Acute coronary syndrome (ACS) refers to a spectrum of conditions including heart attack (myocardial infarction) and unstable angina. Cardiovascular diseases, including ACS, are the leading cause of hospitalizations in the world, across all economy income groups1. Despite improvements in the treatment of ACS, mortality and morbidity associated with this condition continue to place a considerable burden on health systems. According to DRG’s proprietary epidemiology, 2016 saw nearly 1.9 million diagnosed ACS events across the G7 (United States, France, Germany, Italy, Spain, United Kingdom, and Japan).2

ACS treatment can be divided into two phases – acute and posthospital. Antiplatelet agents, such as aspirin in conjunction with an ADP receptor antagonist, represent the standard of care for the majority of ACS patients, whether they are invasively or conservatively managed. Management of patients in the posthospital setting involves the implementation of antithrombotic, neurohormonal blocking, and lipid-modifying strategies. Overall, the main goals of treating ACS are to promote reperfusion of the myocardium and prevent reinfarction in order to promote patient survival. Also, because reperfusion strategies and their associated pharmacotherapies are linked to an increased risk of bleeding, an adequate balance must be reached between the level of inhibition of thrombosis and bleeding. DRG estimates that the combined acute and 12-month posthospital ACS therapy market across the G7 was worth $2.6 billion in 2016 and forecasts its expansion to $2.9 billion in 2026.

According to DRG’s Acute Coronary Syndrome Disease Landscape & Forecast report2, the growth in the ACS market will be driven by sales growth in the posthospital setting. The 12-month posthospital ACS market is set to see the launch of several new therapies, which will drive market expansion across the G7, reaching $2.1 billion in 2026, up from nearly $1.7 billion in 2016. In particular, the PCSK9 inhibitors Amgen’s Repatha (evolocumab) and Sanofi/Regeneron’s Praluent (alirocumab) as well as Novartis’s angiotensin receptor-neprilisin inhibitor (ARNI) Entresto (sacubitril/valsartan) will fuel sales growth and will become market leaders in ACS by 2026. Meanwhile, following the genericization of key branded therapies and due to lack of new drug launches, the hospital-based ACS market is set to suffer a decline in G7 sales from over $900 million in 2016 to under $800 million in 2026.

The majority of therapies expected to launch into 12-month posthospital ACS market, including PCSK9 inhibitors and ARNI, boast a new mechanism of action. Despite the fact that several discontinuations of anti-inflammatory agents over the past years have cast some doubt on the potential of anti-inflammatory agents in ACS, in 2017 Novartis’s canakinumab became the first anti-inflammatory therapy to show improved CV outcomes in a large Phase III trial in ACS patients.3 The success of the Phase III CANTOS trial of canakinumab validated the hypothesis that treatment approaches targeting selectively inflammatory pathways can improve outcomes in ACS and canakinumab is set to become the first purely anti-inflammatory agent to reach the ACS market. Meanwhile, Esperion Therapeutics’ bempedoic acid, a small molecule designed to lower levels of LDL-C via a novel mechanism, may meet an important unmet need for patients intolerant to statins.4

Despite the forecasted growth of the ACS market, several factors will constrain its expansion. Among the main threats to ACS market expansion will be a loss of patent protection for some of the market leaders as well as the high price of novel therapies, which will create a significant barrier to their uptake in the highly-genericized market.

Further in-depth analysis of the ACS market can be found in the Acute Coronary Syndrome Disease Landscape & Forecast report: Comprehensive market intelligence providing world-class epidemiology, keen insight into current treatment paradigms, in-depth pipeline assessments, and drug forecasts supported by detailed primary and secondary research.

  3. Ridker PM, et al. Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. N Engl J Med. 2017 Aug 27.

For more analysis and insights into the cardiovascular and metabolic markets follow Dominika on Twitter @drudnicka_DRG.

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