Treatment Algorithms: Osteoarthritis 2nd Edition - No Pain, But How Much Gain?

Overview

Introduction

Scope

Report Highlights

Reasons to Purchase

DRIVERS AND TRENDS

Overview of the factors shaping osteoarthritis treatment trends across the globe, and individual markets around the world. Understand the key factors that have determined the relative successes of arthritis drug classes and individual products competing in the arthritis market today.

To what degree are analgesics and traditional NSAIDs being ignored due to the incredible demand for COX-II inhibitors?

How has the battle between COX-II inhibitors and traditional NSAIDs played out at the individual market level?

Which unmet needs provide the biggest opportunity for pharmaceutical companies, according to primary care physicians and rheumatologists?

PATIENT POTENTIAL

Understand the demographics and diagnosis rates that shape the potential drug-treated population:

• Evaluate the prevalence of OA in each market
• Identify markets with low diagnosis rates
• Identify fastest growing OA populations

DIAGNOSIS

• Diagnosis methods, co-morbidities, and OA prevalence by disease severity (mild, moderate, severe) is presented in this chapter:
• Who makes the initial OA diagnosis in each market?
• What diagnosis methods are most commonly used?
• What are the most common symptoms presented by patients, by disease severity?

MANAGEMENT OF OSTEOARTHRITIS

An in-depth look at current treatment trends in osteoarthritis, to the level of individual drugs prescribed to manage the disease at each disease severity in the seven major markets:

Prescription by drug class: Analgesics, Traditional NSAIDs, COX-II inhibitors, oral and injectable steroids

Overview of the leading drugs in OA

Individual country trends

• Treatment Guidelines
• Available, but followed?
• Presentation and Management
• Early referrals and target customers
• Non-pharmacological therapy

Watching, waiting, and saving money

• Drug classes prescribed
• COX-II' s take on the tried and true
• Drug use by class

Many options, many opportunities

PATIENT OUTCOMES

• Examines the outcomes that physicians seek when treating osteoarthritis, the level of patient compliance, and unmet needs in the current treatment of OA:
• What factors are influencing compliance, and how can compliance be improved?
• What are physician goals in the treatment of OA
• Which characteristics need the most improvement while physicians await a cure or super-drug?

OSTEOARTHRITIS TREATMENT TREES

• Detailed treatment trees identifying the percentage and total patient numbers treated with specific drug classes, and individual drugs within those classes, based on treatment algorithm survey responses:
• Identify drug-treated patient populations by severity for each market
• Understand perceived compliance rates, and the rate of desired outcome at each level of severity

ACTION POINTS

As osteoarthritis presently has no cure, and physicians have little hope that a cure will be available shortly, physician treatment strategies focus on treating the disease symptoms with minimal side effects. Interestingly, physicians show a greater interest in more effective, safer drugs than a "super-drug" that would cure OA. Companies able to improve on the current efficacy of available NSAIDs will control the market in the future.

In several markets, a significant proportion of diagnosed mild and moderate OA patients are treated solely with non-pharmacologic strategies. Products with a strong safety profile and low cost require only a moderate efficacy level to gain sales to patients that might otherwise take a non-pharmacological approach.

While COX-II inhibitors have steadied compared to traditional NSAIDs in the US, market opportunity exists for COX-II' s in some European countries, as well as Japan. While companies should focus on the COX-II market share battle in the US, expanding the use of COX-II inhibitors in Europe, and eventually Japan, will lead to continued growth within the drug class.

DATASETS

Table of tables

Table 1: Prevalence of osteoarthritis in the seven major markets, 2001

Table 2: Breakdown in the pharmacotherapy prescribed to osteoarthritis patients by severity, 2002

Table 3: Three leading drugs used in OA treatment and approximate patient numbers in the seven major markets, 2002

Table 4: Osteoarthritis Prevalence by Country, (million), 2000-10e

Table 5: Tests and strategies used in the diagnosis of osteoarthritis in the seven major markets, 2002

Table 6: Co-morbidities associated with osteoarthritis

Table 7: ACR non-pharmacologic therapy guidelines for OA

Table 8: ACR pharmacologic therapy guidelines for OA

Table 9: Proportion (%) of initial presentation and initial treatment of OA, seven major markets, by profession

Table 10: Non-pharmacological treatments utilized by physicians for OA in seven major markets, 2002

Table 11: Percentage (%) of diagnosed OA patients receiving non-drug therapy alone in the seven major markets, 2002

Table 12: Breakdown (%) in the pharmacotherapy prescribed to osteoarthritis patients among diagnosed, drug-treated patients in the seven major markets, 2002

Table 13: Composite breakdown (%) in the pharmacotherapy prescribed to osteoarthritis patients, among diagnosed, drug-treated patients across the seven major markets, 2002

Table 14: Leading factors influencing prescribing behavior in the management of osteoarthritis

Table 15: Percentage of diagnosed, drug-treated patients receiving analgesic therapy in the seven major markets, by disease severity, 2002

Table 16: Percentage of diagnosed, drug-treated patients receiving traditional NSAID therapy in the seven major markets, by disease severity, 2002

Table 17: Percentage of diagnosed, drug-treated patients receiving COX-II inhibitor therapy in the seven major markets, 2002

Table 18: Change in COX-II inhibitor prescription rates versus previous six months in six major markets, September and October 2002

Table 19: Percentage of diagnosed, drug-treated patients receiving oral steroid therapy in the seven major markets, 2002

Table 20: Percentage of diagnosed, drug-treated patients receiving injectable steroid therapy in the seven major markets, 2002

Table 21: Percent (%) of diagnosed OA patients receiving hyaluronic acid viscosupplementation, 2001

Table 22: Percentage (%) of diagnosed, drug-treated patients receiving combination therapy in the seven major markets, 2002

Table 23: Breakdown (%) of analgesic therapy for OA in the US, 2002

Table 24: Breakdown (%) of analgesic therapy for OA in Europe, 2002

Table 25: Breakdown (%) of traditional NSAID therapy for osteoarthritis in the US, 2002

Table 26: Breakdown (%) of traditional NSAID therapy for osteoarthritis in Japan, 2002

Table 27: Breakdown (%) of traditional NSAID therapy for osteoarthritis in Europe, 2002

Table 28: Breakdown (%) of traditional NSAID therapy for osteoarthritis in Europe, by severity, 2002

Table 29: Breakdown (%) of COX-II inhibitor therapy for osteoarthritis in the US, 2002

Table 30: Breakdown (%) of COX-II inhibitor therapy for osteoarthritis in Europe, 2002

Table 31: Breakdown (%) of oral steroid therapy for osteoarthritis in the US, 2002

Table 32: Breakdown (%) of oral steroid therapy for osteoarthritis in Europe, 2002

Table 33: Breakdown (%) of injectable steroid therapy for osteoarthritis in the US, 2002

Table 34: Breakdown (%) of injectable steroid therapy for osteoarthritis in Japan, 2002

Table 35: Breakdown (%) of injectable steroid therapy for osteoarthritis in Europe, 2002

Table 36: Yearly cost per patient of sampled leading osteoarthritis drugs, UK, $US, 2002

Table 37: Yearly cost per patient of sampled leading osteoarthritis drugs, France, $US, 2002

Table 38: Yearly cost per patient of sampled leading osteoarthritis drugs, US, $US, 2002

Table 39: Desired outcomes cited by physicians by disease severity, in seven major markets

Table 40: Criteria used by physicians to measure treatment efficacy

Table 41: Compliance rate (%) in seven major markets, by disease severity

Table 42: Exchange rates used in Treatment Algorithm: Osteoarthritis analysis, 2002

Table 43: Breakdown (%) of analgesic therapy for OA in the US, 2002

Table 44: Breakdown (%) of traditional NSAID therapy for osteoarthritis in the US, 2002

Table 45: Breakdown (%) of COX-II inhibitor therapy for osteoarthritis in the US, 2002

Table 46: Breakdown (%) of oral steroid therapy for osteoarthritis in the US, 2002

Table 47: Breakdown (%) of injectable steroid therapy for osteoarthritis in the US, 2002

Table 48: Breakdown (%) of traditional NSAID therapy for osteoarthritis in Japan, 2002

Table 49: Breakdown (%) of injectable steroid therapy for osteoarthritis in Japan, 2002

Table 50: Breakdown (%) of analgesic therapy for OA in France, 2002

Table 51: Breakdown (%) of NSAID therapy for OA in France, 2002

Table 52: Breakdown (%) of COX-II inhibitor therapy for OA in France, 2002

Table 53: Breakdown (%) of oral steroid therapy for OA in France, 2002

Table 54: Breakdown (%) of injectable steroid therapy for OA in France, 2002

Table 55: Breakdown (%) of analgesic therapy for OA in Germany, 2002

Table 56: Breakdown (%) of traditional NSAID therapy for OA in Germany, 2002

Table 57: Breakdown (%) of COX-II inhibitor therapy for OA in Germany, 2002

Table 58: Breakdown (%) of oral steroid therapy for OA in Germany, 2002

Table 59: Breakdown (%) of injectable steroid therapy for OA in Germany, 2002

Table 60: Breakdown (%) of analgesic therapy for OA in Italy, 2002

Table 61: Breakdown (%) of traditional NSAID therapy for OA in Italy, 2002

Table 62: Breakdown (%) of COX-II inhibitor therapy for OA in Italy, 2002

Table 63: Breakdown (%) of oral steroids therapy for OA in Italy, 2002

Table 64: Breakdown (%) of injectable steroids therapy for OA in Italy, 2002

Table 65: Breakdown (%) of analgesic therapy for OA in Spain, 2002

Table 66: Breakdown (%) of traditional NSAID therapy for OA in Spain, 2002

Table 67: Breakdown (%) of COX-II inhibitor therapy for OA in Spain, 2002

Table 68: Breakdown (%) of oral steroid therapy for OA in Spain, 2002

Table 69: Breakdown (%) of injectable steroid therapy for OA in Spain, 2002

Table 70: Breakdown (%) of analgesic therapy for OA in UK, 2002

Table 71: Breakdown (%) of traditional NSAID therapy for OA in UK, 2002

Table 72: Breakdown (%) of COX-II inhibitor therapy for OA in UK, 2002

Table 73: Breakdown (%) of injectable steroid therapy for OA in UK, 2002

Table 74: US physician sample breakdown

Table 75: Japan physician sample breakdown

Table 76: France physician sample breakdown

Table 77: Germany physician sample breakdown

Table 78: Italy physician sample breakdown

Table 79: Spain physician sample breakdown

Table 80: UK physician sample breakdown

List of figures

Figure 1: Proportion of traditional NSAID use to COX-II inhibitor use within overall NSAID class use in osteoarthritis, Europe and US, 2002

Figure 2: Breakdown of COX-II inhibitor therapy for osteoarthritis in the US, 2002

Figure 3: Prevalence of osteoarthritis in the seven major markets, 2002

Figure 4: Osteoarthritis diagnosis rates in the seven major markets, 2002

Figure 5: Diagnosed OA patient populations in seven major markets, 2002

Figure 6: Percent of OA patients initially diagnosed by type of physician in seven major markets

Figure 7: Total diagnosed OA patient population in seven major markets, by disease severity

Figure 8: Percentage of OA patients exhibiting specific symptoms by disease severity

Figure 9: Proportion of patients initially treated, by physician types, in seven major markets, 2002

Figure 10: Patient referral illustrated by percentage of OA patients initially presenting to physician, by type, and percentage of OA patients initially treated by physician, by type

Figure 11: Percentage of mild and moderate OA patients treated with pharmacological, non-pharmacological, and combination therapy in the seven major markets

Figure 12: Total OA drug treated population in seven major markets, based on diagnosis rates and drug treatment rates

Figure 13: Proportion of OA patients receiving analgesics in the seven major markets, 2002

Figure 14: Proportion of OA patients receiving traditional NSAIDs in the seven major markets, 2002

Figure 15: Proportion of OA patients receiving COX-II inhibitors in the seven major markets, 2002

Figure 16: Proportion of OA patients prescribed traditional NSAID and COX-II inhibitors in the seven major markets, 2002

Figure 17: Proportion of OA patients prescribed oral and injectable steroids in the seven major markets, 2002

Figure 18: Breakdown of analgesic therapy for OA in the US, 2002

Figure 19: Breakdown of analgesic therapy for OA in Europe, 2002

Figure 20: Breakdown of traditional NSAID therapy for osteoarthritis in the US, 2002

Figure 21: Breakdown of traditional NSAID therapy for osteoarthritis in Europe, 2002

Figure 22: Breakdown of COX-II inhibitor therapy for osteoarthritis in the US, 2002

Figure 23: Breakdown of COX-II inhibitor therapy for osteoarthritis in Europe, 2002

Figure 24: Breakdown of oral steroid therapy for osteoarthritis in Europe, 2002

Figure 25: Breakdown of injectable steroid therapy for osteoarthritis in the US, 2002

Figure 26: Breakdown of injectable steroid therapy for osteoarthritis in Europe, 2002

Figure 27: Global Hyaluronic Acid Viscosupplementation Market Share by Sales, 2001

Figure 28: Compliance rates in seven major markets, by disease severity

Figure 29: Unmet needs in the treatment of osteoarthritis

Figure 30: Breakdown of the osteoarthritis population by disease severity and overall treatment modality in the US, 2002

Figure 31: Segmentation of the overall drug treated osteoarthritis population by drug class in the US, 2002

Figure 32: Segmentation of the drug treated mild osteoarthritis population by drug class in the US, 2002

Figure 33: Segmentation of the drug treated moderate osteoarthritis population by drug class in the US, 2002

Figure 34: Segmentation of the drug treated severe osteoarthritis population by drug class in the US, 2002

Figure 35: Breakdown of the osteoarthritis population by disease severity and overall treatment modality in Japan, 2002

Figure 36: Segmentation of the overall drug treated osteoarthritis population by drug class in Japan, 2002

Figure 37: Segmentation of the drug treated mild osteoarthritis population by drug class in Japan 2002

Figure 38: Segmentation of the drug treated moderate osteoarthritis population by drug class in Japan, 2002

Figure 39: Segmentation of the drug treated severe osteoarthritis population by drug class in Japan, 2002

Figure 40: Breakdown of the osteoarthritis population by disease severity and overall treatment modality in France, 2002

Figure 41: Segmentation of the overall drug treated osteoarthritis population by drug class in France, 2002

Figure 42: Segmentation of the drug treated mild osteoarthritis population by drug class in France, 2002

Figure 43: Segmentation of the drug treated moderate osteoarthritis population by drug class in France, 2002

Figure 44: Segmentation of the drug treated severe osteoarthritis population by drug class in France, 2002

Figure 45: Breakdown of the osteoarthritis population by disease severity and overall treatment modality in Germany, 2002

Figure 46: Segmentation of the overall drug treated osteoarthritis population by drug class in Germany, 2002

Figure 47: Segmentation of the drug treated mild osteoarthritis population by drug class in Germany, 2002

Figure 48: Segmentation of the drug treated moderate osteoarthritis population by drug class in Germany, 2002

Figure 49: Segmentation of the drug treated severe osteoarthritis population by drug class in Germany, 2002

Figure 50: Breakdown of the osteoarthritis population by disease severity and overall treatment modality in Italy, 2002

Figure 51: Segmentation of the overall drug treated osteoarthritis population by drug class in Italy, 2002

Figure 52: Segmentation of the drug treated mild osteoarthritis population by drug class in Italy, 2002

Figure 53: Segmentation of the drug treated moderate osteoarthritis population by drug class in Italy, 2002

Figure 54: Segmentation of the drug treated severe osteoarthritis population by drug class in Italy, 2002

Figure 55: Breakdown of the osteoarthritis population by disease severity and overall treatment modality in Spain, 2002

Figure 56: Segmentation of the overall drug treated osteoarthritis population by drug class in Spain, 2002

Figure 57: Segmentation of the drug treated mild osteoarthritis population by drug class in Spain, 2002

Figure 58: Segmentation of the drug treated moderate osteoarthritis population by drug class in Spain, 2002

Figure 59: Segmentation of the drug treated severe osteoarthritis population by drug class in Spain, 2002

Figure 60: Breakdown of the osteoarthritis population by disease severity and overall treatment modality in the UK, 2002

Figure 61: Segmentation of the overall drug treated osteoarthritis population by drug class in the UK, 2002

Figure 62: Segmentation of the drug treated moderate osteoarthritis population by drug class in the UK, 2002

Figure 63: Segmentation of the drug treated moderate osteoarthritis population by drug class in the UK, 2002

Figure 64: Segmentation of the drug treated severe osteoarthritis population by drug class in the UK, 2002

Figure 65: Datamonitor Healthcare Consulting

Figure 66: Therapeutic Consulting capabilities