Renal anemia is a serious and common complication of chronic kidney disease (CKD). An in-depth examination of the drivers and obstacles facing nephrologists provides greater insights on product positioning and marketing within the renal anemia space. How is renal anemia being treated, and what are the factors impacting those treatment decisions? This content stream explores how dialysis and nondialysis CKD patients with renal anemia are diagnosed, treated, and managed within France, Germany, Italy, Spain and the UK.

Table of contents

  • Renal Anemia - Current Treatment - Detailed, Expanded Analysis (EU)
    • Physician Prescribing Practices
      • Significant Changes in Renal Anemia Treatment Practices Observed
      • Patient Characteristics
        • Diagnosis Rates of Renal Anemia Vary Among Countries in the EU5
        • Measure of Renal Anemia Severity by Stage
        • Diagnosis of Renal Anemia by CKD Stage
        • Factors Impacting Renal Anemia Diagnosis
        • Primary Practice Setting
      • Treatment Practices
        • Despite Differences in Renal Anemia Diagnosis, Treatment Practices Are Similar
        • ESAs Initated at a Lower Hemoglobin Level Compared with 2013 Level
        • Hemoglobin Level at Initiation, Dose Reduction, Hold ESA
        • Time to Treat with ESAs: CKD-ND
        • Time to Treat with ESAs: Dialysis
        • Waiting Time Before Initiating IV Iron After Oral Iron
        • U.K. Nephrologists Report Lowest Drug Treatment Rate for Renal Anemia
        • Percentage of Patients Receiving Pharmacological Treatment for Renal Anemia
        • Order of Initiation of Agents Treating Renal Anemia: CKD-ND
        • Order of Initiation of Agents Treating Renal Anemia: Dialysis
        • Aranesp Continues to Maintain Highest Patient Share in Europe
        • Physician Share by Drug Class
        • Patient Share: ESAs
        • Patient Share: IV Irons
        • CKD Patients with Renal Anemia Remain on Treatment for 13 Weeks
        • Average Number of Weeks on Therapy Before Progression
        • CKD Patients Are Typically Maintained on Their First-Line Renal Anemia Treatment
        • Percentage of Patients on Each Line of Therapy
        • Percentage of Patients Progressing by Line of Therapy: CKD-ND
        • Percentage of Patients Progressing by Line of Therapy: Dialysis
        • ESA-Treated Patients Frequently Receive IV Iron
        • ESA-Treated CKD-ND Patients on Oral and IV Iron
        • ESA-Treated Dialysis Patients on Oral and IV Iron
      • Persistency and Compliance
        • Oral Irons Associated with High Discontinuation Rates
        • Therapy Discontinuation Rates: CKD-ND
        • Therapy Discontinuation Rates: Dialysis
        • Time to Treatment Discontinuation in Weeks
        • Estimated Annual Compliance by Therapy
      • Sequencing of Treatment
        • Significant Changes in Blood Transfusion and ESA Use Compared with 2013
        • Treatment History of Patients Receiving Blood Transfusion
        • Sequencing of ESA Treatment: CKD-ND
        • Sequencing of ESA Treatment: Dialysis
        • Sequencing of IV Iron Treatment: CKD-ND
        • Sequencing of IV Iron Treatment: Dialysis
      • Recent/Anticipated Changes in Brand Usage/Treatment Approach
        • ESA and IV Iron Patient Share Expected to Remain the Same in Europe
        • Changes in ESA Agent Use Six Months from Now: CKD-ND
        • Changes in ESA Agent Use Six Months from Now: Dialysis
        • Changes in IV Iron Use Six Months from Now: CKD-ND
        • Changes in IV Iron Use Six Months from Now: Dialysis
    • Physician Insight on Medical Practice
      • Renal Anemia Treatment Drivers and Obstacles Depend on the Country
      • Drivers of Treatment Selection
        • Home Administration of ESAs Has Declined Significantly Since 2013
        • Significant Changes in 2016 Reported Protocol Use for Renal Anemia Treatment Compared with 2013
        • Availability of IV Products for CKD-ND and Dialysis Patients
        • Ability to Administer IV Agents in Place of Practice
        • Location of ESA Administration for CKD-ND Patients
        • Protocol Use by Treating Physicians
        • Protocol Use for ESAs
        • Impact of ESA or IV Iron Use on Selection
        • Changes in Anemia Management in Past Six Months: CKD-ND
        • Changes in Anemia Management in Past Six Months: Dialysis
        • Confidence Managing Anemia with IV Irons
        • Impact of Clinical Factors on Renal Anemia Treatment: EU5
        • Impact of Biosimilar Long-Acting ESA on Current ESA Use
        • Factors Influencing Prescribing of Biosimilar ESAs
        • Hemoglobin Levels Drive ESA Treatment Initiation
        • Top Factors Driving Prescribing: EU5
        • Primary Driver for Concurrent Iron and ESA Use
        • Poor Tolerance Is a Major Obstacle to IV Iron Prescribing
        • Top Factors Constraining Prescribing: EU5
        • Top Three Obstacles Impeding Prescribing: France
        • Top Three Obstacles Impeding Prescribing: Germany
        • Top Three Obstacles Impeding Prescribing: Italy
        • Top Three Obstacles Impeding Prescribing: Spain
        • Top Three Obstacles Impeding Prescribing: United Kingdom
        • Top Three Obstacles Impeding Prescribing: EU5
      • Face-to-Face Product Detailing Effectiveness
        • Sales Representatives for IV Irons Promote Their Ability to Lower ESA Dose
        • European Nephrologists Report Seeing Aranesp Sales Representatives Most Frequently
        • Sale Representative Visits for ESAs and IV Irons
        • Sales Representative Visit Frequency in Past Six Months
        • Sales Representatives for Aranesp Receive High Satisfaction Scores
        • Level of Satisfaction with Sales Representatives
        • Efficacy Is Key Message for ESAs
        • Sales Representative Message: ESAs
        • Sales Representative Message: IV Irons
    • Methodology
      • Primary Market Research Methodology
      • Physician Specialty
      • Time in Practice Post-Residency
      • Total Number of CKD Patients Under Personal Management
      • Method of Renal Replacement Therapy
      • Number of Patients Treated for Renal Anemia Under Personal Management
    • Appendix
      • Primary Market Research
        • Description of Practice Location
        • Dialysis Center Affiliation: Germany
        • Dialysis Center Affiliation: France
        • Route of Administration of ESA Agents
        • Daily Dose of Iron for Treating Renal Anemia
        • Average Weekly Dose of ESAs
        • Dose Cap/Maximum in Renal Anemia Protocols at Dialysis Center
        • Maximum ESA Dose per Administration: Hemodialysis
        • Impact of Clinical Factors on Renal Anemia Treatment: France
        • Impact of Clinical Factors on Renal Anemia Treatment: Germany
        • Impact of Clinical Factors on Renal Anemia Treatment: Italy
        • Impact of Clinical Factors on Renal Anemia Treatment: Spain
        • Impact of Clinical Factors on Renal Anemia Treatment: United Kingdom

Author(s): Jihan Khan, PhD; Caitlin Koris, MSPH

Jihan Khan, Ph.D., is a director in the oncology team at DRG. Dr. Khan manages a team of analysts who conduct extensive primary and secondary market research on several oncology indications across the major pharmaceutical markets. She also provides sales and client support across DRG oncology products.

 

Previously, Dr. Khan was a principal analyst on the cardiometabolic team at DRG. Her specialties were the type 2 diabetes and renal disorders markets. Dr. Khan provided forecasts of these pharmaceutical markets by evaluating the agents in development and the changing clinical behaviors and conducting primary research with payers and physicians. Prior to joining DRG, she worked as a knowledge specialist in a company where she conducted in-depth research on products and processes for commercialization. She obtained her Ph.D. in organic chemistry from Brandeis University and was a postdoctoral fellow at Brigham and Women’s Hospital and Harvard Medical School.

Caitlin Koris, MSPH, is a business insights analyst on the cardiovascular, metabolic, and renal disorders team at Decision Resources Group. She has developed expertise in chronic kidney disease and related disorders such as bone and mineral metabolism, renal anemia, hyperkalemia, diabetic nephropathy, and kidney transplant.

Prior to joining DRG, Caitlin was a clinical research monitor for oncology phase I and II trials. She obtained her M.S. in public health/health services research (MSPH) from Emory University, where she focused on pharmacoeconomics/outcomes research and healthcare policy. She has conducted research at the U.S. Centers for Disease Control and at the Food and Drug Administration.


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