Acute coronary syndrome (ACS)─an umbrella term that encompasses acute ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, and unstable angina─is a leading cause of morbidity and mortality in the developed world. We focus on two specific settings in the treatment of ACS: the acute hospital setting and the 12-month posthospital setting in the seven major pharmaceutical markets we cover (United States, France, Germany, Italy, Spain, United Kingdom, and Japan). In the acute setting, where injectable anticoagulants, thrombolytics, and glycoprotein (gp) IIb/IIIa inhibitors dominate, the market is set to suffer a decline in sales due to the generic erosion of key brands and a lack of novel drugs launching. The 12-month posthospital ACS market, which is dominated by oral antiplatelet agents, is currently seen by drug developers as a potentially more-lucrative source of sales compared with the acute setting. Indeed, this market is set to see the launch of ten add-on or replacement therapies during the forecast period.

Questions Answered:

  • What are the drivers and constraints in the acute and 12-month posthospital ACS markets, and how will these markets evolve over the forecast period?
  • What is the current state of treatment in ACS? Which are the most important drugs and why? What are interviewed experts’ insights on current treatment options? What clinical needs remain unfulfilled?
  • What are thought leaders’ opinions of the prospects of the ten add-on and replacement therapies that are set to launch through 2026 in the post-hospital ACS population?
  • How will the anticipated launches of novel lipid-targeting therapies, including Sanofi/Regeneron’s Praluent, Amgen's Repatha, The Medicines Company/Alnylam Pharmaceuticals’ inclisiran, Esperion Therapeutics’ bempedoic acid, Resverlogix’s apabetalone, and Dalcor’s dalcetrapib, affect the treatment of ACS patients in the posthospital setting? What level of market penetration can we expect of these therapies given the increasingly crowded and competitive landscape?

Product Description:

Disease Landscape & Forecast: 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.

Table of contents

  • Acute Coronary Syndrome - Landscape & Forecast - Disease Landscape & Forecast
    • Key Updates
      • October 2017
      • August 2017
      • June 2017
      • March 2017
    • Executive Summary
      • Key Findings
        • Market Share of Acute Coronary Syndrome (Acute Market) Drug Classes: 2016
        • Market Share of Acute Coronary Syndrome (12-Month Posthospital Market) Drug Classes: 2016
        • Market Share of Acute Coronary Syndrome (Acute Market) Drug Classes: 2026
        • Market Share of Acute Coronary Syndrome (12-Month Posthospital Market) Drug Classes: 2026
        • Acute Coronary Syndrome SWOT Analysis
    • Market Outlook
      • Key Findings
        • Market Overview
        • Major-Market Sales of Acute Coronary Syndrome (Acute Market) Therapies by Region and Drug Class: 2016-2026
      • Market Drivers and Constraints
        • What Factors Are Driving the Market for Acute Coronary Syndrome?
        • What Factors Are Constraining the Market for Acute Coronary Syndrome?
        • Key Market Events for Acute Coronary Syndrome: 2016-2026
        • Annual Sales of Acute Coronary Syndrome (Acute Market) Drug Classes in the G7: 2016
        • Annual Sales of Acute Coronary Syndrome (12-Month Posthospital Market) Drug Classes in the G7: 2016
        • Annual Sales of Acute Coronary Syndrome (Acute Market) Drug Classes in the G7: 2026
        • Annual Sales of Acute Coronary Syndrome (12-Month Posthospital Market) Drug Classes in the G7: 2026
        • Patient Share of Acute Coronary Syndrome (Acute Market) Drug Classes in the G7: 2016-2026
        • Patient Share of Acute Coronary Syndrome (12-Month Posthospital Market) Drug Classes in the G7: 2016-2026
      • Drug Class-Specific Trends
        • Patient Share of ADP Receptor Antagonists in Acute Coronary Syndrome (12-Month Posthospital Setting) in the United States: 2016-2026
        • Patient Share of ADP Receptor Antagonists in Acute Coronary Syndrome (12-Month Posthospital Setting) in Europe: 2016-2026
        • Patient Share of ADP Receptor Antagonists in Acute Coronary Syndrome (12-Month Posthospital Setting) in Japan: 2016-2026
    • Forecast
      • Sales of Drugs to Treat Acute Coronary Syndrome (Acute Market) in the Major Pharmaceutical Markets: 2016-2026
      • Sales of Drugs to Treat Acute Coronary Syndrome (12-Month Posthospital Market) in the Major Pharmaceutical Markets: 2016-2026
    • Etiology and Pathophysiology
      • Key Findings
        • Expert Insight
        • Disease Overview
      • Etiology
        • Modifiable Risk Factors for Atherosclerosis
      • Disease Pathophysiology
        • The Response-to-Injury Hypothesis
        • The Response-to-Injury Hypothesis of Atherosclerosis
        • Early-Stage Lesion Development
        • Atherosclerotic Plaque Rupture and Erosion
        • Features and Consequences of Plaque Erosion and Rupture
        • Thrombus Formation
        • Platelet Activation Pathways
        • Cell-Based Model of Coagulation
      • Key Pathways and Drug Targets
        • Summary of ACS Drug Targets
        • Antiplatelet Drug Targets
        • Anticoagulant Drug Targets
    • Epidemiology Overview
      • Introduction
        • Key Findings
        • Expert Insight
      • Epidemiology Populations
        • Disease Definition
        • Methods
        • Sources Used for Diagnosed Events of ACS
        • Diagnosed Events of ACS: 2016-2026 (thousands)
        • Disease Definition
        • Methods
        • Sources Used for Subtypes of ACS Events
        • Diagnosed Events of ACS by Subtype: 2016-2026 (thousands)
        • Disease Definition
        • Methods
        • Sources Used for 12-Month Prevalent Cases of ACS
        • Diagnosed 12-Month Prevalent Cases of ACS: 2016-2026 (thousands)
        • Disease Definition
        • Methods
        • Sources Used for Subtypes of ACS Events
        • Diagnosed 12-Month Prevalent Cases of ACS by Subtype: 2016-2026 (thousands)
    • Current Treatment Overview
      • Key Findings
        • Expert Insight
      • Treatment Goals
        • Key End Points Used in Clinical Trials for Acute Coronary Syndrome
        • Physician Insights on Clinical End Points
      • Key Current Therapies
        • Overview
        • Mechanism of Action of Key Current Drug Classes Used for Acute Coronary Syndrome
        • Current Treatments Used for Acute Coronary Syndrome
        • Market Events Impacting the Use of Key Current Therapies in Acute Coronary Syndrome
        • Advantages and Disadvantages of Cyclooxygenase Inhibitors
        • Expert Insight: Use of Aspirin in the Treatment of Acute Coronary Syndrome
        • Expert Insight: Aspirin Use
        • Advantages and Disadvantages of Clopidogrel
        • Expert Insight: Use of Clopidogrel in the Treatment of Acute Coronary Syndrome
        • Expert Insight: Clopidogrel
        • Advantages and Disadvantages of Prasugrel
        • Expert Insight: Use of Prasugrel in the Treatment of Acute Coronary Syndrome
        • Expert Insight: Prasugrel
        • Advantages and Disadvantages of Ticagrelor
        • Expert Insight: Use of Ticagrelor in the Treatment of Acute Coronary Syndrome
        • Expert Insight: Ticagrelor
        • Advantages and Disadvantages of Cangrelor
        • Expert Insight: Use of Cangrelor in the Treatment of Acute Coronary Syndrome
        • Expert Insight: Cangrelor
        • Advantages and Disadvantages of Glycoprotein IIb/IIIa Inhibitors
        • Expert Insight: Use of Gp IIb/IIIa Inhibitors in the Treatment of Acute Coronary Syndrome
        • Expert Insight: Glycoprotein IIb/IIIa Inhibitors
        • Advantages and Disadvantages of Unfractionated Heparin
        • Expert Insight: Use of Unfractionated Heparin in the Treatment of Acute Coronary Syndrome
        • Expert Insight: Unfractionated Heparin
        • Advantages and Disadvantages of Enoxaparin
        • Advantages and Disadvantages of Bivalirudin
        • Expert Insight: Use of Bivalirudin in the Treatment of Acute Coronary Syndrome
        • Expert Insight: Bivalirudin
        • Advantages and Disadvantages of Fondaparinux
        • Advantages and Disadvantages of Vorapaxar
        • Expert Insight: Use of Vorapaxar in the Treatment of Acute Coronary Syndrome
        • Expert Insight: Vorapaxar
        • Advantages and Disadvantages of Rivaroxaban
        • Expert Insight: Use of Rivaroxaban in the Treatment of Acute Coronary Syndrome
        • Expert Insight: Rivaroxaban
        • Advantages and Disadvantages of Thrombolytics
        • Advantages and Disadvantages of ACE Inhibitors and ARBs
        • Advantages and Disadvantages of Nitrates
        • Advantages and Disadvantages of Beta Blockers
        • Advantages and Disadvantages of Calcium-Channel Blockers
        • Advantages and Disadvantages of Statins
        • Advantages and Disadvantages of Cholesterol Absorption Inhibitors
        • Advantages and Disadvantages of Prescription Omega-3 Fatty Acid Drugs
        • Advantages and Disadvantages of Niacin-Based Drugs
      • Medical Practice
        • Overview
        • Treatment Guidelines
        • Regional Acute Coronary Syndrome Treatment Guidelines
        • Drug Selection
        • Factors Influencing Drug Selection in Acute Coronary Syndrome
        • Treatment Decision Tree for ST-Elevation Myocardial Infarction: All Countries
        • Treatment Decision Tree for Unstable Angina/Non-ST-Elevation Myocardial Infarction: All Countries
    • Unmet Need Overview
      • Key Findings
        • Expert Insight
      • Attainment of Unmet Needs
        • Current Attainment of Unmet Needs in Acute Coronary Syndrome
        • Future Attainment of Unmet Needs in Acute Coronary Syndrome
        • Top Unmet Needs in Acute Coronary Syndrome: Current and Future Attainment
    • Emerging Therapies Overview
      • Key Findings
        • Expert Insight
        • Pipeline Trends for Acute Coronary Syndrome
      • Key Emerging Therapies
        • Notable Developments Among Key Emerging Therapies for Acute Coronary Syndrome
        • Key Emerging Therapies in Development for Acute Coronary Syndrome
        • Estimated Launch Dates of Key Emerging Therapies for the Treatment of Acute Coronary Syndrome
        • Canakinumab Profile
        • Canakinumab Clinical Development
        • Key Development Milestones for Canakinumab in the Treatment of Acute Coronary Syndrome
        • Expert Insight: Use of Canakinumab in the Treatment of Acute Coronary Syndrome
        • Expert Insight: Canakinumab
        • Expectations for Launch and Sales Opportunity of Canakinumab in Acute Coronary Syndrome
        • Evolocumab Profile
        • Evolocumab Clinical Development
        • Key Development Milestones for Evolocumab in the Treatment of Acute Coronary Syndrome
        • Alirocumab Profile
        • Alirocumab Clinical Development
        • Key Development Milestones for Alirocumab in the Treatment of Acute Coronary Syndrome
        • Inclisiran Profile
        • Inclisiran Clinical Development
        • Key Development Milestones for Inclisiran in the Treatment of Acute Coronary Syndrome
        • Expert Insight: Use of PCSK9 Inhibitors in the Treatment of Acute Coronary Syndrome
        • Expert Insight: PCSK9 Inhibitors
        • Expectations for Launch and Sales Opportunity of PCSK9 Inhibitors in Acute Coronary Syndrome
        • Dalcetrapib Profile
        • Dalcetrapib Clinical Development
        • Key Development Milestones for Dalcetrapib in the Treatment of Acute Coronary Syndrome
        • Anacetrapib Profile
        • Anacetrapib Clinical Development
        • AMG-899 Profile
        • AMG-899 Clinical Development
        • Expert Insight: Use of CETP Inhibitors in the Treatment of Acute Coronary Syndrome
        • Expert Insight: CETP Inhibitors
        • Expectations for Launch and Sales Opportunity of CETP Inhibitors in Acute Coronary Syndrome
        • Vascepa Profile
        • Vascepa Clinical Development
        • Key Development Milestones for Vascepa in the Treatment of Acute Coronary Syndrome
        • Epanova Profile
        • Epanova Clinical Development
        • Key Development Milestones for Epanova in the Treatment of Acute Coronary Syndrome
        • Expert Insight: Use of Prescription Omega-3 Fatty Acid Drugs in Acute Coronary Syndrome
        • Expectations for Launch and Sales Opportunity of Prescription Omega-3 Fatty Acid Drugs in Acute Coronary Syndrome
        • Bempedoic Acid Profile
        • Bempedoic Acid Clinical Development
        • Key Development Milestones for Bempedoic Acid in the Treatment of Acute Coronary Syndrome
        • Expert Insight: Use of Bempedoic Acid in the Treatment of Acute Coronary Syndrome
        • Expectations for Launch and Sales Opportunity of Bempedoic Acid in Acute Coronary Syndrome
        • Entresto Profile
        • Entresto Clinical Development
        • Key Development Milestones for Entresto in the Treatment of Acute Coronary Syndrome
        • Expert Insight: Use of Entresto in the Treatment of Acute Coronary Syndrome
        • Expectations for Launch and Sales Opportunity of Entresto in Acute Coronary Syndrome
        • Apabetalone Profile
        • Apabetalone Clinical Development
        • Key Development Milestones for Apabetalone in the Treatment of Acute Coronary Syndrome
        • Expert Insight: Use of Apabetalone in the Treatment of Acute Coronary Syndrome
        • Expectations for Launch and Sales Opportunity of Apabetalone in Acute Coronary Syndrome
        • Stem Cell Therapies Clinical Development
        • Expert Insight: Use of Stem Cell Therapies in Acute Coronary Syndrome
        • Expert Insight: Stem Cell Therapies
        • Expectations for Launch and Sales Opportunity of Stem Cell Therapies in Acute Coronary Syndrome
      • Early-Phase Pipeline Analysis
        • Notable Developments in the Early-Phase Pipeline for Acute Coronary Syndrome
        • Select Compounds in Early-Phase Development for Acute Coronary Syndrome
      • Key Discontinuations and Failures in Acute Coronary Syndrome
      • Access & Reimbursement Overview
        • Region-Specific Reimbursement Practices
          • Key Market Access Considerations in Acute Coronary Syndrome: United States
          • General Reimbursement Environment: United States
          • Key Market Access Considerations in Acute Coronary Syndrome: EU5
          • General Reimbursement Environment: EU5
          • Key Market Access Considerations in Acute Coronary Syndrome: Japan
          • General Reimbursement Environment: Japan
      • Appendix
        • Key Abbreviations Related to Acute Coronary Syndrome
        • Brands, Marketers, and Generic Availability of Key Therapies for ACS by Market
        • Acute Coronary Syndrome Bibliography

    Author(s): Dominika Rudnicka-Noulin

    Dominika Rudnicka-Noulin, PhD, MSc is a senior business insights analyst in the Cardiovascular, Metabolic and Renal division at Decision Resources Group, specializing in cardiovascular diseases, with expertise in heart failure and acute coronary syndrome.

    Prior to joining DRG, Dominika held a position of an associate editor at Nature Communications, working across a variety of therapy areas. Dominika also worked for three years as a Postdoctoral Research Associate on a joint project between Imperial College London and MedImmune aimed at developing more potent antibody-based drugs. Dominika gained her PhD at the Institut Pasteur in Paris, France where her work was funded by the European Commission Marie Skłodowska-Curie Actions