Pipeline Insight: Antiarrhythmics - RSD1235 in a class of its own
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Scope of the analysis - page 3
- Historical perspective of the antiarrhythmics market - page 3
- Size of the antiarrhythmics market in 2005 - page 3
- Datamonitor insight into the antiarrhythmic market - page 5
- At the end of 2005, sales within the antiarrhythmics drug market were in decline. With the main problems of current antiarrhythmic drug therapy surrounding their pro-arrhythmic and toxic side effects, it may be sufficient for developmental compounds to demonstrate equivalent efficacy but superior safety profiles to gain market share from the current genericized treatments. - page 5
- By 2015 the global antiarrhythmic market will be worth $3.5 billion, with sales of pipeline products accounting for over two thirds of the market by this time. Cardiome's RSD1235 (intravenous formulation) is predicted to command 27% of the whole market by 2015 on the back of good safety and efficacy data, combined with the involvement of Japanese pharmaceutical giant, Astellas, in the sales and marketing of the product in the US. - page 6
- Of the orally active antiarrhythmics currently vying for amiodarone's crown, P&G Pharmaceuticals' Stedicor (azimilide) looks set to win the battle with Sanofi-Aventis' next generation antiarrhythmic Multaq (dronedarone), due to a combination of robust late-stage clinical trial data for Stedicor, particularly from the SHIELD (Shock Inhibition Evaluation with Azimilide) study, and lingering concerns over the relative safety of Multaq. - page 8
- Summary - page 10
- Key metrics - page 11
- CHAPTER 2 PATIENT POTENTIAL - page 22
- Normal heart electrical activity - page 22
- What do we mean by the term arrhythmia? - page 24
- Bradycardia - page 25
- Tachycardia - page 26
- Supraventricular tachycardias (SVTs) - page 26
- Ventricular tachycardias - page 27
- Other arrhythmias originating in the atria - page 28
- Premature supraventricular contraction or premature atrial contraction (PAC) - page 28
- Other arrhythmias originating in the ventricle - page 28
- Premature ventricular contraction (PVC) - page 28
- Pathophysiology of cardiac arrhythmia - page 28
- Normal cardiac electrical activity vs irregularity - page 29
- Non-nodal/fast response action potentials - page 30
- Nodal/pacemaker action potentials - page 32
- Epidemiology of atrial fibrillation - page 33
- Future trends in the incidence and prevalence of AF - page 34
- Methodology - page 35
- Unmet needs in arrhythmia - page 35
- Decreased mortality - page 36
- Improved safety - page 38
- Improved quality of life (QoL) - page 39
- Improved treatment options for patients with underlying co-morbid conditions - page 39
- Other unmet needs - page 40
- The ideal anti-AF drug! - page 41
- CHAPTER 3 PIPELINE OVERVIEW - page 42
- Pipeline overview - page 42
- Breakdown by development stage - page 44
- Breakdown by company - page 46
- Breakdown by mechanism - page 48
- CHAPTER 4 R&D APPROACH - page 49
- Principles of antiarrhythmic pharmacotherapy - page 49
- Classification of current antiarrhythmics - page 50
- Class I antiarrhythmics - page 51
- Class II antiarrhythmics - page 52
- Class III antiarrhythmics - page 52
- Class IV antiarrhythmics - page 53
- Classification of pipeline products - page 53
- Novel targets for the treatment of cardiac arrhythmias - page 53
- Potassium channel blockers - page 54
- Sodium channel blockers - page 55
- Adenosine A1 receptor agonists - page 58
- Novel targets for the treatment of cardiac arrhythmias - page 53
- Clinical trial design in arrhythmia - page 61
- Comparator therapy - page 61
- There is no single gold standard therapy - page 61
- Chronic trials - page 62
- In-hospital trials - page 62
- Comparator therapy - page 61
- Clinical trial endpoints in arrhythmia - page 63
- Mortality rates - page 63
- Efficacy - page 64
- Chronic trials - page 64
- In-hospital trials - page 64
- Safety data - page 64
- Cost efficacy - page 65
- Patient numbers - page 65
- Chronic trials - page 65
- In-hospital trials - page 65
- Trial length - page 65
- Starting points - page 66
- Patient selection - page 66
- Hybrid therapy trials - page 66
- CHAPTER 5 CLASS III ORAL ANTIARRHYTHMICS LATE-STAGE DRUG ANALYSIS & FORECASTS - page 68
- Definition of current comparator therapies - page 68
- Cordarone (amiodarone) - page 68
- Indications - page 70
- Side effects - page 70
- Amiodarone's efficacy - page 71
- Conclusion - page 72
- Cordarone (amiodarone) - page 68
- Multaq (dronedarone; SR-33589) - page 73
- Drug overview - page 73
- Clinical trial data - page 74
- Datamonitor comments - page 76
- Patient potential - page 77
- Marketing factors - page 78
- SWOT analysis of dronedarone - page 79
- Performance against benchmark criteria - page 79
- Forecasts to 2015 - page 80
- Stedicor (azimilide) - page 81
- Drug overview - page 81
- Clinical trial data - page 82
- ASAP - page 83
- ALIVE - page 84
- SHIELD - page 87
- Ongoing Trials - page 89
- A-STAR (Azimilide supraventricular Tachyarrhythmia reduction) - page 90
- A-COMET I and II (The azimilide cardioversion maintenance trials) - page 90
- Patient potential - page 91
- Azimilide in the ICD population - page 91
- Azimilide in the AF population - page 92
- Marketing factors - page 92
- SWOT analysis - page 93
- Performance against benchmark criteria - page 94
- Forecast to 2015 - page 95
- Definition of current comparator therapies - page 68
- CHAPTER 6 CLASS III INTRAVENOUS ANTIARRYHTHMIC LATE-STAGE DRUG ANALYSIS & FORECASTS - page 96
- Definition of current comparator therapies - page 96
- Corvert (ibutilide) - page 96
- Conclusion - page 98
- RSD1235 (intravenous formulation) - page 98
- Drug overview - page 98
- Development history - page 99
- Clinical trial data - page 99
- Phase I - page 99
- Phase II - page 100
- Phase III - page 101
- Ongoing trials - page 105
- Patient potential - page 106
- Marketing Factors - page 108
- Performance against benchmark criteria - page 108
- SWOT analysis - page 110
- Forecast to 2015 - page 110
- Pulzium (tedisamil) - page 111
- Drug overview - page 111
- Clinical trial data - page 113
- Phase I - page 113
- Phase II - page 113
- Phase III - page 113
- Patient potential - page 117
- Marketing Factors - page 118
- Performance against benchmark criteria - page 119
- SWOT analysis: Tedisamil compared to Flecainide - page 120
- Forecast to 2015 - page 120
- Definition of current comparator therapies - page 96
- CHAPTER 7 ADENOSINE RECEPTOR AGONIST LATE-STAGE DRUG ANALYSIS & FORECASTS - page 122
- Definition of current comparator therapies - page 122
- Adenosine - page 122
- Tecadenoson (CVT-510) - page 123
- Drug overview - page 123
- Clinical trial data - page 123
- Phase III - page 124
- Patient potential - page 128
- Marketing factors - page 129
- Performance against benchmark criteria - page 131
- SWOT analysis - page 132
- Forecast to 2015 - page 132
- Definition of current comparator therapies - page 122
- CHAPTER 8 OTHER PIPELINE ANTIARRHYTHMICS - page 134
- Phase II compounds - page 136
- AVE-0118 - page 136
- Drug overview - page 136
- Preclinical data - page 136
- Phase II trials - page 137
- AZD-7009 - page 137
- Drug overview - page 137
- Phase I trials - page 137
- Nibentan - page 138
- Drug overview - page 138
- Preclinical data - page 138
- RSD1235 Oral - page 139
- Drug overview - page 139
- Phase I trials - page 140
- Phase II trials - page 140
- Selodenoson IV - page 141
- Drug overview - page 141
- Phase II trials - page 141
- Preclinical data - page 142
- Phase I trials - page 142
- SSR-149744 - page 143
- Preclinical studies - page 143
- Clinical trials - page 143
- AVE-0118 - page 136
- Phase I compounds - page 144
- AVE-1231 - page 144
- PJ-875 - page 144
- Selodenoson (oral controlled release) - page 144
- Phase II compounds - page 136
- CHAPTER 9 COMPARATIVE ANALYSIS OF ANTIARRHYTHMIC PIPELINE - page 145
- Comparative forecasts - page 145
- Comparative analysis - page 146
- APPENDIX A - page 150
- Methodology - page 150
- Datamonitor forecast methodology. - page 150
- Epidemiology forecasts - page 150
- Product forecasts - page 150
- Datamonitor drug assessment summary - page 151
- Datamonitor forecast methodology. - page 150
- Contributing experts - page 153
- References - page 154
- Report methodology - page 155
- Methodology - page 150
- APPENDIX B - page 156
- About Datamonitor - page 156
- About Datamonitor Healthcare - page 156
- Datamonitor Healthcare's therapy area capabilities - page 157
- About the cardiovascular analysis team - page 158
- Key therapy team members - page 159
- Dr Allison Fleetwood, Director, Cardiovascular, Diabetes and Women's Health - page 159
- Dr Duncan Emerton, Senior Analyst, Cardiovascular (report contact) - page 159
- Disclaimer - page 160
- About Datamonitor - page 156
- List of Tables
- Table 1: Prevalence estimates for atrial fibrillation, 2005-15 - page 11
- Table 2: US and M5EU forecasted sales for antiarrhythmic pipeline products ($m), 2007-15 - page 11
- Figure 7: Electrocardiogram of a single heartbeat - page 29
- Table 3: Mechanism of a non-pacemaker cardiac action potential - page 32
- Table 4: Prevalence estimates for atrial fibrillation, 2005-15 - page 34
- Table 5: The antiarrhythmic R&D pipeline, 2006 - page 43
- Table 6: Distribution of antiarrhythmic drugs by company, 2006 - page 47
- Table 7: Key Class III antiarrhythmic drugs in late-stage development for cardiac arrhythmia, 2006 - page 68
- Table 8: Amiodarone: key facts - page 69
- Table 9: Results of both AF/AFL and PSVT arms of the four ASAP trials - page 84
- Table 10: ALIVE: survival and safety of all and high-risk patients - page 85
- Table 11: Key intravenous, multi-factorial antiarrhythmic drugs in late-stage R&D for cardiac arrhythmia, 2006 - page 96
- Table 12: Conversion of AF to SR in the ACT 1 study - page 102
- Table 13: Non-cardiac Adverse Events (0- to 24-hour period) - page 103
- Table 14: Key adenosine receptor agonists in late-stage development for cardiac arrhythmia, 2006 - page 122
- Table 15: TEMPEST: Primary Efficacy Assessment - page 126
- Table 16: Other developmental antiarrhythmics, 2006 - page 135
- Table 17: US and M5EU forecasted sales for antiarrhythmic pipeline products ($m), 2007-15 - page 145
- Table 18: Research, clinical and commercial attractiveness summary for key late-phase pipeline antiarrhythmic products - page 146
- Table 19: Datamonitor drug assessment parameters - page 151
- List of Figures
- Figure 1: The global antiarrhythmics market 2005 by volume (SU) and sales ($) - page 4
- Figure 2: Future expansion of the global antiarrhythmics market will be fueled by five new product launches between 2007 and 2010 - page 7
- Figure 3: Impacts on the global antiarrhythmic market, 2006-2015 - page 10
- Figure 4: Electrical activity of the heart-yellow coloring indicates the electrical path - page 22
- Figure 5: The relationship between electrical and mechanical events in the cardiac cycle - page 23
- Figure 6: Segmentation and inter-relationships of the main types of arrhythmia - page 25
- Figure 8: Schematic diagram of an action potential generated by a non-nodal e.g. ventricular muscle cell - page 31
- Figure 9: Key unmet needs in the treatment of arrhythmia, 2006 - page 36
- Figure 10: 2002 guidelines for management of AF in patients with concomitant heart disease - page 40
- Figure 11: Pipeline overview of antiarrhythmic drugs, 2006 - page 44
- Figure 12: Distribution by each phase of development , 2006 - page 45
- Figure 13: Sanofi-Aventis is developing over a quarter of the pipeline products, 2006 - page 46
- Figure 14: Breakdown of antiarrhythmic pipeline by mode of action, 2006 - page 48
- Figure 15: The fast-response action potential - page 54
- Figure 16: A ventricular action potential and the effect of Class I drugs - page 57
- Figure 17: Global sales decline of the antiarrhythmics market, 2002-05 - page 73
- Figure 18: DAFNE trial design - page 75
- Figure 19: SWOT analysis of dronedarone - page 79
- Figure 20: Assessment of dronedarone's performance indicators compared to amiodarone - page 80
- Figure 21: US and M5EU sales forecast for Multaq ($m), 2007-15. - page 81
- Figure 22: SVA4 - a typical ASAP trial design - page 83
- Figure 23: ALIVE trial design - page 85
- Figure 24: SWOT analysis of Stedicor - page 93
- Figure 25: Assessment of azimilide's performance indicators - page 94
- Figure 26: US and M5EU sales forecast for Stedicor ($m), 2007-15 - page 95
- Figure 27: CRAFT trial design - page 100
- Figure 28: Assessment of RSD1235's performance indicators compared to Ibutilide - page 109
- Figure 29: SWOT analysis of RSD1235 - page 110
- Figure 30: Sales forecast for RSD1235 IV in the US and EU markets, 2007-15 - page 111
- Figure 31: IV tedisamil trial design - page 114
- Figure 32: Assessment of Tedisamil's performance indicators compared to Flecainide - page 119
- Figure 33: Tedisamil SWOT analysis - page 120
- Figure 34: Sales forecast for Tedisamil in the US and EU markets, 2009-15 - page 121
- Figure 35: TEMPEST trial design - page 125
- Figure 36: Assessment of Tecadenoson performance indicators compared to adenosine - page 131
- Figure 37: SWOT analysis of tecadenoson - page 132
- Figure 38: Sales forecast for Tecadenoson in the US and EU markets, 2010-15 - page 133
- Figure 39: Research, clinical and commercial attractiveness summary for key late-stage antihypertensive pipeline products - page 147
- Figure 40: Research, clinical and commercial attractiveness summary for key late-stage antiarrhythmic products - page 148
- Figure 41: Example of Datamonitor drug assessment scorecard - page 152
- Figure 42: Example of Datamonitor drug assessment graph - page 153
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