Feature | August 23, 2012

Generic Clopidogrel Will Contract U.S. Market, Before the Uptake of Novel Agents Increases

In PCI-treated patients in the acute setting, increasing use Angiomax and otamixaban will expand the market over the next decade

August 23, 2012 — Decision Resources, a research and advisory firm for pharmaceutical and healthcare issues, finds that the 12-month post-hospital acute coronary syndrome market will initially contract from just under $2 billion in 2011 to about $1.6 billion in 2013, mainly as a result of the U.S. genericization of clopidogrel (Bristol-Myers Squibb/Sanofi’s Plavix) in 2012. Decision Resources forecasts that the post-hospital acute coronary syndrome antiplatelet/anticoagulant market will then expand to almost $2.7 billion in 2021, owing largely to uptake of oral agents with novel modes of action, such as AstraZeneca’s ticagrelor (Brilinta) and the CETP inhibitors, Merck’s anacetrapib and Eli Lilly’s evacetrapib.

“We expect anacetrapib to be the first CETP inhibitor to launch for acute coronary syndrome in 2018, followed by evacetrapib in 2019,” said Decision Resources Analyst Conor Walsh, Ph.D. “We anticipate that these agents will demonstrate significant reductions in cardiovascular events in their Phase III trials, mainly driven by their highly effective LDL-C-lowering abilities. As a result, sales of this drug class are forecast to be $578 million in 2021 in the 12-month post-hospital setting, equivalent to about one-fifth of total sales in this market.”

The Pharmacor advisory service entitled Acute Coronary Syndrome also finds that ticagrelor — approved in Europe in 2010 and in the United States in 2011 — is the drug most likely to change medical practice in acute coronary syndrome. In a Phase III clinical trial, this ADP receptor antagonist significantly reduced the risk of mortality compared with clopidogrel, which has been a mainstay of therapy for the indication.

“In 2021, despite a slow start, we forecast that ticagrelor will earn major-market sales in excess of $650 million for acute coronary syndrome treatment up to 12 months,” Walsh said.

The findings also reveal that, in patients being treated for percutaneous coronary intervention, higher-priced anticoagulants such as The Medicines Company’s bivalirudin (Angiomax)  and Sanofi’s emerging factor Xa antagonist otamixaban will gradually capture share, at the expense of unfractionated heparin. This trend will partly offset the sales decline in this class due to the genericization of Sanofi’s Lovenox/Clexane.

Also, in the acute setting, generic erosion of the glycoprotein (gp) IIb/IIIa inhibitor eptifibatide (Merck/GlaxoSmithKline’s Integrilin) and a general reduction in the use of drugs from this class will be responsible for a drop in market value in excess of $150 million through 2021 in the United States, France, Germany, Italy, Spain, the United Kingdom and Japan.

For more information: www.decisionresources.com


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