Non-Hodgkin Lymphoma: “Malignant Growth of White Blood Cells”

Non-Hodgkin Lymphoma (NHL) is the leading cause of mortality and morbidity worldwide. It begins in lymphocytes present in lymph nodes of body parts such as neck or chest or under the arms. It widely spreads to the other lymph nodes and to other organs such as bone marrow, lungs, or liver. NHL is classified by World Health Organization (WHO) on the basis of microscopic appearance, chromosome features of the lymphoma cells and proteins present on the surface of the lymphoma. The Non-Hodgkin Lymphomas are classified as B-Cell Lymphomas and T-Cell Lymphoma.

High incidence is observed in the United States as compared to the EU 5 (United Kingdom, France, Germany, Spain, and Italy) and Japan in 2016. In Europe, high incidence was observed in Germany whereas low incidence was observed in Spain. The market of NHL is expected to increase to USD 9,072.8 Million by the end of the year 2023. Among these markets, United States has the largest market share whereas Spain contributes the lowest market share in 2016. The increase in the number of diagnosed cases of NHL is stimulating the growth of the market.

 

Treatment mainly depends on the clinical behavior of NHL on the basis of how fast the tumor is growing in patients. Chemotherapy, radiation therapy, immunotherapy, stem cell transplantation and targeted therapy are used for treating the lymphoma.  Its pipeline is robust with the involvement of several novel small molecule inhibitors and next-generation monoclonal antibodies. Major players such as Gilead Sciences, Acerta Pharma, and Celgene Corporation are involved in the development of therapies for this indication. Also, the launch of Pixantrone and Copanlisib shall fuel the market growth for Non-Hodgkin Lymphoma.

Among the marketed drugs, Rituxan is the blockbuster drug which is approved for the treatment of Non-Hodgkin Lymphoma, CD20 positive Follicular B-cell non-Hodgkins lymphoma, Chronic Lymphocytic Leukemia, and CD20 positive diffuse large B-cell non-Hodgkin’s lymphoma. Also, the approval of Obinutuzumab for Chronic Lymphocytic Leukemia and Follicular Lymphoma; idelalisib for Relapsed Chronic lymphocytic leukemia, follicular B-cell NHL, and small lymphocytic lymphoma; and ibrutinib for chronic lymphocytic leukemia has a significant impact on the market. Expiry of patents of Zevalin in 2019 will also affect the market growth for Non-Hodgkin Lymphoma.

Insight by:
Anuj Thakur
Analyst

DelveInsight is a leading Business Consulting and Market Research Firm. We help our clients to find answers relevant to their business, facilitating their decision-making. DelveInsight also serves as a knowledge partner for business strategy and market research. We provide comprehensive analytical reports across various therapeutic indications. DelveInsight has a database of 3000+ high-quality analytical reports.

Chemotherapy Induced Nausea and Vomiting (CINV): Most Dreaded Side effects…

Chemotherapy-induced nausea and vomiting (CINV) are severe side effects of cancer treatment which makes a patient uncomfortable and has to be dealt properly as many patients delay their chemotherapy cycles/ refuse further treatment due to fear of future nausea and vomiting. It is classified as Anticipatory, Acute, Delayed, Breakthrough and Refractory CINV based on the time of CINV occurrence. In comparison to all, Anticipatory CINV is the most difficult one to control. High incidence cases of Chemotherapy-Induced Nausea and Vomiting (CINV) were observed in the United States as compared to EU 5 (United Kingdom, Spain, Germany, France and Italy) and Japan.  It is expected that a total of 279,635 Incident CINV cases will be there in the 7 major markets in 2023.

The treatment of CINV is based on the type of CINV occurred/is expected to occur and the chemotherapy regimen patient has undergone. The first line of treatment includes Dexamethasone, Lorazepam, Ondasetron, etc and the second line includes granisetron, domperidone, etc. Usually, a combination of 5-HT3 Antagonist, Dexamethasone, and NK1 receptor antagonist is the most preferred treatment. The Global market for CINV is expected to increase by a CAGR of 8.32%. The drugs- Sancuso, Sustol, Aloxi, Akynzeo and Emend have a strong hold over the CINV market. Apart from these, the expected launch of Pipeline drugs Cinvanti and Rolapitant, the CINV market will be further boosted in the coming years.

With the use of current antiemetic regimens, delayed CINV may be more common than acute CINV as the emetic regimens have more negative effects on quality of life in CINV patients. Although there are a number of drugs in the market for prophylactic treatment of vomiting, there is no drug approved for nausea. There is an unmet need for treatment options when it comes to pediatric CINV patients.

Insight by:
Tejaswini Reddy
Associate Analyst

DelveInsight is a leading Business Consulting and Market Research Firm. We help our clients to find answers relevant to their business, facilitating their decision-making. DelveInsight also serves as a knowledge partner for business strategy and market research. We provide comprehensive analytical reports across various therapeutic indications. DelveInsight has a database of 3000+ high-quality analytical reports.

Acromegaly and Gigantism: It’s all about excessive Growth Hormone…

Gigantism is excessive production of Growth Hormone (GH) in children which is extremely rare and leads to exaggerated bone growth and an abnormal increase in height. It results from high linear growth due to excessive action of insulin-like growth factor I (IGF-I) while the epiphyseal growth plates are open during childhood. Acromegaly is the same disorder of IGF-I excess but occurs after the growth plate cartilage fuses in adulthood. In Acromegaly, GH hypersecretion occurs after epiphyseal plate closure and stature is not affected. During adolescence, vertical growth is aggravated by hypogonadotropic hypogonadism and the resulting lack of gonadal steroids, which delays epiphyseal closure.

The Prevalence of Acromegaly is higher in the United States compared to the other countries. It is estimated that the Acromegaly prevalent cases in the 7 MM (United States, Germany, Italy, France, Spain, United Kingdom and Japan) may reach up to 55,607 cases by 2023. The low prevalence rate was found among men as compared to women in the United States. Female gender presented as a major risk factor. Higher prevalence of Acromegaly was observed in age-group 18–44 years (i.e., in adults) followed by the 45-64 years age group.

Pituitary gigantism is very rare and the description of the disease is limited to small series and case reports. People with gigantism have a 2x-3x higher mortality rate than people without the disorder. The prevalent cases of Gigantism in the United States are higher than the other European countries. It is estimated that the Gigantism prevalent cases in the 6 MM expected to reach up to 253 cases by the year 2023.

The main goal of treatment in Acromegaly and gigantism patients is to lower GH and IGF-1 levels to normal. Treatment may be Transnasal transsphenoidal surgery, Endoscopic transnasal transsphenoidal surgery, Pituitary irradiation or medications like Somatostatin analogues, Dopamine agonists and Growth hormone antagonist. A combination of all three or any two methods may be used for the treatment of Acromegaly.

Insight By:
Tejaswini Reddy
Associate Analyst

DelveInsight is a leading Business Consulting and Market Research Firm. We help our clients to find answers relevant to their business, facilitating their decision-making. DelveInsight also serves as a knowledge partner for business strategy and market research. We provide comprehensive analytical reports across various therapeutic indications. DelveInsight has a database of 3000+ high-quality analytical reports.

Hemophilia A- Market Scenario

Hemophilia is the most common inherited bleeding disorder which leads to spontaneous bleeding as the blood does not clot properly. Hemophilia, characterized by the spontaneous bleeding and swollen joints due to bleeding into the joints, is of several different types- such as Hemophilia A, Hemophilia B, and Hemophilia C. Hemophilia A is the most common type, which occurs due to the deficiency or decrease of factor VIII- a factor that plays a major role in clotting blood. The severity of Hemophilia A depends on the presence of plasma levels of factor VIII.

According to the National Heart, Lung, and Blood Institute (NHLBI), Hemophilia A is observed among 8 out of 10 patients with Hemophilia. Hemophilia A (factor VIII deficiency) is four times as common as Hemophilia B (Factor IX deficiency).

 

There are around 20 drugs which are being marketed worldwide for the treatment, prophylaxis or management for Hemophilia A. Though Kogenate FS (developed by Bayer HealthCare) lost its patent, still, it is the top-selling drug of Hemophilia A contributing to the majority of the market size. The market is also dominated with several recombinant proteins developed by the major players such as Baxter, Bayer, and Pfizer. Among major players, Shire Plc is the most progressive company which has recently been acquired Baxalta in June 2016.

Advate is also leading the race for Hemophilia A.  Revenues of Advate have had a major impact on the market. Development of novel coagulating factors, technological advancement, and advancement in diagnosis techniques are stimulating the growth of the market.


Additionally, Baxalta (now Shire) is also facing tough competition from the Biogen IDEC with the launch of long-acting therapies such as Eloctate for Hemophilia A.  Bayer has recently received approval Recombinant Factor VIII, Kovaltry in 2016 which is expected to fuel the market growth for the forecasted period. Hemophilia A market is expected to increase due to upcoming Hemophilia therapies which shall be launched in 2019 (Turoctocog alfa pegol for Hemophilia A and LR769 for Hemophilia A and Hemophilia B) and 2021 (Emicizumab and Damoctocog alfa pegol for Hemophilia A).

Insight by:
Sukhvinder Singh
Associate Analyst

DelveInsight is a leading Business Consulting and Market Research Firm. We help our clients to find answers relevant to their business, facilitating their decision-making. DelveInsight also serves as a knowledge partner for business strategy and market research. We provide comprehensive analytical reports across various therapeutic indications. DelveInsight has a database of 3000+ high-quality analytical reports.

Narcolepsy: Treatment options and market outlook

Narcolepsy is characterized by symptoms such as excessive daytime sleepiness, cataplexy (sudden loss of muscle control, often triggered by strong emotions) and fragmented sleep. Narcolepsy occurs throughout the world but occurrence rates vary among populations. Occurrence of Narcolepsy is estimated to be 1 in 2,000 people in the United States and it affects around 3 million people worldwide, as reported in many epidemiology based studies. The occurrence rate of narcolepsy is remarkably lower in Israel and quite higher in Japan compared to the United States and Europe. In Europe, the occurrence rate is found to be higher in UK and Germany than other European countries. Most studies suggest that around 70% of narcolepsy cases remain undiagnosed and untreated.

Hypocretin (Orexin), produced by the special cells in the brain is important for regulating the Sleep/Wake Cycle. The death of these special cells leads to the complications of Narcolepsy. As these cells have not yet been possible to replace, the only way to treat Narcolepsy is to relieve the symptoms. The symptoms like Sleep/Wake Irregularities and REM (Rapid Eye movement) Intrusion can be treated by using modern medications and Lifestyle adjustments. Common medications for treating symptoms of narcolepsy include stimulants (Provigil), Sodium oxybate (Xyrem) and Antidepressants (Selective serotonin reuptake inhibitors such as Prozac, Zoloft and newer antidepressants Effexor. Sodium oxybate (Xyrem) is highly effective in treating cataplexy along with few Selective serotonin reuptake inhibitors (SSRIs).

PROVIGIL by Cephalon and XYREM by Jazz Pharmaceuticals are the top selling drugs capturing the majority of the market for Narcolepsy. Other drugs are also being used for the treatment of narcolepsy as the secondary indication, but do not have much impact on the overall market size. As per our estimation, more than 85% of total global market share will be covered by the United States by 2023.  The Annual Cost of Therapy (ACOT) of Xyrem in the United States is quite higher than that in Europe. The US has the highest share in Narcolepsy space among major markets, mainly owing to higher ACOT of Xyrem. The market in Europe is estimated to be increasing and largely depends on the sales of PROVIGIL (modafinil) and XYREM (sodium oxybate) which are majorly contributing to the total European market. The upcoming pipeline drugs JZP-110 and FT218 are expected to be launched in 2017 and 2018, respectively. These drugs are expected to have a major impact on the market in the coming years. For Japan, the market scenario is quite different to that of Europe and US as both Provigil and Xyrem are not marketed in Japan. Basically, the market size in Japan is largely depending on the sales of the other drugs that are used as secondary treatment options for Narcolepsy. As per our analyses, the Narcolepsy market in Japan is expected to remain stable; however, a nominal decline can be seen by the year 2023, owing to the decrease in overall population.

Insight By:
Mohammad Rizwan
Associate Analyst

DelveInsight is a leading Business Consulting and Market Research Firm. We help our clients to find answers relevant to their business, facilitating their decision-making. DelveInsight also serves as a knowledge partner for business strategy and market research. We provide comprehensive analytical reports across various therapeutic indications. DelveInsight has a database of 3000+ high-quality analytical reports.

Sarcopenia: “Aging-Associated Strength Loss Condition”

Sarcopenia is an age-related geriatric syndrome which involves the loss of strength of skeletal muscles. The condition leads to impaired mobility, increased disability, more number of falls, as well as loss of physical function. Sarcopenia is observed in both physically inactive and active people, where factors such as inadequate protein intake, increased splanchnic extraction of amino acids and vitamin D deficiency increase the chances of developing this condition. Higher prevalence of Sarcopenia is observed in the United States as compared to Japan and EU5. On the contrary, higher awareness and improvement in care can slowly decrease the number of prevalent cases of Sarcopenia across the seven major markets by 2.17% over the 10-year forecast period (2013-2023).

There is no test or any specific level of muscle mass that will diagnose sarcopenia and there has been no approved drug or treatment therapy, even though companies are in neck to neck competition to work towards the development of their molecule to bring it to the market. The only drug in the pipeline is enobosarm, which is in Phase III stage of development by GTx Inc. However, any further development is stalled as the company is looking for licensing partners because the primary outcomes of Phase III trial were not up to mark for FDA filings. Thus, the primary treatment for Sarcopenia is still restricted to exercise and resistance training or strength training, which helps in increasing the muscle strength along with endurance with weights or resistance bands.

However, new technologies are still being developed to combat the disease that includes SARCOB Platform Technology by Biophytis, HuCAL Technology by Novartis, and Rycal Science Technology by Cytokinetics. These new technologies are the ones that play a major role in stimulating the growth of sarcopenia market. The market share in the 7 major markets (US, EU5, Japan) of Sarcopenia is expected to increase to USD 54.35 million by the end of the year 2023. Among these markets, United States has the largest market share whereas France contributes the lowest as of 2016. Sarcopenia, still an unexploited indication, needs effective and intensive research for developing better medication and improved treatment options.

Insight by:
Diksha Wadhwa
Associate Analyst

The Current Scenario for Interstitial Cystitis(IC)

Interstitial cystitis (IC), also known as painful bladder syndrome, is a chronic disease that results in recurring discomfort or pain in the bladder and the surrounding pelvic region. This is considered as multiple bladder conditions as it can lead to many other problems. Interstitial cystitis can be of two types: Non-Ulcerative (90% of IC cases) and Ulcerative (5%-10% of IC cases), where the exact cause is unknown. However, researchers believe that many factors are at play which may contribute to the development of the condition like Bladder trauma, Bladder over-distention, pelvic floor muscle dysfunction, and bacterial infection (cystitis), etc. Damage to the bladder wall allows particles in the urine, such as potassium, to leak into the bladder lining.

The diagnosis of interstitial cystitis can be challenging as the patient poses a variety of symptoms that may be difficult to diagnose and may also lead to misdiagnosis, underdiagnosis and delayed diagnosis. United States has the highest incident probable IC Cases. 90% of IC cases occur in women. Though only 10% of IC cases occur in men, it is believed that is underestimated due to misdiagnosis.

The Interstitial Cystitis market is mainly driven by Elmiron, which is the only approved oral drug by FDA specifically for IC. Another option includes bladder instillations like Cystistat, Hyacyst, Uracyst, etc., which are not approved by FDA. NSAIDs, Anti-depressants, anti-histamines, etc are also used for controlling symptoms of IC. The overall market of IC in 7 major markets for Elmiron and bladder instillations was found to be around USD 261.3 millions, of which major share is of U.S.

With drugs in the pipeline for IC, the market is expected to grow at a steady rate. There is no cure for interstitial cystitis (IC). However, many treatment options are available to help relieve the symptoms of bladder pain, urgency, and frequency. The combination of various treatments is the best approach to treating interstitial cystitis.

Insight by:
Anuj Thakur
Analyst

DelveInsight is a leading Business Consulting and Market Research Firm. We help our clients to find answers relevant to their business, facilitating their decision-making. DelveInsight also serves as a knowledge partner for business strategy and market research. We provide comprehensive analytical reports across various therapeutic indications. DelveInsight has a database of 3000+ high-quality analytical reports.

AKT Inhibitors: A potential Cancer Immunotherapy Target

Targeted therapy is the most preferred option for cancer treatment and a number of new targets are being discovered which target cancer specific receptors, AKT being one of them. Protein kinase B (PKB), also known as AKT, belongs to serine/threonine protein kinase superfamily. AKT has been validated as a potential target as it plays a central role in many types of cancer, and studies have proven that the AKT signaling cascade is frequently impaired in many types of cancer and, in some cases; it is associated with tumor aggressiveness.

Also, AKT/PI3K pathway is an important signal transduction pathway and it has been observed that PI3K is overexpressed in ovarian and cervical cancer, along with causing mutations associated with breast cancer, glioblastoma and gastric cancer. Since AKT pathway plays a critical role in regulation of cell’s apoptotic pathway and AKT/PI3K pathway, it is being studied extensively as a target for cancer therapy.

The AKT Inhibitors pipeline has a number of drugs under development but in spite of increasing knowledge regarding AKT functions and activation, no AKT inhibitor has yet been approved for oncologic use. All the major components of the AKT pathway which consists of PI3Ks, PDK1, AKT and mTOR, are the focus of research for targeted cancer therapy, however, till now a limited number of drugs has emerged from this approach.

Midostaurin by Novartis is in pivotal stage of development for FLT3-mutated acute myeloid leukemia (AML) which has shown good results and is expected to be the first AKT Inhibitor to be approved. Major companies like Genentech, Novartis, Merck and GlaxoSmithKline are in the race for AKT inhibitors development and are expected to enter the pivotal stage soon. No approved drugs and the vast potential of AKT Inhibitors are thus the major driving factors for AKT Inhibitors pipeline.

Insight By:
Tejaswini Reddy
Associate Analyst

DelveInsight is a leading Business Consulting and Market Research Firm. We help our clients to find answers relevant to their business, facilitating their decision-making. DelveInsight also serves as a knowledge partner for business strategy and market research. We provide comprehensive analytical reports across various therapeutic indications. DelveInsight has a database of 3000+ high-quality analytical reports.

Medical tourism in India

India is well known for its monuments and scenic beauty across the globe, but what if I say that Medical tourism is also an emerging jewel for India? Like a magnet, it attracts a number of foreign patients to come and experience the medical expertise for various medical conditions. Globalisation of healthcare services has resulted in drawing the attraction of visitors not only from USA and UK, but also from Gulf region, Africa and from countries like Bangladesh, Sri Lanka, etc. The medical tourism in India is growing at a rapid pace and is evident from that fact that the estimated worth of this sector was around US$3 billion in October 2015, and is projected to increase to $7–8 billion by 2020.

The most popular treatments the patients go for are cardiac bypass, bone-marrow transplant, eye surgery and hip transplant. Chennai is known as the medical hub of India while Noida and National Capital Region is in the race of becoming hotspot for the medical sector. Hospital chains like Tata, Fortis Healthcare, Apollo, Max, and Wockhardt, are equipped with latest equipment and instruments which meet standard quality, and have made a huge contribution in bringing in the foreign patients.

Apart from world class treatment and best physicians, there are few other factors as well which have resulted in increasing medical tourism. The main reason is the low cost of surgeries as compared to what it is in their native country. For example, according to the United Network for Organ Sharing, the total cost of a hip transplant is around $17,000 in the USA while its only $9,000 in India. The quality of care the patients feel here also plays a vital role in emerging medical tourism. Up-to-date medical technology is adopted by the Indian doctors and their proficiency in handling different cases builds up the trust of foreigner patients. Despite having vast diversity, knowledge of the English language has also diminished barriers and people from outside countries feel comfortable in being treated at various facilities across the country. In regions with less penetration of the foreign languages, translators are also in trend to reduce language barrier.

The factors elucidated above have helped India in increasing medical tourism which according to analysts is expected to reach USD 32.5 billion by 2019 as compared to what it was USD $10.5 billion in 2012. This sector has been growing at a rate of 15-2% per year. If the process of getting visa gets streamlined, there would be fewer problems in terms of money and waiting period, resulting in India becoming the top destination for patients to come for their treatments.

Insight by:
Megha Khandelwal
Associate Analyst

 

Epidemiology: Fatty Liver Disease

Fatty liver disease is the common form of Non-alcoholic fatty liver disease (NAFLD), whereas very extreme form of NAFLD is termed as Non-alcoholic Steatohepatitis (NASH). NASH is characterized by deposition of fat with 5%-10% of liver weight in liver of people who drink very little or no drinking leading to inflammation and scarring of liver, with obesity and diabetes regarded as main causes of NAFLD.

The progress of fatty liver to NASH is estimated to be only 1.7 per 1000 person, so not all NAFLD results into NASH. The DIONYSOS study revealed that the frequency of NAFLD remission was 55 per 1000 person per year. In US and Japan the incidences of hepatocellular carcinoma have increased due to NAFLD, NASH and NASH related cirrhosis. Incidences of NAFLD and NASH are increasing rapidly in US and seem to be the second largest cause for liver transplantation. The adult proportion with NASH has increased by 170% from 2004-2013.

PubMed/Medline searches from 1989 to 2015 showed that global incidences of occurrence of NAFLD are 25.24%. The data included was only of selected groups and nothing related to alcohol consumption or any other liver disease was included. The highest prevalence was seen in Middle East and South America and lowest in Africa. Incidences of NAFLD were 0.44 per 1000 person while liver specific mortality and overall mortality for NASH and NAFLD were 0.77 per 1000. The incidence risk ratios for liver specific mortality for NAFLD were 1.94 and 1.05.

Classification Group NAFDL group Prevalence Remarks
Geographic General population 6%-33%
North America 11%-46%
Europe 4%-49% Incidence estimate: 29 per 100 000 person-years
South America 27%-35%
Asia 15%-44% Incidence estimate: 31-86 per 1000 person-years
Risk factors Obesity Up to 90% 51% with NAFLD have obesity
Diabetes mellitus 69% 30%-50% with diabetes have NAFLD
Hypertension 35%-40% 39.4% with hypertension have NAFLD
Dyslipidemia 50% Up to 90% with dyslipidemia have NAFLD

 

A case study conducted in Chinese population was aimed to identify risk factors for NAFLD through a span of 8 years. The study found 691 patients out of the ones enrolled were diagnosed with NAFLD. In the 8 year follow up, it was seen that 337 subjects developed NAFLD and there was increased body mass index (BMI), serum uric acid, fasting plasma glucose, decreased low density lipoprotein cholesterol as well as in high density lipoprotein cholesterol. On the other hand, 123 participants showed decrease in BMI, fasting plasma glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, and γ-glutamyl transpeptidase and were seen as NAFLD free. From the study, it was very clear that if the risk factors are reduced, then NAFLD can be reversed.

Insight by:
Neha Chaudhary
Associate Analyst

DelveInsight is a leading Business Consulting and Market Research Firm. We help our clients to find answers relevant to their business, facilitating their decision-making. DelveInsight also serves as a knowledge partner for business strategy and market research. We provide comprehensive analytical reports across various therapeutic indications. DelveInsight has a database of 3000+ high-quality analytical reports.