Management of Urinary Incontinence and Overactive Bladder - A Global Overview
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- About the CNS pharmaceutical analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Scope of the analysis - page 3
- Objective of the analysis - page 3
- Datamonitor insight into the urinary incontinence and overactive bladder market - page 4
- Drug therapy for urinary disorders has predominantly focused on the overactive bladder market-particularly urge urinary incontinence (UUI). However, as the UUI market becomes increasingly crowded, pharmaceutical companies must able to demonstrate to physicians that there is a clear difference between their newer products and the more established products on the market. By focusing on the urgency and frequency symptoms, companies may be able to tap into an under-served market niche. - page 5
- Stress urinary incontinence is considered the most common subtype of urinary incontinence. Nevertheless, poor awareness and limited treatment options for this condition have impacted presentation, diagnosis and treatment rates. The recent approval of duloxetine in the EU presents physicians with a much-needed treatment alternative, but uptake has been slow. - page 7
- Interstitial cystitis (IC) is considered a rare disorder and poor understanding of its underlying causes have made diagnosis, management, and development of effective drugs for the disorder difficult. At present there are few effective treatments for IC and as a result, many physicians prescribe a wide variety of treatments that are not specifically approved for IC but may treat one or more of the symptoms. However, experts in the field believe that this could be leading to suboptimal treatment outcomes, and highlight the need for research into this area. - page 9
- CHAPTER 2 OAB AND UI TREATMENT TREES - page 19
- UUI - page 20
- Dry OAB - page 21
- SUI - page 22
- MUI - page 23
- IC - page 24
- CHAPTER 3 INTRODUCTION - page 25
- Normal bladder function - page 25
- Definition of urinary incontinence and overactive bladder - page 27
- Urinary Incontinence - page 27
- Overactive bladder-wet versus dry - page 28
- Interstitial cystitis - page 30
- Etiology - page 31
- Overactive bladder-wet and dry - page 31
- SUI - page 32
- MUI - page 32
- Interstitial cystitis - page 32
- CHAPTER 4 EPIDEMIOLOGY - page 34
- Stress urinary incontinence is the most common form of UI - page 34
- The prevalence of OAB/UI varies according to study - page 35
- US - page 36
- EU - page 36
- Japan - page 37
- Other markets - page 37
- Prevalence of OAB/UI usually rises with increasing age - page 38
- Interstitial cystitis is rare - page 39
- CHAPTER 5 PRESENTATION AND DIAGNOSIS - page 42
- Presentation - page 42
- Less than half of patients seek treatment for UI/OAB - page 42
- A variety of reasons for patients failing to seek help for OAB/UI - page 44
- Bothersome symptoms or symptoms affecting quality of life have the greatest impact on a patient's decision to see a healthcare professional - page 45
- Diagnosis - page 47
- Physicians may underestimate the severity of condition - page 50
- Physicians use different measures to assess severity of condition - page 52
- Pharmaceutical companies can help improve presentation and diagnosis - page 53
- Improve general public/patient awareness and aim to reduce stigma - page 53
- Improve awareness and facilitate diagnosis/prescribing among front-line healthcare providers - page 56
- Presentation - page 42
- CHAPTER 6 REFERRAL PATTERN - page 62
- PCPs are typically the first healthcare professionals with whom patients will have discussed their symptoms - page 62
- Referrals from PCPs to specialists increase with the severity of the condition - page 62
- CHAPTER 7 CURRENT TREATMENT - page 66
- OAB (UUI and dry OAB) - page 66
- Pharmacological versus non-pharmacological therapy - page 66
- UUI treatment - page 67
- The majority of patients with UUI receive a pharmacological therapy - page 67
- Decreasing the number of incontinence episodes is the key goal when treating a patient with UUI - page 68
- Pharmacological interventions are introduced when UUI is affecting day-to-day activities - page 69
- Tolterodine is the most popular first- and second-line drug treatment for UUI - page 70
- Dry OAB treatment - page 71
- Fewer patients with dry OAB receive pharmacotherapy than patients with UUI - page 71
- Improving quality of life is the key goal when treating a patient with dry OAB - page 73
- Pharmacological interventions are introduced when dry OAB is affecting day-to-day activities - page 73
- Physicians' treatment choice for dry OAB is typically the same as for UUI - page 74
- Stress urinary incontinence - page 74
- Pharmacological versus non-pharmacological therapy in SUI - page 74
- Non-pharmacological therapies are the most popular treatment choice for SUI - page 75
- Decreasing the number of incontinence episodes occurring upon exertion is the key goal when treating a patient with SUI - page 76
- Pelvic-floor exercises are the most popular non-pharmacological therapy choice - page 76
- Surgery is seen as the definitive treatment option for SUI but is not appropriate for all patients - page 80
- Pharmacological interventions are introduced when SUI has any effect, or a significant effect, on day-to-day activities. - page 80
- Tolterodine is the most popular first- and second-line drug treatment for SUI - page 82
- Duloxetine is the most popular third-line drug treatment for SUI - page 84
- Pharmacological versus non-pharmacological therapy in SUI - page 74
- Mixed urinary incontinence - page 85
- Pharmacological versus non-pharmacological therapy - page 85
- Treatment is usually based on the symptom that causes the greatest distress - page 85
- Improving quality of life is the key goal when treating a patient with MUI - page 85
- The majority of patients with MUI receive pharmacological therapy - page 86
- Tolterodine and oxybutynin (immediate release) are the most popular first- and second-line drug treatment for MUI - page 88
- Duloxetine is the most popular third-line drug treatment for MUI - page 90
- Pharmacological versus non-pharmacological therapy - page 85
- Interstitial cystitis - page 90
- Pharmacological treatment for IC - page 92
- Tricyclic antidepressants are the most popular first-line drug treatment for IC - page 93
- Oxybutynin (immediate release) is the most popular second-line drug treatment for IC - page 94
- Pharmacological treatment for IC - page 92
- OAB (UUI and dry OAB) - page 66
- CHAPTER 8 DRUG INFLUENCES AND PERCEPTION OF CURRENT TREATMENTS - page 97
- Attributes that most influence prescribing choice - page 97
- Physician perception of marketed products for OAB/UI - page 101
- Physician perception of marketed drugs for OAB - page 101
- Physician perception of marketed drugs for SUI - page 103
- Physician perception of drugs for MUI - page 105
- Physician perception of drugs for IC - page 107
- Switch from first- to second-line therapy - page 110
- Unmet needs - page 111
- CHAPTER 9 PIPELINE PRODUCTS - page 112
- Pipeline overview - page 112
- Physician awareness - page 116
- APPENDIX A - page 119
- Key products in late-stage development - page 119
- Staybla/Uritos (imidafenacin) (ONO-8025) (KRP-197) - page 119
- Urespan (temiverine hydrochloride) - page 120
- Fesoterodine - page 122
- Phase II trials - page 122
- Phase III - page 123
- Esoxybutynin - page 124
- Bibliography - page 126
- Introduction - page 126
- Epidemiology - page 127
- Presentation and diagnosis - page 128
- Current treatment - page 129
- Pipeline Products - page 130
- Websites - page 130
- Key products in late-stage development - page 119
- APPENDIX B - page 133
- Physician research methodology - page 133
- Physician Sample breakdown - page 133
- Urinary Incontinence and Overactive Bladder Insight Study - Physician Questionnaire - page 134
- Section One Overview of Urinary Incontinence and overactive Bladder - page 134
- Epidemiology - page 134
- Presentation - page 135
- Diagnosis - page 136
- Referral pattern - page 136
- Section Two Stress Urinary Incontinence - page 139
- Diagnosis and treatment of SUI - page 139
- Non-pharmacological treatment - page 140
- Pharmacological treatment for SUI - page 141
- Section Three Overactive Bladder With Urge Symptoms and/or Incontinence - page 144
- Diagnosis and treatment of UUI - page 144
- Pharmacological treatment for UUI - page 145
- Diagnosis and treatment of 'dry OAB' - page 148
- Pharmacological treatment for dry OAB - page 149
- Section Four Mixed Stress/Urge Urinary Incontinence - page 152
- Diagnosis and treatment of mixed SUI/UUI - page 152
- Non-pharmacological treatment - page 153
- Pharmacological treatment for mixed SUI/UUI - page 155
- Section Five Interstitial Cystitis - page 158
- Diagnosis and treatment of IC - page 158
- Pharmacological treatment for IC - page 159
- Section Six Drug Profiles - page 162
- Section A: Drug influences on physicians' choice - page 162
- Section B: The general treatment of urinary incontinence and overactive bladder - page 169
- Section One Overview of Urinary Incontinence and overactive Bladder - page 134
- Urinary Incontinence and Overactive Bladder Insight Study - Continence nurse questionnaire - page 171
- Section One Epidemiology - page 171
- Section Two Presentation and help seeking behavior - page 172
- Section Three Diagnosis and management - page 177
- Referral pattern - page 178
- Section Four Treatment - page 181
- Non-pharmacological treatment - page 183
- Pharmacological treatment - page 184
- Section Five General - page 185
- Section A: Drug influences - page 185
- Section B: The general treatment of urinary incontinence and overactive bladder - page 187
- Contributing experts - page 190
- US - page 190
- Japan - page 190
- Europe - page 191
- APPENDIX C - page 192
- About Datamonitor - page 192
- About Datamonitor Healthcare - page 192
- About the CNS analysis team - page 193
- Disclaimer - page 195
- About Datamonitor - page 192
- List of Tables
- Table 1: Definitions of UUI, SUI and MUI, according to the ICS - page 28
- Table 2: Level of symptoms physicians consider to be mild, moderate and severe - page 51
- Table 3: The severity index developed by Sandvik et al. (2003) - page 52
- Table 4: Interviewed physicians' rankings of specific indicators in determining the severity of OAB/UI subtype - page 52
- Table 5: Percentage of total patients across the seven major markets presenting to PCP with a subtype of OAB/UI and treated by that PCP - page 63
- Table 6: First-line pharmacological treatments prescribed for UUI, by type of physician - page 70
- Table 7: Second-line pharmacological treatments prescribed for UUI, by type of physician - page 71
- Table 8: Overview of non-pharmacological treatments for SUI - page 77
- Table 9: First-line pharmacological treatments for SUI, by type of physician prescribing - page 82
- Table 10: Second-line pharmacological treatments for SUI, by type of physician prescribing - page 83
- Table 11: Third-line pharmacological treatments for SUI, by type of physician prescribing - page 84
- Table 12: First-line pharmacological treatments for MUI , by type of physician prescribing - page 89
- Table 13: Second-line pharmacological treatments for MUI, by type of physician prescribing - page 89
- Table 14: Third-line pharmacological treatments for MUI, by type of physician prescribing - page 90
- Table 15: First-line pharmacological treatments for IC across seven major markets, by type of physician prescribing - page 94
- Table 16: Second-line pharmacological treatments for IC, by type of physician prescribing - page 95
- Table 17: Compounds in late-stage development (Phase III and above) for OAB/UI across the seven major markets - page 112
- Table 18: Compounds in Phase II development for OAB/UI across the seven major markets - page 113
- Table 19: Compounds in Phase I development for OAB/UI across the seven major markets - page 114
- Table 20: Compounds in preclinical development for OAB/UI across the seven major markets - page 115
- Table 21: Physician sample by country and respondent type - page 133
- List of Figures
- Figure 1: Prevalence, presentation, diagnosis and treatment of UUI across the seven major markets - page 20
- Figure 2: Prevalence, presentation, diagnosis and treatment of dry OAB across the seven major markets - page 21
- Figure 3: Prevalence, presentation, diagnosis and treatment of SUI across the seven major markets - page 22
- Figure 4: Prevalence, presentation, diagnosis and treatment of MUI across the seven major markets - page 23
- Figure 5: Prevalence, presentation, diagnosis and treatment of IC across the seven major markets - page 24
- Figure 6: Normal bladder function - page 26
- Figure 7: Relationship between UI and OAB - page 30
- Figure 8: Female population suffering from each OAB/UI subtype - page 35
- Figure 9: Female OAB/UI patients according to age group, across the seven major markets - page 38
- Figure 10: Female patients with IC who also suffer from incontinence - page 40
- Figure 11: Female sufferers who seek treatment for OAB/UI - page 42
- Figure 12: Reasons patients do not seek or delay seeking medical help, according to interviewed continence nurses, US - page 45
- Figure 13: Motivators/triggers for seeking help, according to interviewed continence nurses - page 46
- Figure 14: Female patients receiving an accurate diagnosis on initial presentation to a physician - page 48
- Figure 15: Diagnosed patients with severity of OAB/UI subtype - page 50
- Figure 16: Influence of educational methods on encouraging patients to seek physician treatment, according to interviewed continence nurses - page 54
- Figure 17: Percentage of patients with mild, moderate and severe OAB/UI disorders who have treatment overseen by PCP versus specialist - page 64
- Figure 18: Percentage of patients with mild, moderate and severe UUI who receive treatment, by type of treatment administered - page 67
- Figure 19: Points at which interviewed physicians consider it appropriate to introduce pharmacological interventions for UUI, across seven major markets - page 69
- Figure 20: Percentage of patients being treated for mild, moderate and severe dry OAB who receive pharmacological treatment - page 72
- Figure 21: Types of treatments being administered to patients with mild, moderate and severe SUI - page 75
- Figure 22: Percentage of patients for whom non-pharmacological intervention is recommended for SUI - page 78
- Figure 23: Point at which physicians consider it appropriate to introduce pharmacological interventions for SUI, across the seven major markets - page 81
- Figure 24: Percentage of patients with MUI who receive treatment, by type of treatment - page 86
- Figure 25: Percentage of patients recommended non-pharmacological intervention for MUI - page 87
- Figure 26: Point at which physicians consider it appropriate to introduce pharmacological interventions for MUI, across the seven major markets - page 88
- Figure 27: Percentage of patients with IC who receive treatment, by type of treatment - page 92
- Figure 28: Time at which physicians consider it appropriate to introduce pharmacological interventions for IC, across the seven major markets - page 93
- Figure 29: Influence of therapy attributes on treatment choice for each OAB/UI disorder - page 97
- Figure 30: Influence of side effects on prescribing decision - page 98
- Figure 31: Risks of specific side effects, according to interviewed physicians - page 100
- Figure 32: Performance of key drugs used for UUI against attributes that interviewed physicians consider influential when choosing therapy - page 102
- Figure 33: Performance of key drugs used in SUI against attributes that interviewed physicians consider influential in therapy decisions - page 104
- Figure 34: Performance of key drugs used for MUI against attributes that interviewed physicians consider influential when choosing therapy - page 106
- Figure 35: Performance of key drugs used for IC against attributes that interviewed physicians consider influential when choosing therapy - page 108
- Figure 36: Key reasons for switching from a first-line to a second-line therapy - page 110
- Figure 37: Most significant unmet needs in UI and OAB, according to interviewed physicians across the seven major markets - page 111
- Figure 38: Interviewed physicians' awareness of new treatments for OAB/UI - page 116
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