Monday, May 23, 2011

ASTHMA To Claim Younger Victims

 Like in many other segments, the revenue growth in seven major markets (the US, UK, Italy, Spain, Germany, France and Japan) is expected to slow down from 2010 to 2012 in the respiratory/asthma therapeutic segment. This decline could be attributed to expiry of patents of leading brands and resultant price erosion. In the current scenario countries like India, China etc, which have a strong generic presence, apart from the need to provide medical aid to a growing patient population, also have a good business opportunity.

Decision Resources and GlobalData had estimated that the global asthma drug market was $12.4 billion in 2009, registering an expected compound annual growth rate (CAGR) of 1.5 per cent which would grow to $14 billion by 2017. It is also reported that India's asthma drug market, which was estimated to be worth $246 million in 2009 is likely to grow at an annual growth rate of approximately 10 per cent to reach $403 million by 2014. This is close to some European Union countries in terms of value. Rahul Sehgal, President, Nestor Pharmaceuticals remarks on its market potential, “I would personally feel that the domestic pharma companies are likely to emerge as more competitive and aggressive players in the coming time. “

Shakti Chakraborty, President – India Region Formulations, Lupin also agrees with this estimate, saying, “We have seen no dearth of opportunities or lack on the part of domestic pharma companies to drive growth; rather we have seen a steady increase in our volumes and market share over the years.

Hitesh Gajaria, Executive Director, KPMG India says, “Domestic companies have a very strong presence in India’s asthma therapy market, much more than multinational companies.“ Some of the leading domestic players in this therapeutic area are Dr Reddy’s (DRL), Lupin and Cipla. A few of the MNCs active in the domain are GSK, AstraZeneca and Merck.

The therapy for asthma varies from corticosteroids to beta-agonists, and due to the availability of multiple drugs that act through multiple modes of action, there is an increase in scope for different players. There are more than 120 companies in the Asthma market with approximately 50 branded drugs, Gajaria adds.

Chakraborty explains, “The Indian Council of Medical Research (ICMR) reported that 13 million people in India over the age of 15 suffer from asthma, or around two per cent of this total age group. Nearly seven million are men, and just over six million women. The worst-affected age group is the 15-35-year-olds.

Over the years, the prominent trend emerging in India in respiratory ailments is its increased incidence in children. While asthma and bronchitis were ailments largely restricted to the elderly, over the years, research has shown that an increasing number of children are being affected by this. A lot of this is correlated to demographic changes in Indian cities, like the increase in the number of industries, density of population by migration from rural areas in search of jobs, and increased number of carbon-emitting automobiles on Indian roads, amongst others.

Global scenario

The countries worst affected by asthma are Ireland, the UK, Australia and New Zealand. Sehgal shares global facts and figures. In Australia, one child in six under 16 suffers from this condition. In Western Europe, the number of Asthma cases has doubled in the last decade. In the US the number has risen by 60 per cent since early 1980s. Around 5000 Americans die from asthma each year. Asthma is 26 per cent more prevalent in black than white American children. Around eight per cent of the Swiss population suffer from asthma, compared with just two per cent 25 years ago. There are four million asthmatics in Germany, some three million Japanese are suffering from the condition, of whom seven per cent have severe symptoms and 30 per cent have moderate problems. In India, it is estimated that there are up to 20 million asthmatics, with up to 15 per cent of children aged five to 11 years old having the symptoms. In Brazil, Costa Rica, Panama, Peru and Uruguay the percentage is nearly 30 per cent, whereas in Kenya 20 per cent of children have asthma.

It would be only apt to say that most countries would offer a fair market based on affluence/buying capacity and population value centric sales will be high. Since the resources available to MNCs are large compared to domestic players, it is possible for them to be more aggressive in terms of marketing and endorsing drugs. However, with patents for most drugs expiring and with the increased production of generic versions by domestic players, cheaper alternatives will be preferred so this advantage is no longer as valid as it was a couple of years back..

Highlighting the intense capabilities of Indian pharma players Gajaria says, “In India, domestic players are powerful in their own right. Players like Lupin and Dr Reddy's are money spinners with intensive product portfolios and impressive generic capabilities with the ability to successfully position their products in the market. Fixed-dosed combination (FDC) drugs are the latest in asthma therapy and represent a major opportunity for multinational pharma companies. The use of combination therapy as maintenance treatment will gradually pick up in India where the practice is still to treat asthma on an as-needed basis as opposed to treating it as a chronic disease that requires maintenance-treatment. However, even as this trend of treatment picks up, the competition will only intensify.”

Acute respiratory diseases in India have grown by 33 per cent from 2005-2010, which is a significantly higher rate compared to other communicable diseases. This increase could be curbed by improved access to medical care, a growing drug-treated population and a rising number of higher-income, brand-conscious asthma patients demanding more efficacious agents.

Proper therapy

Indian specialists struggle with patient compliance when treating asthma. The importance of consistent maintenance therapy is paramount because improved disease outcomes are not achieved unless continuous therapy is administered consistently. “The Indian asthma market would benefit from new, more convenient therapies, which would boost patient compliance,” adds Sehgal.

Gajaria remarks, “Asthma requires diligent maintenance therapy, with many multiple dose regimens. The therapy is usually complicated and the schedules are not simple. It is often observed that lack of patient education leads to under dosing and hence ineffective treatment. With a large population of illiterate patients, the specialists struggle to ensure complete dosing and hence effective disease management. Combination fixed dose drug treatment could be a possible answer to this problem, and could ensure in simplifying the treatment regimen thus ensuring more compliance.”

A Ranbaxy spokesperson emphasises, “Ranbaxy is committed to providing patient friendly solutions for the effective management of respiratory disorders. The company offers a wide range of innovative products in the Asthma segment to suit the convenience of patients.”

Chakraborty opines that Indian specialists struggle with patient compliance when treating Asthma. Consistent maintenance therapy is of prime importance because effective therapies are not achieved unless maintenance procedures are administered consistently. The Indian asthma market would benefit from new, more-convenient therapies, which would boost patient compliance.

Lupin has also taken several initiatives involving doctors as well as end customers. Chakraborty justifies, “We have brought in specialists from abroad to educate doctors and also set up asthma awareness camps in rural as well as urban areas around the country. We aim not only to treat existing patients but also to share methods to avoid practices that cause asthma. These camps are set up to raise awareness of asthma in order for people inflicted with this disease to seek the appropriate treatment in a timely manner,to properly screen patients for those who are suffering from asthma through practical and objective methods/measurements,to provide asthma medications which are affordable and can be administered by patients themselves on a daily basis and to track patient progress and outcomes in order to measure the level of success of this project so as to ultimately determine the most effective ways to improve the conditions of patients with asthma in rural India. “

Government support

The Indian Government has taken a few initiatives in the past in this regard, like in November 2009 the Indian Council for Medical Research (ICMR) and the UK Medical Research Council (MRC) jointly hosted a workshop in New Delhi. Experts from India and the UK reviewed the current disease burden in their respective countries. The partnership between ICMR and MRC aimed to combine the strengths of the Indian and UK chronic disease research communities. Gajaria recommends, “The Government should make attempts to ensure educating the public about these lifestyle related diseases; knowledge about the disease is the first step to fighting it. Chronic diseases like diabetes, cardiovascular diseases, chronic obstructive pulmonary disease (COPD) and other respiratory diseases, including asthma, face intense patient non-compliance which stems from lack of education and trust. The Government can collaborate with pharma companies, or with other non profit healthcare organisations to change this situation.”

Sehgal shares a similar view, “Greater advocacy is required to raise global awareness of this growing threat and to help dispel some myths surrounding chronic diseases, including the myth that a chronic disease cannot be prevented and that these diseases only burden high income countries. Tobacco smoke and indoor and outdoor pollution are two major causes of chronic diseases and both are preventable but India has no national programme to tackle the problem.” Adds Chakraborty, “The government should focus on improving sanitation standards and set up more powerful pollution control initiatives to begin with. Educational camps, seminars should be conducted and awareness material about the disease should be given at a rural as well as district level.”

Chakraborty summarises, “We are confident of maintaining our existing pace of growth and going forward, we will introduce more and more patient-friendly and high-quality drugs and delivery mechanisms to counter asthma. We expect to sustain our growth and increase our market share from the existing 18 per cent even further in the future.”

Source: Express pharma


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