Atrial Fibrillation – Landscape & Forecast – Disease Landscape & Forecast

Atrial fibrillation is the most commonly encountered, sustained cardiac arrhythmia in clinical practice. The fixed-dose, nonmonitored NOACs for stroke prevention, which offer much-improved efficacy, safety, and/or convenience compared with VKAs, are driving growth in the AF market. The expected launch of tecarfarin and label expansion of existing current therapies will lead to further expansion of the AF market. However, the entry of generics for the NOACs, starting with dabigatran etexilate, is expected to limit expansion of the NOAC market and sales of the branded agents. Other constraints to the growth of the AF market are prescribing restrictions and reimbursement limitations in certain markets. The use of nonpharmacological treatment approaches for management of AF is another hindrance to the growth of the AF pharmaceutical market.

Questions Answered:

  • Thought leaders report that they are treating increasing numbers of patients with paroxysmal and persistent AF. How extensive is this trend; how will it affect drug sales over the study period? What other changes in medical practice are expected to impact future drug sales?
  • Oral anticoagulants, led by NOACs, hold a sizable share of the AF market. Which drug and regional segment is expected to dominate the global AF market? What will be the key drivers and deterrents for the AF market during the 2016-2026 forecast period? How large a role can emerging therapy tecarfarin play in this increasingly crowded landscape?
  • Generic versions of NOACs are anticipated to become available in the market starting in 2018. What will be the commercial impact of these lower-priced alternatives on the oral anticoagulant market?
  • Treatment options for underserved patient segments, such as those with renal insufficiency and mechanical heart valves, are in sight. How do thought leaders perceive the emerging therapies such as tecarfarin and bucindolol? How large is the commercial opportunity for these agents, and what competitors might they face down the road?
  • Currently available treatments for AF management are still considered to be of suboptimal efficacy. What are the major unmet needs that have been identified for the optimal management of AF patients? Which drugs in the emerging therapies pipeline are deemed most appropriate to fulfill these unmet needs by the thought leaders?

Scope:

Markets covered: United States, France, Germany, Italy, Spain, United Kingdom, and Japan.

Primary research: 19 country-specific interviews with thought leaders.

Epidemiology: 12-month prevalent cases, incident cases; paroxysmal, persistent, and permanent AF patients.

Emerging therapies: Phase II: 4 drugs; Phase III: 5 drugs. Coverage of select preclinical and Phase I products.

Market forecast features: Patient-based market forecast extending through 2026, segmented by AF subpopulations (paroxysmal, persistent, and permanent AF).

Table of contents

  • Atrial Fibrillation - Landscape & Forecast - Disease Landscape & Forecast
    • Key Updates
      • December 2017
    • Executive Summary
      • Key Findings
        • Market Share of Atrial Fibrillation Drug Classes: 2016
        • Market Share of Atrial Fibrillation Drug Classes: 2026
        • Atrial Fibrillation SWOT Analysis
    • Market Outlook
      • Key Findings
        • Expert Insight
        • Market Overview
      • Market Drivers and Constraints
        • What Factors Are Driving the Market for Atrial Fibrillation?
        • What Factors Are Constraining the Market for Atrial Fibrillation?
        • Key Market Events for Atrial Fibrillation: 2016-2026
        • Sales of Atrial Fibrillation Therapies in the Major Pharmaceutical Markets: 2016-2026
        • Major-Market Patient Share by Drug Class in Atrial Fibrillation: 2016-2026
        • Patient Share of Atrial Fibrillation Drug Classes by Market in 2016
        • Patient Share of Atrial Fibrillation Drug Classes by Market in 2026
      • Drug Class-Specific Trends
        • Sales of the Non-Vitamin K Antagonist Oral Anticoagulants for Atrial Fibrillation in the Major Markets: 2016-2026
        • Major-Market Patient Share of the Non-Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation: 2016-2026
        • Sales of the Vitamin K Antagonists for Atrial Fibrillation in the Major Markets: 2016-2026
        • Estimated Sales of Tecarfarin in the United States: 2016-2026
        • Major-Market Patient Share of the Vitamin K Antagonists in Atrial Fibrillation: 2016-2026
    • Forecast
      • Sales of Drugs to Treat Atrial Fibrillation in the Major Pharmaceutical Markets: 2016-2026
    • Etiology and Pathophysiology
      • Key Findings
        • Expert Insight
        • Disease Overview
      • Etiology
        • Natural History
        • Classification of Atrial Fibrillation
        • Major Clinical Manifestations of Atrial Fibrillation
        • Signs and Symptoms of Atrial Fibrillation
      • Disease Pathophysiology
        • The Cardiac Conduction System
        • Phases and Ionic Currents of the Human Cardiac Action Potential
        • Comparison of ECG Recordings from Healthy and AF Patients
        • Electrical Remodeling
        • Contractile Remodeling
        • Structural Remodeling
        • Ion Channels and Gap Junction Abnormalities
        • Ion-Channel Expression Changes in Human Atrial Fibrillation
        • Inflammatory Factors Contributing to Atrial Fibrillation
        • Electrophysiological Mechanisms
        • The Role of Genetics in Atrial Fibrillation Induction
      • Key Pathways and Drug Targets
        • Atrial Fibrillation Drug Targets and Rationale
        • Antithrombotic Drug Targets
    • Epidemiology
      • Key Findings
        • Key Findings
        • Expert Insights
      • Epidemiology Populations
        • Disease Definition
        • Methods
        • Diagnosed Prevalent Cases
        • Sources Used for Drug-Treated Events of Atrial Fibrillation
        • Drug-Treated Event Cases of Atrial Fibrillation: 2016-2026
        • Methods
        • Sources Used for Diagnosed Prevalent Cases by Subtype
        • Diagnosed Prevalent Cases of Atrial Fibrillation by Subtype
    • Current Treatment Overview
      • Key Findings
        • Expert Insight
      • Treatment Goals
        • Key End Points Used in Clinical Trials for Atrial Fibrillation
        • Physician Insights on Clinical End Points
      • Key Current Therapies
        • Overview
        • Mechanism of Action of Key Current Drug Classes Used for Atrial Fibrillation
        • Current Treatments Used for Atrial Fibrillation
        • Market Events Impacting the Use of Key Current Therapies in Atrial Fibrillation
        • Advantages and Disadvantages of Vitamin K Antagonists
        • Expert Insight: Vitamin K Antagonists
        • Advantages and Disadvantages of Dabigatran Etexilate
        • Key Ongoing Clinical Trials of Dabigatran Etexilate in the Treatment of Atrial Fibrillation
        • Expert Insight: Dabigatran Etexilate
        • Advantages and Disadvantages of Rivaroxaban
        • Key Ongoing Clinical Trials of Rivaroxaban in the Treatment of Atrial Fibrillation
        • Expert Insight: Rivaroxaban
        • Advantages and Disadvantages of Apixaban
        • Key Ongoing Clinical Trials of Apixaban in the Treatment of Atrial Fibrillation
        • Expert Insight: Apixaban
        • Advantages and Disadvantages of Edoxaban
        • Key Ongoing Clinical Trials of Edoxaban in the Treatment of Atrial Fibrillation
        • Expert Insight: Edoxaban
        • Class Ia Antiarrhythmics
        • Advantages and Disadvantages of Class Ia Antiarrhythmics
        • Expert Insight: Class Ia Antiarrhythmics
        • Advantages and Disadvantages of Class Ic Antiarrhythmics
        • Expert Insight: Class Ic Antiarrhythmics
        • Advantages and Disadvantages of Amiodarone
        • Advantages and Disadvantages of Sotalol
        • Advantages and Disadvantages of Dronedarone
        • Expert Insight: Class III Antiarrhythmics
        • Advantages and Disadvantages of Beta Blockers
        • Expert Insight: Beta Blockers
        • Advantages and Disadvantages of Calcium-Channel Blockers
        • Expert Insight: Calcium-Channel Blockers
        • Advantages and Disadvantages of Vernakalant
        • Expert Insight: Atrial-Selective Antiarrhythmics
        • Advantages and Disadvantages of Cardiac Glycosides
        • Expert Insight: Cardiac Glycosides
        • Advantages and Disadvantages of Antiplatelet Agents
        • Expert Insight: Antiplatelet Agents
      • Medical Practice
        • Overview
        • Treatment Guidelines
        • Country-Specific Atrial Fibrillation Treatment Guidelines
        • Drug Selection
        • Factors Influencing Drug Selection in Atrial Fibrillation
        • Anticoagulation Treatment Decision Tree for Atrial Fibrillation
        • Treatment Decision Tree for Atrial Fibrillation: United States
        • Treatment Decision Tree for Atrial Fibrillation: France
        • Treatment Decision Tree for Atrial Fibrillation: Germany
        • Treatment Decision Tree for Atrial Fibrillation: Italy
        • Treatment Decision Tree for Atrial Fibrillation: Spain
        • Treatment Decision Tree for Atrial Fibrillation: United Kingdom
        • Treatment Decision Tree for Atrial Fibrillation: Japan
    • Unmet Need Overview
      • Key Findings
        • Expert Insight
      • Attainment of Unmet Needs
        • Current Attainment of Unmet Needs in Atrial Fibrillation
        • Future Attainment of Unmet Needs in Atrial Fibrillation
        • Top Unmet Needs in Atrial Fibrillation: Current and Future Attainment
    • Emerging Therapies Overview
      • Key Findings
        • Expert Insight
        • Pipeline Overview
        • Pipeline Trends for Atrial Fibrillation
      • Key Emerging Therapies
        • Notable Developments Among Key Emerging Therapies for Atrial Fibrillation
        • Key Emerging Therapies in Development for Atrial Fibrillation
        • Estimated Launch Dates of Key Emerging Therapies for the Treatment of Atrial Fibrillation
        • Tecarfarin Profile
        • Tecarfarin Clinical Development
        • Key Development Milestones for Tecarfarin in the Treatment of Stroke Prevention in Atrial Fibrillation
        • Expert Insight: Use of Tecarfarin in the Treatment of Stroke Prevention in Atrial Fibrillation
        • Expert Insight: Tecarfarin
        • Expectations for Launch and Sales Opportunity of Tecarfarin in Atrial Fibrillation
        • Likely Uses of Tecarfarin for the Treatment of Stroke Prevention in Atrial Fibrillation
        • Bucindolol Hydrochloride Profile
        • Bucindolol Hydrochloride Clinical Development
        • Key Development Milestones for Bucindolol Hydrochloride in the Treatment of Atrial Fibrillation in Heart Failure Patients
        • Expert Insight: Use of Bucindolol Hydrochloride in the Treatment of Atrial Fibrillation
        • Expert Insight: Bucindolol Hydrochloride
        • Expectations for Launch and Sales Opportunity of Bucindolol Hydrochloride in Atrial Fibrillation
      • Early-Phase Pipeline Analysis
        • Notable Developments in the Early-Phase Pipeline for Atrial Fibrillation
        • Select Phase II Development Programs for Atrial Fibrillation
        • Select Phase I and Preclinical Development Programs for Atrial Fibrillation
      • Key Discontinuations and Failures in Atrial Fibrillation
        • Key Discontinuations and Failures
    • Access & Reimbursement Overview
      • Region-Specific Reimbursement Practices
        • Key Market Access Considerations in Atrial Fibrillation: United States
        • General Reimbursement Environment: United States
        • Key Market Access Considerations in Atrial Fibrillation: EU5
        • General Reimbursement Environment: EU5
        • Key Market Access Considerations in Atrial Fibrillation: Japan
        • General Reimbursement Environment: Japan
    • Appendix
      • Key Abbreviations Related to Atrial Fibrillation
      • Brands, Marketers, and Generic Availability of Key Therapies for Atrial Fibrillation by Market
      • Atrial Fibrillation Bibliography