Last Updated 23 December 2014
Acute coronary syndrome (ACS)—an umbrella term that encompasses acute ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA)—is a leading cause of morbidity and mortality in the developed world. ACS is usually the outcome of atherosclerosis in the coronary arteries with concomitant endothelial dysfunction, followed by plaque disruption and thrombin formation. Despite ongoing improvements in ACS management, rates of reinfarction and death are high, and there remains a pressing need for new antithrombotic and antiatherosclerotic therapies that can reduce ischemic complications and mortality in both the acute and posthospital settings.

Questions Answered in This Report:

  • Eli Lilly/Daiichi Sankyo’s prasugrel (Effient/Efient) and AstraZeneca’s ticagrelor (Brilinta/Brilique) are adenosine diphosphate (ADP) receptor antagonists that are more potent, consistent, and faster-acting than clopidogrel (Bristol-Myers Squibb/Sanofi-Aventis’s Plavix/Iscover, generics). What are thought leaders’ opinions of these agents? In the era of generic clopidogrel, how do thought leaders plan to use these novel agents?

  • Numerous add-on antithrombotic therapies have failed to demonstrate efficacy without increasing bleeding in the treatment of ACS. However, Bayer/Janssen’s rivaroxaban (Xarelto) and Merck’s vorapaxar (Zontivity) appear to have succeeded where others have failed. What are thought leaders’ opinions of rivaroxaban’s prospects and of the prospects of other add-on antithrombotic therapies that remain in development?

  • Following the results of the ACUITY, HORIZONS-AMI, and ISAR-REACT-4 trials, use of the Medicines Company’s bivalirudin (Angiomax/Angiox) enjoyed uptake at the expense of the glycoprotein (gp) IIb/IIIa inhibitors and unfractionated heparin (UH) in the ACS acute setting. However, conflicting clinical trial data have called into question the clinical utility and cost-effectiveness of bivalirudin. What are the prospects for uptake of bivalirudin through 2023? What effect will the entry of generic bivalirudin have on the anticoagulant market in the ACS acute setting?

  • A wide array of add-on therapies are expected to launch in the ACS 12-month posthospital setting between 2013 and 2023. Such therapies use diverse treatment approaches, ranging from more-aggressive management of lipid levels to targeting inflammatory pathways that are thought to contribute to the pathogenesis of ACS. For which treatment strategies do experts express the most enthusiasm? What level of market penetration can we expect of new therapies given the increasingly crowded and competitive landscape?


Markets covered: United States, France, Germany, Italy, Spain, United Kingdom, Japan.

Primary research: 22 country-specific interviews with thought leaders.

Epidemiology: Number of diagnosed STEMI events, NSTEMI events, and UA events; number of prevalent ACS cases in the year following an ACS event.

Population segments in market forecast: STEMI patients, NSTEMI patients, UA patients in acute ACS setting, and ACS patients in posthospital, chronic setting.

Emerging therapies: Phase II: 18 drugs; Phase III: 10 drugs; preregistration: 1 drugs; registered: 38 drugs. Coverage of 6 select preclinical and Phase I products.

Author(s): Joseph Dwyer, Ph.D., M.Res.
Donal Minihan, M.V.B., Ph.D.