamin D - page 82
- Figure 49: ESRD impact on control mechanisms of vitamin D, phosphate, and calcium - page 83
- Figure 50: Patient treatment pattern - page 84
- Figure 51: Mechanism of calcitriol treatment - page 85
- Figure 52: Hectorol market positioning has changed from reducing hypercalcemia to a focus on the flexibility in formulations - page 86
- Figure 53: Zemplar's mechanism of action - page 87
- Figure 54: Why Zemplar is better than calcitriol - page 88
- Figure 55: Sensipar's mechanism of action - page 89
- Figure 56: Vitamin D ESRD SHPT market drivers - page 89
- Figure 57: The US vitamin D ESRD market - page 91
- Figure 58: Pricing in the US ESRD market - page 93
- Figure 59: The German, French, and UK vitamin D markets - page 94
- Figure 60: The Spanish vitamin D market - page 96
- Figure 61: The Italian Vitamin D market - page 97
- Figure 62: Major patent expiries - page 98
- Figure 63: Hyperphosphatemia - page 100
- Figure 64: ESRD phosphate control - page 100
- Figure 65: Elevated Ca x P increases mortality risk - page 101
- Figure 66: US phosphate binder market - page 104
- Figure 67: US phosphate binder prices - page 105
- Figure 68: EU phosphate binder markets - page 106
- Figure 69: EU phosphate binder prices - page 107
- Figure 70: Phosphate binders patent expiries - page 107
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